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Affiliation(s)
- J Simon Bell
- Centre for Medicine Use and Safety Faculty of Pharmacy and Pharmaceutical Sciences Monash University (Parkville Campus) 381 Royal Parade, Parkville Victoria 3052 Australia.
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Deeks LS, Cooper GM, Draper B, Kurrle S, Gibson DM. Dementia, medication and transitions of care. Res Social Adm Pharm 2015; 12:450-60. [PMID: 26265028 DOI: 10.1016/j.sapharm.2015.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/04/2015] [Accepted: 07/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses. OBJECTIVES To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice. METHOD Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer's Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion. RESULTS Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training. CONCLUSIONS Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training.
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Affiliation(s)
- Louise S Deeks
- Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia.
| | - Gabrielle M Cooper
- Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia
| | - Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia
| | - Susan Kurrle
- Faculty of Medicine, University of Sydney, Sydney, Australia; Rehabilitation and Aged Care Service, Hornsby Hospital, Sydney, Australia
| | - Diane M Gibson
- Faculty of Health, University of Canberra, ACT 2601, Australia
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Abstract
Younger onset dementia (YOD) not only affects the person with the diagnosis but the whole family, which often includes young people. A limited body of research on this group of young people indicates that they experience varying degrees of emotional trauma. We explored the lived experiences of young people having a parent with YOD from the perspective of the social model of disability. Data were available from semi-structured interviews with 12 young people who had a parent with YOD looking at their lived experiences between 8 and 24 years. Thematic analysis identified four main themes: the emotional toll of caring, keeping the family together, grief and loss and psychological distress. The social model of disability theory provides a helpful framework for these families who experience significant emotional distress, demonstrating that the disability is often socially constructed by a society, which marginalizes and excludes them. A ‘whole family’ approach is proposed, where the needs of young people and their parents are respected and responded to age appropriately.
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Affiliation(s)
- Karen Hutchinson
- Cognitive Decline Partnership Centre, University of Sydney, Australia
| | - Chris Roberts
- Northern Clinical School – Hornsby, University of Sydney, Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, University of Sydney, Australia; Hornsby Ku-ring-gai Hospital, Australia
| | - Michele Daly
- Northern Clinical School – Hornsby, University of Sydney, Australia
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van Houwelingen AH, Cameron ID, Gussekloo J, Putter H, Kurrle S, de Craen AJM, Maier AB, den Elzen WPJ, Blom JW. Disability transitions in the oldest old in the general population. The Leiden 85-plus study. Age (Dordr) 2014; 36:483-493. [PMID: 23990275 PMCID: PMC3889888 DOI: 10.1007/s11357-013-9574-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/22/2013] [Indexed: 05/30/2023]
Abstract
Transitions between disability states in older people occur frequently. This study investigated predictors of disability transitions in the oldest old and was performed in the Leiden 85-plus study, a population-based prospective cohort study among 597 participants aged 85 years. At baseline (age 85 years), data on sociodemographic characteristics and chronic diseases were obtained. Disabilities in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured annually for 5 years with the Groningen Activities Restriction Scale (GARS). Mortality data were obtained. A statistical multi-state model was used to assess the risks of transitions between no disabilities, IADL disability, BADL disability, and death. At baseline, 299 participants (50.0 %) were disabled in IADL only, and 155 participants (26.0 %) were disabled in both BADL and IADL. During 5-year follow-up, 374 participants (62.6 %) made >1 transition between disability states, mostly deterioration in disability. Males had a lower risk of deterioration [hazard ratio (HR), 0.75 (95 % CI, 0.58-0.96)] compared to females. No gender differences were observed for improvement [HR, 0.64 (95 % CI, 0.37-1.11)]. Participants with depressive symptoms were less likely to improve [HR, 0.50 (95 % CI, 0.28-0.87)]. Participants with depressive symptoms [HR, 1.46 (95 % CI, 1.12-1.91)], >1 chronic disease [HR, 1.60 (95 % CI, 1.27-2.01)], and with cognitive impairment [HR, 1.60 (95 % CI, 1.20-2.13)] had the highest risk of deteriorating. Disability is a dynamic process in the oldest old. Deterioration is more common than improvement. Older men are less likely to deteriorate than women. The presence of depressive symptoms, chronic disease, and cognitive impairment predicts deterioration.
