1
|
Osadnik CR, Brighton LJ, Burtin C, Cesari M, Lahousse L, Man WDC, Marengoni A, Sajnic A, Singer JP, Ter Beek L, Tsiligianni I, Varga JT, Pavanello S, Maddocks M. European Respiratory Society statement on frailty in adults with chronic lung disease. Eur Respir J 2023; 62:2300442. [PMID: 37414420 DOI: 10.1183/13993003.00442-2023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
Frailty is a complex, multidimensional syndrome characterised by a loss of physiological reserves that increases a person's susceptibility to adverse health outcomes. Most knowledge regarding frailty originates from geriatric medicine; however, awareness of its importance as a treatable trait for people with chronic respiratory disease (including asthma, COPD and interstitial lung disease) is emerging. A clearer understanding of frailty and its impact in chronic respiratory disease is a prerequisite to optimise clinical management in the future. This unmet need underpins the rationale for undertaking the present work. This European Respiratory Society statement synthesises current evidence and clinical insights from international experts and people affected by chronic respiratory conditions regarding frailty in adults with chronic respiratory disease. The scope includes coverage of frailty within international respiratory guidelines, prevalence and risk factors, review of clinical management options (including comprehensive geriatric care, rehabilitation, nutrition, pharmacological and psychological therapies) and identification of evidence gaps to inform future priority areas of research. Frailty is underrepresented in international respiratory guidelines, despite being common and related to increased hospitalisation and mortality. Validated screening instruments can detect frailty to prompt comprehensive assessment and personalised clinical management. Clinical trials targeting people with chronic respiratory disease and frailty are needed.
Collapse
Affiliation(s)
- Christian R Osadnik
- Monash University, Department of Physiotherapy, Frankston, Australia
- Monash Health, Monash Lung, Sleep, Allergy and Immunology, Frankston, Australia
| | - Lisa J Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Will D C Man
- Heart Lung and Critical Care Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alessandra Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Andreja Sajnic
- Department for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb, Croatia
| | - Jonathan P Singer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lies Ter Beek
- Vrije Universiteit Amsterdam, University Medical Center Groningen, Amsterdam, The Netherlands
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janos T Varga
- Semmelweis University, Department of Pulmonology, Budapest, Hungary
- National Koranyi Institute of Pulmonology, Department of Pulmonary Rehabilitation, Budapest, Hungary
| | | | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| |
Collapse
|
2
|
Gomez M, Marc C, Talha A, Ruiz N, Noublanche S, Gillibert A, Bergman S, Rony L, Maynard V, Hubert L. Fast track care for pertrochanteric hip fractures: How does it impact length of stay and complications? Orthop Traumatol Surg Res 2019; 105:979-984. [PMID: 31253557 DOI: 10.1016/j.otsr.2019.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/25/2019] [Accepted: 04/10/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The medical and economic impact of treating pertrochanteric hip fractures is growing. We hypothesized that fast track surgery of pertrochanteric fractures would reduce the length of stay (LOS) without compromising the quality of care. MATERIALS AND METHODS This was a prospective, observational, single-center cohort study conducted between 2014 and 2016 at the Angers Teaching Hospital in France. The enrolled patients had an isolated A1 or A2 proximal femur fracture (AO classification) that was treated surgically by intramedullary nailing and required post-acute rehabilitation (PAR) care. The exposed FT cohort was transferred into the PAR pathway on postoperative day 1. The non-exposed (control) group was provided with postoperative care in the surgery unit before transfer to PAR. The primary outcome was the total LOS (LOS in surgery+LOS in PAR). The secondary objectives were to determine the immediate survival, 1-year survival, postoperative complications and average cost of hospitalization. RESULTS The study enrolled 109 patients initially, with 54 patients eligible for analysis after matching (27 pairs). The LOS in PAR and total LOS were 45.85±19.24 days and 48.56±19.36 days in the FT group (n=27), and 68.41±48.77 days and 77.85±48.80 days in the control group (n=27). Thus the LOS in PAR and total LOS were significantly lower in the FT group (p=0.022, p=0.003). There was no significant difference in the number of early deaths, complications, and 1-year survival without rehospitalization between cohorts. The mean cost per patient was lower in the FT cohort. DISCUSSION The FT pathway has already been adopted in orthopedics. For patient who suffer a hip fracture, it contributes to reducing the total LOS without negatively impacting the quality of care. Early health economics studies support this care pathway. CONCLUSION The FT approach to treating pertrochanteric fractures reduces total LOS without increasing mortality or complication rates. The 1-year survival is comparable. LEVEL OF EVIDENCE IIB, Exposed/Unexposed cohort.
