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Boucaud-Maitre D, Simo N, Villeneuve R, Rambhojan C, Thibault N, Joseph SP, Bonnet M, Dramé M, Vainqueur L, Rinaldo L, Letchimy L, Dartigues JF, Cesari M, Rolland Y, Vellas B, Amieva H, Tabué-Teguo M. Clinical profiles of older adults in French Caribbean nursing homes: a descriptive cross-sectional study. Front Med (Lausanne) 2024; 11:1428443. [PMID: 39355845 PMCID: PMC11442247 DOI: 10.3389/fmed.2024.1428443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/23/2024] [Indexed: 10/03/2024] Open
Abstract
Background Nursing homes in the Caribbean are scarce and the characteristics of their residents have not been previously documented. This study aimed to describe the clinical profiles of residents living in nursing homes in Guadeloupe and Martinique (French West Indies). Methods This is a cross-sectional study of the baseline screening data from the KASEHPAD (Karukera Study of Ageing in nursing homes) study. Clinical characteristics and geriatric scale scores, including the Activities of Daily Living (ADL), Mini-Mental State Examination (MMSE), Mini Nutritional Assessment Short-Form (MNA-SF) and Short Physical Performance Battery (SPPB) were collected and analysed. Results A total of 332 older adults were recruited between September 2020 and November 2022. The mean age of the residents was 81.3 ± 10.1, with a male-female ratio of 1:1. Diabetes was reported in 28.3% of the residents, hypertension in 66.6% and heart disease in 18.4%. Dementia was diagnosed in 52.3% of the residents and 74.9% had a MMSE score ≤18. The prevalence of Parkinson's disease was 9.0%. Additionally, 18.4% were unable to perform any basic activities of daily living (ADL score of 0). The prevalence of physical impairment (SPPB < 8) was 90.0%. One-quarter of the residents were classified as undernourished (MNA-SF score ≤ 7). Conclusion Residents in Caribbean nursing homes are younger than in metropolitan France, whereas they present quite similar clinical profiles. Notably, a high prevalence of diabetes, cardiovascular diseases and neurodegenerative diseases was observed. This study represents a preliminary effort to address the knowledge gap regarding the aging trajectories of older adults in the Caribbean and could guide the development of future nursing homes in these countries.
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Affiliation(s)
- Denis Boucaud-Maitre
- Centre Hospitalier Le Vinatier, Bron, France
- University of the French West Indies, EpiCliV Research Team, Fort-de-France, France
| | - Nadine Simo
- University of the French West Indies, EpiCliV Research Team, Fort-de-France, France
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, France
| | - Roxane Villeneuve
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, France
| | | | - Nathalie Thibault
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, France
| | | | - Michel Bonnet
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, France
| | - Moustapha Dramé
- University of the French West Indies, EpiCliV Research Team, Fort-de-France, France
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, France
| | - Larissa Vainqueur
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, France
| | - Leila Rinaldo
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, France
| | - Laurys Letchimy
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, France
| | | | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Hélène Amieva
- Inserm U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
| | - Maturin Tabué-Teguo
- University of the French West Indies, EpiCliV Research Team, Fort-de-France, France
- Inserm U1219 Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Boucaud-Maitre D, Simo N, Villeneuve R, Bonnet M, Dramé M, Tabué-Teguo M. Comparison of quality of life of older adults living in foster families versus nursing homes. Results from the KASA studies. J Nutr Health Aging 2024; 28:100358. [PMID: 39244789 DOI: 10.1016/j.jnha.2024.