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Affiliation(s)
- Anne H. van Houwelingen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Ian D. Cameron
- Rehabilitation Studies Unit, Sydney Medical School-Northern, University of Sydney, Ryde, New South Wales Australia
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics and BioInformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Susan Kurrle
- Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, New South Wales Australia
| | - Anton J. M. de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea B. Maier
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Section of Gerontology and Geriatrics, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Wendy P. J. den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Villani AM, Miller MD, Cameron ID, Kurrle S, Whitehead C, Crotty M. Development and relative validity of a new field instrument for detection of geriatric cachexia: preliminary analysis in hip fracture patients. J Cachexia Sarcopenia Muscle 2013; 4:209-16. [PMID: 23686412 PMCID: PMC3774920 DOI: 10.1007/s13539-013-0108-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/14/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Geriatric cachexia is distinct from other age-related muscle wasting syndromes; however, detection and therefore treatment is challenging without the availability of valid instruments suitable for application in the clinical setting. This study assessed the sensitivity and specificity of a newly developed screening instrument utilising portable assessments against previously defined and commonly accepted diagnostic criteria for detection of geriatric cachexia. METHODS Cross-sectional analyses from 71 older adults' post-surgical fixation for hip fracture were performed. The diagnostic criteria required measures of appendicular skeletal muscle index derived from dual-energy X-ray absorptiometry and anorexia assessed by ≤70 % of estimated energy requirements. These assessments were replaced with mid-upper arm muscle circumference and the Simplified Nutritional Appetite Questionnaire, respectively, to create a field instrument suitable for screening geriatric cachexia. Sensitivity, specificity and positive and negative predictive values were calculated. RESULTS The current diagnostic algorithm identified few patients as cachectic (4/71; 5.6 %). The sensitivity and specificity of the geriatric cachexia screening tool was 75 and 97 %, respectively. The screening tool had a positive predictive value of 60 % and a negative predictive value of 99 %. CONCLUSIONS Given the unexpected prevalence of cachexia in such a vulnerable group, these results may suggest problems in operationalising of the consensus definition and diagnostic criteria. Although the application of a newly developed screening tool using portable field measures looks promising, the authors recommend additional research to identify the prevalence of geriatric cachexia, which captures all diagnostic criteria from the consensus definition. Future investigation may then be positioned to explore the predictive validity of screening tools using portable field measures, which potentially achieve higher sensitivity.
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Affiliation(s)
- Anthony M Villani
- Department of Nutrition and Dietetics, School of Medicine, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Affiliation(s)
- Henry Brodaty
- Dementia Collaborative Research Centre Sydney New South Wales Australia
| | - Susan Kurrle
- University of Sydney Hornsby New South Wales Australia
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Abstract
Geriatric consultation teams are one of the models for bringing comprehensive geriatric assessment to vulnerable and frail older people in the acute care hospital setting. While ward-based comprehensive geriatric assessment has been established as effective with reference to improving functional status and other outcomes, the team-based variant remains unproven for outcomes other than mortality in the medium term, as shown in a recent study published in BMC Medicine by Deschodt and colleagues. Further research might establish the effectiveness of the team-based model but, for current clinical practice, the emphasis should be on streaming older people with complex problems needing multidisciplinary assessment and treatment to ward-based models of comprehensive geriatric assessment.
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Affiliation(s)
- Ian D Cameron
- Rehabilitation Studies Unit, Sydney Medical School Northern, University of Sydney, Ryde, NSW, Australia.