Collapse
Affiliation(s)
- Mathurin Gomez
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France.
| | - Clément Marc
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France
| | - Abdelhafid Talha
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France
| | - Nicolas Ruiz
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France
| | - Sophie Noublanche
- Soins de Suite et Réadaptation, CHU Angers, 4, rue Larrey, Angers 49000, France
| | - André Gillibert
- Département de biostatistique et de recherche clinique, CHU Rouen, 1, rue de Germont, Rouen 76000, France
| | - Sara Bergman
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France
| | - Louis Rony
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France
| | - Vincent Maynard
- Département d'Anesthésie Réanimation, CHU Angers, 4, rue Larrey, Angers 49000, France
| | - Laurent Hubert
- Département de Chirurgie Osseuse, CHU d'Angers, 4, rue Larrey, Angers 49000, France
| | -
- 18, rue de Bellinière, Trélazé 49800, France
| |
Collapse
|
3
|
|
4
|
Ugolini G, Ghignone F, Zattoni D, Veronese G, Montroni I. Personalized surgical management of colorectal cancer in elderly population. World J Gastroenterol 2014; 20:3762-3777. [PMID: 24833841 PMCID: PMC3983435 DOI: 10.3748/wjg.v20.i14.3762] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/09/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population. In this phase of the life cycle, treatment is frequently suboptimal. Despite the fact that, nowadays, older people tend to be healthier than in previous generations, surgical undertreatment is frequently encountered. On the other hand, surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability. Unfortunately, due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors (heterogeneity, frailty, etc.), there is a dearth of evidence-based clinical guidelines for the management of these patients. The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly. More than in any other patient group, both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC. Although cure and sphincter preservation are the primary goals, many other variables need to be taken into account, such as maintenance of cognitive status, independence, life expectancy and quality of life.
Collapse
|
5
|
Folbert ECE, Smit RS, van der Velde D, Regtuijt EMM, Klaren MH, Hegeman JHH. Geriatric fracture center: a multidisciplinary treatment approach for older patients with a hip fracture improved quality of clinical care and short-term treatment outcomes. Geriatr Orthop Surg Rehabil 2013; 3:59-67. [PMID: 23569698 DOI: 10.1177/2151458512444288] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Since April 1, 2008, patients aged ≥65 years presenting with a hip fracture at Ziekenhuisgroep Twente, Almelo (ZGT-A), The Netherlands, have been admitted to the geriatric fracture center (GFC) and treated according to the multidisciplinary treatment approach. The objective of this study was to evaluate how implementation of the treatment approach has influenced the quality of care given to older patients with hip fracture. DESIGN Prospective cohort study with historical control group. METHOD Two groups of patients with hip fracture were compared, 1 group was treated according to the new multidisciplinary treatment approach in 2009-2010, and the other group received the usual treatment in 2007-2008. The number of readmissions within 30 days after discharge was compared, and an analysis was carried out regarding the number of complications, the number of consultations with various specialists and with the geriatrician, and the duration of hospital stay. RESULTS In all, 140 patients from 2009 to 2010 group and 90 patients from 2007 to 2008 group were included. In 2009-2010 group, the number of readmissions within 30 days dropped by 11 percentage points (P = .001). The incidence of the number of complications decreased with a median of 1 compared with 2007-2008 (P = .017) group. Delirium was diagnosed to be 6 percentage points more frequent. The median number of consultations with various specialists per patient decreased by 1 percentage point as a result of geriatrician cotreatment (P = .002). The median duration of hospital stay was 1 day shorter than that in 2007-2008 group. CONCLUSION The use of the multidisciplinary treatment approach led to a significant reduction in the number of readmissions within 30 days after discharge. It appears to be associated with improved short-term treatment outcomes for older patients with a hip fracture.