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVES Professional foster families for dependent older adults could be an alternative to nursing homes. Engagement in the family life and close contact with a single reference person could enhance their quality of life (QOL). This study aimed to compare the Health-Related Quality of Life (HrQOL) and subjective QOL among older adults living in foster families versus those in nursing homes. DESIGN Cross-sectional analysis from twin studies conducted in foster families (the KASAF study) and nursing homes (the KASEHPAD study). SETTING AND PARTICIPANTS Older adults (aged 60 years or older) in French Caribbean Islands living in foster families or nursing homes. MEASUREMENTS HrQOL was measured using the EuroQol-five dimensions (EQ5D-3L) and QOL was assessed using a Visual Analog Scale (QOL-VAS). For older adults unable to complete these scales, proxy EQ-5D-3L assessments were conducted by paramedical staff or foster caregivers. RESULTS A total of 439 older adults, with 107 in foster families and 332 in nursing homes were included. Participants living in foster families were less often male, had less often hypertension, were more dependent or physical impaired and had lower score of cognition. In multivariate analyses, factors associated with low self-reported HRQoL (n = 240) were Mini Mental State Examination (MMSE) score (β: -0.011; p = 0.003) and Activities of Daily Living (ADL) score (β: 0.014; p < 0.001). A lower QOL-VAS score (n = 150) was associated with living in a nursing home compared to living in a foster family (β: -19.48 points; p < 0.001) and with the ADL score (2.94 points; p = 0.019). In older adults with major cognitive disorders, the only factor associated with low proxy EQ-5D proxy index score (n = 136) was dependency (β: 0.167; p < 0.001). CONCLUSION HrQOL was similar between older adults living in nursing homes and foster families. Additionally, older adults reported a better subjective quality of life when residing in foster families. These findings suggest that the foster family model may meet the social and environmental needs of dependent older adults for whom nursing homes are not suitable.
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Affiliation(s)
- Denis Boucaud-Maitre
- Centre Hospitalier Le Vinatier, Bron, France; Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique.
| | - Nadine Simo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique; Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Roxane Villeneuve
- Centre Hospitalo-Universitaire de Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Michel Bonnet
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Moustapha Dramé
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique; Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
| | - Maturin Tabué-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique; Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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Wondimkun YA, Caughey GE, Inacio MC, Air T, Lang C, Sluggett JK. Glucose-lowering medicines use before and after entry into long-term care facilities. Diabetes Obes Metab 2024. [PMID: 39223861 DOI: 10.1111/dom.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
AIM To examine changes in the use of glucose-lowering medicine (GLM) 12 months before and 12 months after long-term care facility (LTCF) entry among people with diabetes. MATERIALS AND METHODS A national retrospective cohort study was conducted using linked health and aged care data from the Registry of Senior Australians National Historical Cohort. Residents of LTCFs with diabetes aged 65 years or older from 2015 to 2019 were included. Prevalence of GLM use and the number of defined daily doses (DDDs) dispensed per 1000 resident-days were estimated quarterly (91-day) using Poisson regression models, or negative binomial regression when overdispersion was present. RESULTS Among the 50 993 residents studied (median age 84 years), the prevalence of GLM use was 58.4% (95% confidence interval [CI] 58.0%-58.8%) in the 9-12 months pre-LTCF entry and 56.3% (95% CI 55.9%-56.8%) in the 9-12 months post-entry. The number of DDDs/1000 resident-days increased from 1015.2 (95% CI 1002.3-1028.1) to 1253.8 (95% CI 1168.4-1339.3) during the same period. GLM use in the 3 months pre-entry was 56.8% (95% CI 56.4%-57.2%) compared with 61.7% (95% CI 61.3%-62.1%) in the 3 months post-entry, with the increased use driven mainly by insulin. No marked changes in the number of GLMs dispensed or GLM type were observed at 9-12 months post-entry compared with 3 months pre-entry. Among 22 792 individuals dispensed a GLM in the 3 months prior to LTCF entry, 50.2% continued the same GLM at 9-12 months post-entry. CONCLUSIONS GLM use peaked in the first 3 months following LTCF entry, driven mainly by insulin, hence, residents may benefit from close monitoring of diabetes treatment during this period.