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Sherrington C, Lord SR, Close JC, Barraclough E, Taylor M, O’Rourke S, Kurrle S, Tiedemann A, Cumming RG, Herbert RD. A simple tool predicted probability of falling after aged care inpatient rehabilitation. J Clin Epidemiol 2011; 64:779-86. [DOI: 10.1016/j.jclinepi.2010.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 09/01/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
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Klenk J, Kurrle S, Rissmann U, Kleiner A, Heinrich S, König HH, Becker C, Rapp K. Availability and use of hip protectors in residents of nursing homes. Osteoporos Int 2011; 22:1593-8. [PMID: 20683703 DOI: 10.1007/s00198-010-1366-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 07/06/2010] [Indexed: 11/24/2022]
Abstract
SUMMARY Potential predictors of availability and use of hip protectors were studied in residents of 48 nursing homes. The likelihood of being offered a hip protector was reduced in men, in residents with very low or very high care needs, in residents with migration background, and in recipients of welfare aid. INTRODUCTION The purpose of this study is to analyze potential predictors of availability and use of hip protectors in residents of nursing homes. METHODS In 48 German nursing homes, individual information on availability and use of hip protectors was collected from all institutionalized residents (3,924 residents; 78.2% women). Information on nursing home characteristics was obtained by telephone interview. The effect of individual variables and of nursing home characteristics on hip protector availability and use was estimated using multilevel logistic regression analyses. RESULTS The prevalence of hip protectors being made available was 10.0% in women and 6.2% in men. Sixty-four percent of those with a hip protector used it during the 4 weeks prior to the examination. The likelihood of being offered a hip protector was reduced in men (odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43; 0.83), in residents with very low or very high care needs (OR, 0.32; 95% CI, 0.18; 0.56 and OR, 0.55; 95% CI, 0.38; 0.79, respectively), in residents with a migration background (OR, 0.30; 95% CI, 0.09; 0.99), and in recipients of welfare aid (OR, 0.60; 95% CI, 0.44; 0.81). Nursing home characteristics such as the size of the nursing home or staff participation rate in training measures had no effect on hip protector availability and use. CONCLUSION Predictors of hip protector availability were sex, the degree of care need, migration status, and welfare aid. The lower availability of hip protectors in residents with welfare aid and migration status may be an indicator for health inequality in the German health system.
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Affiliation(s)
- J Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany.
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Thomas S, Halbert J, Mackintosh S, Cameron ID, Kurrle S, Whitehead C, Miller M, Crotty M. Walking aid use after discharge following hip fracture is rarely reviewed and often inappropriate: an observational study. J Physiother 2011; 56:267-72. [PMID: 21091417 DOI: 10.1016/s1836-9553(10)70010-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
QUESTIONS What walking aid prescription occurs at discharge after hip fracture? What changes in walking aid use occur in the following six months? Who initiates changes in walking aids and why? DESIGN Prospective longitudinal observational study. PARTICIPANTS 95 community-dwelling older adults who had undergone surgical treatment of a hip fracture. OUTCOME MEASURES Range of walking aids prescribed at discharge and participants' recall of advice about progression were recorded. Progression of walking aids was observed fortnightly over 6 months. With any change in walking aid use, an independent physiotherapist determined if it was appropriate and participants reported the reason for the change. RESULTS Most participants were discharged from their final inpatient setting with a wheeled frame (92%). Eighty-two (86%) participants were not aware of any goals set by the physiotherapist for the first 6 months and 89 (94%) stated that a review time had not been set. Despite this, 78 (82%) participants changed their walking aid, on average 8 weeks (SD 6) after discharge. However, 32% of those who changed their walking aids were using an inappropriate aid or using it incorrectly. Six months after discharge, 40% of participants had not returned to using their pre-morbid indoor aid and 50% their outdoor aid. CONCLUSION A review of walking aid by a physiotherapist is rare within six months after discharge following hip fracture. Most patients make their own decision about what walking aid is most appropriate. This has safety implications in a group at high risk of falls.