Collapse
|
6
|
Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebø V, Saltvedt I, Skovlund E, Ræder J, Conroy S. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatr 2012; 12:36. [PMID: 22817102 PMCID: PMC3583172 DOI: 10.1186/1471-2318-12-36] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/09/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hip fractures mainly affect older people. It is associated with high morbidity and mortality, and in particular a high frequency of delirium. Incident delirium following hip fracture is associated with an increased risk of dementia in the following months, but it is still not firmly established whether this is an association or a causal relationship. Orthogeriatric units vary with respect to content and timing of the intervention. One main effect of orthogeriatric care may be the prevention of delirium, especially if preoperative and postoperative care are provided. Thus, the aim of Oslo Orthogeriatric Trial, is to assess whether combined preoperative and postoperative orthogeriatric care can reduce the incidence of delirium and improve cognition following hip fracture. METHODS/DESIGN Inclusion and randomisation will take place in the Emergency Department, as soon as possible after admission. All patients with proximal femur fractures are eligible, irrespective of age, pre-fracture function and accommodation, except if the fracture is caused by a high energy trauma or the patient is terminally ill. The intervention is pre-and post-operative orthogeriatric care delivered on a dedicated acute geriatric ward. The primary outcome measure is a composite endpoint combining the Clinical Dementia Rating Scale (CDR) and the 10 word memory task at four months after surgery. Secondary outcomes comprise incident delirium, length of stay, cognition, mobility, place of residence, activities of daily living and mortality, measured at 4 and 12 months after surgery. We have included 332 patients in the period 17th September 2009 to 5th January 2012. DISCUSSION Our choice of outcome measures and our emphasis of orthogeriatric care in the preoperative as well as the postoperative phase will enable us to provide new knowledge on the impact of orthogeriatric care on cognition. TRIALS REGISTRATION ClinicalTrials.gov NCT01009268.
Collapse
|
7
|
Saltvedt I, Prestmo A, Einarsen E, Johnsen LG, Helbostad JL, Sletvold O. Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture. BMC Res Notes 2012; 5:355. [PMID: 22800378 PMCID: PMC3463430 DOI: 10.1186/1756-0500-5-355] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/27/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip fractures are common among frail elderly persons and often have serious consequences on function, mobility and mortality. Traditional treatment of these patients is performed in orthopedic departments without additional geriatric assessment. However, studies have shown that interdisciplinary geriatric treatment may be beneficial compared to traditional treatment. The aim of the present study is to investigate whether treatment of these patients in a Department of Geriatrics (DG) during the entire hospital stay gives additional benefits as compared to conventional treatment in a Department of Orthopaedic Surgery (DOS). FINDINGS A new clinical pathway for in-hospital treatment of hip fracture patients was developed. In this pathway patients were treated pre-and postoperatively in DG. Comprehensive geriatric assessment was performed as an interdisciplinary, multidimensional, systematic assessment of all patients focusing on each patient's capabilities and limitations as recommended in guidelines and systematic reviews. Identification and treatment of co-morbidities, pain relief, hydration, oxygenation, nutrition, elimination, prevention and management of delirium, assessment of falls and osteoporosis were emphasized. Discharge planning started as early as possible. Initiation of rehabilitation with focus on early mobilisation and development of individual plans was initiated in hospital and continued after discharge from hospital. Fracture specific treatment was based upon standard treatment for the hospital, expert opinions and a review of the literature. CONCLUSION A new treatment program for old hip fracture patients was developed, introduced and run in the DG, the potential benefits of which being compared with traditional care of hip fracture patients in the DOS in a randomised clinical trial.