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Affiliation(s)
- Yohanes A Wondimkun
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Hawassa University, College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Catherine Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Maruoka H, Hamada S, Hattori Y, Arai K, Arimitsu K, Higashihara K, Saotome S, Kobayashi A, Watanabe N, Kurata N, Kishimoto K, Kojima T. Changes in chronic disease medications after admission to a Geriatric Health Services Facility: A multi-center prospective cohort study. Medicine (Baltimore) 2023; 102:e33552. [PMID: 37233437 PMCID: PMC10219748 DOI: 10.1097/md.0000000000033552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023] Open
Abstract
Older adults often receive polypharmacy, including some medications for chronic diseases. Nutritional management after admission to a nursing home may enable to deprescribe some chronic disease medications. This study aimed to investigate the status of deprescribing of chronic disease medications among nursing home residents, and to assess the appropriateness based on changes of laboratory test values and nutritional status. A multi-center prospective cohort study was conducted in 6 Geriatric Health Services Facilities, a major type of nursing homes in Japan. Newly admitted residents aged ≥ 65 years who took ≥1 medication for hypertension, diabetes, or dyslipidemia at admission were recruited. Participants who stayed for 3 months were included in the analysis. Medications at admission and 3 months after admission and situations for deprescribing were investigated. Changes in body mass index, blood pressure, laboratory tests (e.g., cholesterol and hemoglobin A1c levels), energy intake, and International Classification of Functioning, Disability and Health staging were evaluated. Sixty-nine participants (68% female, 62% aged ≥ 85 years) were included. At admission, 60 participants had medications for hypertension, 29 for dyslipidemia, and 13 for diabetes. Those receiving lipid-modifying drugs (mainly statins) decreased from 29 to 21 (72%; P = .008), since their cholesterol levels was within the normal range or was low at admission, and they had no history of cardiovascular events. However, there were no statistically significant changes in the frequencies of antihypertensive drugs (60 to 55; 92%; P = .063) or antidiabetic drugs (13 to 12; 92%; P = 1.000). During the 3-month observation, body mass index and diastolic blood pressure decreased, while energy intake and serum albumin level increased. Nutritional management after admission to a ROKEN may facilitate appropriate deprescribing of lipid-modifying drugs, by offseting the effects of discontinuation of these drugs.
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Affiliation(s)
- Hiroshi Maruoka
- Yokohama Aobanosato Geriatric Health Services Facility, Yokohama, Japan
- Division of Social Pharmacy, Department of Healthcare and Regulatory Sciences, School of Pharmacy, Showa University, Tokyo, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuaki Arai
- Division of Social Pharmacy, Department of Healthcare and Regulatory Sciences, School of Pharmacy, Showa University, Tokyo, Japan
- Ooarai Geriatric Health Services Facility, Ibaraki, Japan
| | - Kayoko Arimitsu
- Nursing Plaza Kouhoku Geriatric Health Services Facility, Yokohama, Japan
| | | | - Saiko Saotome
- Onahama Tokiwaen Geriatric Health Services Facility, Fukushima, Japan
| | - Asami Kobayashi
- Rehabilitation Port Yokohama Geriatric Health Services Facility, Yokohama, Japan
| | - Noriko Watanabe
- Yokohama Aobanosato Geriatric Health Services Facility, Yokohama, Japan
| | - Naomi Kurata
- Division of Social Pharmacy, Department of Healthcare and Regulatory Sciences, School of Pharmacy, Showa University, Tokyo, Japan
| | - Keiko Kishimoto
- Division of Social Pharmacy, Department of Healthcare and Regulatory Sciences, School of Pharmacy, Showa University, Tokyo, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Boucaud-Maitre D, Meillon C, Letenneur L, Villeneuve R, Dartigues JF, Amieva H, Tabue-Teguo M. Health trajectories of elderly living in French senior housing: a longitudinal perspective. Sci Rep 2023; 13:5471. [PMID: 37015961 PMCID: PMC10073120 DOI: 10.1038/s41598-023-32429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
Senior housing for older adults could be an alternative or a transitional care model between home care and nursing home care. Using two longitudinal cohorts of community dwellers aged 65 years or older, we compared risks of mortality and of nursing homes admission between older adults who did or did not move to senior housing over time. In the 3C study (n = 2104, 17 years of follow-up), 143 (6.8%) participants moved into a senior housing during the follow-up. This move was associated with a lower risk of mortality (hazard ratio (HR): 0.64; 95% confidence interval (CI) 0.46-0.77) and a higher risk of nursing home admissions (HR: 1.54 (1.10-2.15)). The risks of hospitalizations (HR: 0.54 (0.40-0.73)) and falls (HR: 0.63 (0.50-0.79)) were lower. In the PAQUID study (n = 3777, 27 years of follow-up), 161 (4.3%) participants moved into a senior housing. This move was also associated with a lower mortality risk (HR: 0.72 (0.58-0.88)) and a higher risk of nursing home admissions (HR: 1.39 (1.05-1.86)). Our results showing lower risks of mortality suggest that senior housing may be a relevant model for vulnerable older adults.