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Koczy P, Becker C, Rapp K, Klie T, Beische D, Büchele G, Kleiner A, Guerra V, Rißmann U, Kurrle S, Bredthauer D. Effectiveness of a Multifactorial Intervention to Reduce Physical Restraints in Nursing Home Residents. J Am Geriatr Soc 2011; 59:333-9. [DOI: 10.1111/j.1532-5415.2010.03278.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cameron ID, Kurrle S, Quine S, Sambrook P, March L, Chan D, Stocks J, Lockwood K, Cook B, Schaafsma FG. Increasing adherence with the use of hip protectors for older people living in the community. Osteoporos Int 2011; 22:617-26. [PMID: 20571769 DOI: 10.1007/s00198-010-1334-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 05/14/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED For people at high risk of hip fracture living in community settings, providing hip protectors at no cost increased adherence, but the additional effect of an educational programme was limited. Overall, the level of adherence was modest. INTRODUCTION The objective of the study was to increase adherence with hip protector use by older people at high risk of hip fracture. The study included two randomised controlled trials with 308 older people recruited from three hospital rehabilitation wards and 171 older people recruited from the community. METHODS Participants were randomised into three groups. The control group received a brochure about hip protectors. The no cost group were fitted with free hip protectors and asked to use them. The combined group received free hip protectors and education sessions about their use. Adherence with the use of hip protectors at 3 and 6 months after recruitment was measured. Secondary outcomes were falls, fractures and hospitalisations. RESULTS Very few participants in the two control groups bought a hip protector. Overall adherence in the four intervention groups was modest, but higher in the community recruitment setting (49%) than in the hospital recruitment setting (36%) at 6 months. In the community recruitment group, at 3 months of follow-up, a significantly higher number of participants in the combined group (62%) were wearing hip protectors compared to the no cost group (43%, p=0.04). Five hip fractures occurred during the study, with four sustained whilst not wearing the hip protectors. CONCLUSION Providing hip protectors at no cost to community living older people at high risk of hip fractures modestly increases initial acceptance and adherence with hip protector use. Additional education may further increase hip protector use in people living in the community in the short term.
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Affiliation(s)
- I D Cameron
- Sydney Medical School, University of Sydney, Sydney, Australia.
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Rapp K, Cameron ID, Kurrle S, Klenk J, Kleiner A, Heinrich S, König HH, Becker C. Excess mortality after pelvic fractures in institutionalized older people. Osteoporos Int 2010; 21:1835-9. [PMID: 20057998 DOI: 10.1007/s00198-009-1154-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 12/03/2009] [Indexed: 11/27/2022]
Abstract
UNLABELLED Mortality after pelvic fracture was calculated in residents of nursing homes. Compared with a matched comparison nonfracture group, excess mortality was found during the first 2 months after pelvic fracture. INTRODUCTION Low energy pelvic fractures are mainly observed in people of advanced older age. The incidence of these fractures has increased considerably during the last decades. Information about excess mortality after pelvic fractures in older people is not available. METHODS To calculate excess mortality, a retrospective cohort study was conducted. Data from residents institutionalized in Bavarian nursing homes between 2001 and 2006 were used. For each patient with a pelvic fracture (n=1,154), five residents without pelvic fracture (n=5,770) were matched by sex, age, date of admission to the nursing home, and level of care (measure for the need of care). Hazard regression models were applied. RESULTS An excess mortality was found during the first months after pelvic fracture. In women, the increased mortality risk was limited to the first (hazard rate ratio (HR) 1.83, 95% confidence interval (CI) 1.42-2.37) and second (HR 1.52, 95% CI 1.13-2.04) months after the injury. In men, excess mortality was more pronounced (HR 2.95, 95% CI 1.57-5.54 for the first month) and appeared to last longer than in women. The majority of deaths due to pelvic fractures in the first 2 months after injury occurred following discharge from the hospital to the nursing home. CONCLUSION Pelvic fractures are associated with an increased mortality. These results should encourage the development of preventive measures to reduce this excess mortality.