Collapse
Affiliation(s)
- Ingvild Saltvedt
- Department of Geriatrics, St, Olav Hospital, University Hospital of Trondheim, Trondheim, Norway.
| | | | | | | | | | | |
Collapse
|
8
|
Fusco O, Ferrini A, Santoro M, Lo Monaco MR, Gambassi G, Cesari M. Physical function and perceived quality of life in older persons. Aging Clin Exp Res 2012; 24:68-73. [PMID: 22643307 DOI: 10.1007/bf03325356] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Physical function and quality of life represent two major components of multidimensional evaluation in older people. The aim of the study was to verify which specific physical function measure is a more important predictor of quality of life in these individuals. METHODS Data are from 73 community-dwelling older persons attending a geriatric cardiovascular clinic. Linear regressions and analyses of covariance were performed to explore the relationships between physical function measures (4-meter walking test [4mWS], Short Physical Performance Battery [SPPB], Activities of Daily Living [ADL], and Instrumental ADL [IADL]) and quality of life (assessed using the European Quality of Life [EuroQoL] instrument). To provide fair comparisons across all the physical function measures, results were provided according to their increase in standard deviation (SD). RESULTS The mean age of the sample population (women 52%) was 77.6 (SD=8.3) years old. Given significant gender interactions between physical function and quality of life, separate analyses were conducted for men and women. In women, all physical function measures were significantly associated with quality of life measures in unadjusted models (p-values<0.05). The EuroQoL visual analogic scale maintained its significant associations with SPPB, ADL and IADL, even after adjustment for potential confounders. In men, no physical function measure was consistently associated with quality of life in the fully-adjusted models. Gender-specific differences in the perception of quality of life were reported for disabilities in specific IADL tasks. CONCLUSIONS Physical function is associated with quality of life in older persons. In particular, disabilities in some specific IADL tasks seem to be especially perceived by women as undermining their quality of life. The use of the IADL scale in men may not be as reliable as in women.
Collapse
Affiliation(s)
- Oriana Fusco
- Department of Gerontology, Geriatrics, and Physical Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | |
Collapse
|
9
|
A comparison between two co-managed geriatric programmes for hip fractured elderly patients. Aging Clin Exp Res 2011; 23:431-6. [PMID: 21127396 DOI: 10.1007/bf03337767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Hip fracture in older people is an event associated with a high incidence of morbidity and mortality. In this study we compared the clinical outcomes of two groups of orthogeriatric patients in an orthogeriatric care (OC) programme. The OC course, developed into the GeriatricWard, starts from the Emergency Department (OC-1, n=174) or from the Orthopaedic Department after surgery (OC-2, n=87). METHODS For this purpose, OC patients were prospectively enrolled from March 2007 to June 2009, following OC criteria. Door-to-bed time, time to surgery, mobilisation time, length of stay, and post-operative complications were compared between the OC groups. RESULTS OC-1 patients differ from OC-2 ones only for residence at admission (14.4% vs 4.6% lived in nursing homes, p=0.02). Concerning outcomes, in the OC-1 group only mobilization time was significantly lower (p=0.01). No differences were observed in post-operative complications. CONCLUSIONS In frail older people, hip fracture co-management, with the geriatrician as primary attendant, leads to satisfying outcomes. The OC-1 and OC-2 courses exhibit similar clinical results. An improvement in several organisational aspects, including coordination between hospital and rehabilitation services, is warranted.