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Affiliation(s)
- K Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
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Bird M, Llewellyn-Jones R, Smithers H, Andrews C, Cameron I, Cottee A, Hutson C, Jenneke B, Kurrle S, Russell B. Challenging Behaviours in Dementia: a Project at Hornsby/Ku-Ring-Gai Hospital. Australas J Ageing 2010. [DOI: 10.1111/j.1741-6612.1998.tb00217.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kurrle S, Cameron ID, Maier AB. Trajectories of disability in the last year of life. N Engl J Med 2010; 363:294; author reply 295. [PMID: 20665928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Sherrington C, Lord SR, Close JCT, Barraclough E, Taylor M, Oâ Rourke S, Kurrle S, Tiedemann A, Cumming RG, Herbert RD. Development of a tool for prediction of falls in rehabilitation settings (Predict_FIRST): a prospective cohort study. J Rehabil Med 2010; 42:482-8. [PMID: 20544161 DOI: 10.2340/16501977-0550] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To develop and internally validate a simple falls prediction tool for rehabilitation settings. DESIGN Prospective cohort study. PARTICIPANTS A total of 533 inpatients. METHODS Possible predictors of falls were collected from medical records, interview and physical assessment. Falls during inpatient stays were monitored. RESULTS Fourteen percent of participants fell. A multivariate model to predict falls included: male gender (odds ratio (OR) 2.70, 95% confidence interval (CI) 1.57-4.64), central nervous system medications (OR 2.50, 95% CI 1.47-4.25), a fall in the previous 12 months (OR 2.21, 95% CI 1.07-4.56), frequent toileting (OR 2.14, 95% CI 1.27-3.62) and tandem stance inability (OR 2.00, 95% CI 1.11-3.59). The area under the curve for this model was 0.74 (95% CI 0.68-0.80). The Predict_FIRST tool is a unit weighted adaptation of this model (i.e. 1 point allocated for each predictor) and its area under the curve was 0.73 (95% CI 0.68-0.79). Predicted and actual falls risks corresponded closely. CONCLUSION This tool provides a simple way to quantify the probability with which an individual patient will fall during a rehabilitation stay.
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Affiliation(s)
- Catherine Sherrington
- The George Institute for International Health, Missenden Road, Sydney NSW 2050, Australia.
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Kurrle S, Cameron I. P4‐253: The association of frailty with cognitive impairment in a cohort of community living older people. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Only relatively recently has the issue of elder abuse come to prominence in Australia. Until the late 1980s it was a hidden problem with little knowledge of its presence. Attention was drawn to elder abuse after the publication of a number of reports and research projects, allowing the development of responses at national and state levels. This paper gives an overview of the development of elder abuse as a social, legal and medical issue in Australia, and describes the diverse range of responses from the national, state and territory governments.
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Affiliation(s)
- Susan Kurrle
- Faculty of Medicine, University of Sydney, NSW, Australia.
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Thomas SK, Humphreys KJ, Miller MD, Cameron ID, Whitehead C, Kurrle S, Mackintosh S, Crotty M. Individual nutrition therapy and exercise regime: a controlled trial of injured, vulnerable elderly (INTERACTIVE trial). BMC Geriatr 2008; 8:4. [PMID: 18302787 PMCID: PMC2291467 DOI: 10.1186/1471-2318-8-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 02/26/2008] [Indexed: 04/08/2023] Open
Abstract
Background Proximal femoral fractures are amongst the most devastating consequences of osteoporosis and injurious accidental falls with 25–35% of patients dying in the first year post-fracture. Effective rehabilitation strategies are evolving however, despite established associations between nutrition, mobility, strength and strength-related functional outcomes; there has been only one small study with older adults immediately following fragility fracture where a combination of both exercise and nutrition have been provided. The aim of the INTERACTIVE trial is to establish whether a six month, individualised exercise and nutrition program commencing within fourteen days of surgery for proximal femur fracture, results in clinically and statistically significant improvements in physical function, body composition and quality of life at an acceptable level of cost and resource use and without increasing the burden of caregivers. Methods and Design This randomised controlled trial will be performed across two sites, a 500 bed acute hospital in Adelaide, South Australia and a 250 bed acute hospital in Sydney, New South Wales. Four hundred and sixty community-dwelling older adults aged > 70 will be recruited after suffering a proximal femoral fracture and followed into the community over a 12-month period. Participants allocated to the intervention group will receive a six month individualised care plan combining resistance training and nutrition therapy commencing within 14 days post-surgery. Outcomes will be assessed by an individual masked to treatment allocation at six and 12 months. To determine differences between the groups at the primary end-point (six months), ANCOVA or logistic regression will be used with models adjusted according to potential confounders. Discussion The INTERACTIVE trial is among the first to combine nutrition and exercise therapy as an early intervention to address the serious consequence of rapid deconditioning and weight loss and subsequent ability to regain pre-morbid function in older patients post proximal femoral fracture. The results of this trial will guide the development of more effective rehabilitation programs, which may ultimately lead to reduced health care costs, and improvements in mobility, independence and quality of life for proximal femoral fracture sufferers. Trial registration Australian Clinical Trials Registry: ACTRN12607000017426.
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Affiliation(s)
- Susie K Thomas
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, South Australia, Australia.
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Halbert J, Crotty M, Whitehead C, Cameron I, Kurrle S, Graham S, Handoll H, Finnegan T, Jones T, Foley A, Shanahan M. Multi-disciplinary rehabilitation after hip fracture is associated with improved outcome: A systematic review. Acta Derm Venereol 2007; 39:507-12. [PMID: 17724548 DOI: 10.2340/16501977-0102] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While hip fractures are an important cause of disability, dependency and death in older adults, the benefit of multi-disciplinary rehabilitation for people who have sustained hip fracture has not been demonstrated. METHODS Systematic review of randomized controlled trials which compare co-ordinated multi-disciplinary rehabilitation with usual orthopaedic care in older people who had sustained a hip fracture. Outcome measures included: mortality, return home, "poor outcome", total length of hospital stay, readmissions and level of function. RESULTS We identified 11 trials including 2177 patients. Patients who received multi-disciplinary rehabilitation were at a lower risk (Risk Ratio 0.84, 95% CI 0.73-0.96) of a "poor outcome" - that is dying or admission to a nursing home at discharge from the programme, and showed a trend towards higher levels of return home (Risk Ratio 1.07, 95% CI 1.00-1.15). Pooled data for mortality did not demonstrate any difference between multi-disciplinary rehabilitation and usual orthopaedic care. CONCLUSION This is the first review of randomized trials to demonstrate a benefit from multi-disciplinary rehabilitation; a 16% reduction in the pooled outcome combining death or admission to a nursing home. This result supports the routine provision of organized care for patients following hip fracture, as is current practice for patients after stroke.
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Affiliation(s)
- Julie Halbert
- Rehabilitation Studies Unit (Flinders University), Repatriation General Hospital, Daws Park, SA, Australia.
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74
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Affiliation(s)
- Ian D Cameron
- Rehabilitation Studies Unit, University of Sydney, Ryde, NSW 2112, Australia
| | - Susan Kurrle
- University of Sydney, Hornsby, NSW 2077, Australia
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75
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Kurrle S. Elder abuse. AUSTRALIAN FAMILY PHYSICIAN 2004; 33:807-12. [PMID: 15532155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Elder abuse is a common and yet often unrecognised problem in our community. With up to 5% of the community dwelling older population being victims of abuse, the general practitioner has a pivotal role in identifying this abuse. OBJECTIVE This article provides an outline of the definition of elder abuse, describes the types of abuse seen and the reasons for occurrence of abuse. It summarises the role of the GP in the identification and management of abuse and provides guidance on intervention strategies. Case studies are used to illustrate the issues discussed. DISCUSSION Elder abuse is defined as any pattern of behaviour which causes physical, psychological, financial or social harm to an older person. The role of the GP in identifying abuse is critical. The vast majority of older people visit their GP at least once a year, and the GP often has a long standing relationship with their patient and the patient's family. They are therefore ideally placed to identify elder abuse.