Collapse
|
10
|
Geriatric medicine and health care system: how can they fit together? ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
11
|
Ranhoff AH, Holvik K, Martinsen MI, Domaas K, Solheim LF. Older hip fracture patients: three groups with different needs. BMC Geriatr 2010; 10:65. [PMID: 20849652 PMCID: PMC2955032 DOI: 10.1186/1471-2318-10-65] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 09/18/2010] [Indexed: 12/20/2022] Open
Abstract
Background Norway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric units where orthopaedic care is combined with interdisciplinary geriatric care. The characteristics and needs of older hip fracture patients are poorly described. The aim of this paper is to describe the characteristics of these patients in order to better understand their need for care and rehabilitation. Methods This is an observational study based on a quality register for all patients 65+ years in an orthogeriatric unit who are operated for a hip fracture. The unit covers 250,000 inhabitants in Oslo. Patient data were collected in the aim of quality control. The quality database includes demographic, medical, and functional data collected from routine assessment by the interdisciplinary team. Results From January 2007 to September 2009, 1010 patients, included 241 (24%) from long-term care institutions, were enrolled in the database. Mean age was 85.1 years (SD 7.1), 76% were female, and 83% had experienced an indoor fall. Chronic diseases were registered in 88%, and 38% of the community-dwelling patients had pre-fracture cognitive impairment defined as IQCODE-SF > 3.6. Complications were observed in 51% of the patients, of which the most common were a need for blood transfusion, delirium, and urinary tract infections. Post-operative orthopaedic infections were rare (3.1%). Patients from long-term care were older, (87 vs. 84 years, p < 0.001), more had American Society of Anaesthesiologists (ASA) score >/= 3 (67% vs. 48%, p < 0.001) and a higher number of chronic medical conditions (mean 2.2 vs. 1.6, p < 0.001). Among community-dwelling patients, those who had fallen indoors were older, more often female, had ASA score >/= 3, chronic medical conditions, impairment in pre-fracture ADL and cognitive function, and more complications during hospital stay. Conclusions Older hip fracture patients in this orthogeriatric unit may be divided into three groups; patients who are relatively fit and have experienced outdoors falls (17%), frail community-dwelling patients who have fallen indoors (59%), and patients from long-term care institutions (24%). Different caring pathways are needed for these groups.
Collapse
Affiliation(s)
- Anette H Ranhoff
- Department of Medicine, Diakonhjemmet Hospital, PB 23 Vinderen, 0319 Oslo, Norway.
| | | | | | | | | |
Collapse
|
12
|
Frondini C, Lunardelli ML. Ortogeriatria: un nuovo modello di assistenza ai pazienti anziani con frattura di femore e comorbilità. ITALIAN JOURNAL OF MEDICINE 2010. [DOI: 10.1016/j.itjm.2010.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
13
|
Grue EV, Kirkevold M, Mowinchel P, Ranhoff AH. Sensory impairment in hip-fracture patients 65 years or older and effects of hearing/vision interventions on fall frequency. J Multidiscip Healthc 2008; 2:1-11. [PMID: 21197343 PMCID: PMC3004562 DOI: 10.2147/jmdh.s4126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Examine the effect of nursing interventions to improve vision and hearing, systematic assessment, and referral to sensory specialists on falling. Methods: Controlled intervention trial targeting hip fracture patients, 65 years and older, living at home and having problems seeing/reading regular print (VI) or hearing normal speech (HI). Intervention group = 200, control group = 131. The InterRAI-AcuteCare (RAI-AC) and the Combined-Serious-Sensory-Impairment interview guide (KAS-Screen) were used. Follow-up telephone calls were done every third month for one year. Results: Mean age was 84.2 years, 79.8% were female, and 76.7% lived alone. HI was detected in 80.7% and VI in 59.8%. Falling was more frequent among the intervention group (P = 0.003) and they also more often moved to a nursing home (P < 0.001) and were dependent walking up stairs (P = 0.003). Conclusions: This study could not document the effect of intervention on falling, possibly because of different base line characteristics (more females, P = 0.018, and more living alone P = 0.011 in the intervention group), differences in nursing care between subjects, and different risk factors. Interventions to improve sensory function remain important in rehabilitation, but have to be studied further.
Collapse
Affiliation(s)
- Else V Grue
- Diakonhjemmet University College, Department of Research and Development, Oslo, Norway
| | | | | | | |
Collapse
|