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Affiliation(s)
- Susan Kurrle
- Rehabilitation and Aged Care Service, Hornsby Ku-ring-gai Health Service, New South Wales.
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76
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Cameron I, Crotty M, Currie C, Finnegan T, Gillespie L, Gillespie W, Handoll H, Kurrle S, Madhok R, Murray G, Quinn K, Torgerson D. Geriatric rehabilitation following fractures in older people: a systematic review. Health Technol Assess 2000; 4:i-iv, 1-111. [PMID: 10702905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- I Cameron
- Department of Medicine, University of Sydney, Australia
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77
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Birks C, Lockwood K, Cameron I, Kurrle S, Burnside W, Easter S, Venman J, Cumming R, Quine S, Salkeld G, Finnegan T. Hip Protectors: Results of a User Survey. Australas J Ageing 1999. [DOI: 10.1111/j.1741-6612.1999.tb00084.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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78
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79
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Affiliation(s)
- Susan Kurrle
- Rehabilitation and Aged Care ServiceHornsby Ku‐ring‐gai HospitalSydneyNSW
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80
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81
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Cameron I, Kurrle S, Cumming R. Preventing falls in the elderly at home: a community-based program. Med J Aust 1996; 165:459-60. [PMID: 8913255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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82
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Affiliation(s)
- Ian Cameron
- Rehabilitation and Aged Care ServiceHornsby Ku‐ring‐gai HospitalPalmerston RoadHornsbyNSW2077
| | - Susan Kurrle
- Rehabilitation and Aged Care ServiceHornsby Ku‐ring‐gai HospitalPalmerston RoadHornsbyNSW2077
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83
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Kurrle S. Abuse of the elderly. A hidden problem. Aust Fam Physician 1992; 21:1742-8. [PMID: 1476503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Only recently has abuse of the elderly been recognised as a problem. The author describes the types of abuse encountered, provides clues on how to detect them, outlines reasons for the occurrence of abuse and suggests what to do when a case of abuse is identified.
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Affiliation(s)
- S Kurrle
- Hornsby Ku-ring-gai Hospital, Sydney
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84
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Broe GA, Kurrle S. Geriatric assessment by general practitioners. Med J Aust 1992; 156:110-4. [PMID: 1736050 DOI: 10.5694/j.1326-5377.1992.tb126424.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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85
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Kurrle S. Insomnia in the elderly. Aust Fam Physician 1988; 17:638-9. [PMID: 3073746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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86
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Kurrle S. Leg ulcers. Aust Fam Physician 1988; 17:534-6. [PMID: 3046590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Bronchial provocation tests with gentamicin solution, 40 mg/ml, and with the drug vehicle solution alone were carried out in 29 subjects aged 19 to 66 years. There were 18 subjects with bronchial asthma, four with chronic bronchitis, four with primary carcinoma of the lung, and three with no chest disease. Two millilitres of each of the two test solutions was given to each subject, in duplicate, via a nebuliser driven by a Bird Mark 8 respirator. Ventilatory function (FEV1 and VC) was measured before and after each inhalation, and changes were expressed as percentage variations from baseline. Seven subjects, all from the asthmatic group, developed at least one immediate FEV1 fall of 20% or more. The reactions ranged up to 71% and occurred to both test solutions. There was a trend towards greater reactions to the vehicle. In two subjects pretreatment with salbutamol and sodium cromoglycate did not modify these reactions. In three of the seven, inhalation of 2 ml normal saline produced FEV1 falls of 25% to 30%, but these falls were not as great as each subject's reactions to the test solutions. Skin prick tests using the gentamicin solution were negative in all subjects. These results show that substantial obstructive reactions may occur in some asthmatic subjects after inhalation of gentamicin. The reactions appear to be non-immunological in nature and may be due to an irritant effect of the drug vehicle.
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