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Affiliation(s)
- Denis Boucaud-Maitre
- Direction de la Recherche et de l'Innovation, Centre Hospitalier le Vinatier, Bron, France.
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique.
| | - Céline Meillon
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | - Luc Letenneur
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | - Roxane Villeneuve
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | | | - Hélène Amieva
- Univ. Bordeaux, Inserm, U1219 Bordeaux Population Health Center, Bordeaux, France
| | - Maturin Tabue-Teguo
- Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique
- Centre Hospitalo-Universitaire de Martinique, Fort-de-France, Martinique
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Gabet A, Grave C, Tuppin P, Lesuffleur T, Guenancia C, Nguyen-Thanh V, Guignard R, Blacher J, Olié V. Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope? Front Cardiovasc Med 2022; 9:856689. [PMID: 35548431 PMCID: PMC9081923 DOI: 10.3389/fcvm.2022.856689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population. Methods For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017–2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017–2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists. Results In 2020, IRR significantly decreased for initiations of antihypertensives (−11.1%[CI95%, −11.4%;−10.8%]), lipid-lowering drugs (−5.2%[CI95%, −5.5%;−4.8%]), oral anticoagulants in atrial fibrillation (−8.6%[CI95%, −9.1%;−8.0%]), and smoking cessation medications (−50.9%[CI95%, −51.1%;−50.7%]) compared to 2017–2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017–2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women. Conclusion The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.
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Affiliation(s)
- Amélie Gabet
- Santé Publique France, Paris, France
- *Correspondence: Amélie Gabet,
| | | | | | | | | | | | | | - Jacques Blacher
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, AP-HP, Université de Paris, Paris, France
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Abstract
OBJECTIVES Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence. DESIGN Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia. SETTING AND PARTICIPANTS NH residents with dementia. MEASUREMENTS Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy. RESULTS Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07). CONCLUSIONS Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.
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Ansart M, Epelbaum S, Houot M, Nedelec T, Lekens B, Gantzer L, Dormont D, Durrleman S. Changes in the use of psychotropic drugs during the course of Alzheimer's disease: A large-scale longitudinal study of French medical records. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12210. [PMID: 34541292 PMCID: PMC8439142 DOI: 10.1002/trc2.12210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/30/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We aim to understand how patients with Alzheimer's disease (AD) are treated by identifying in a longitudinal fashion the late-life changes in patients' medical history that precede and follow AD diagnosis. METHODS We use prescription history of 34,782 patients followed between 1996 and 2019 by French general practitioners. We compare patients with an AD diagnosis, patients with mild cognitive impairment (MCI), and patients free of mental disorders. We use a generalized mixed-effects model to study the longitudinal changes in the prescription of eight drug types for a period 15 years before diagnosis and 10 years after. RESULTS In the decades preceding diagnosis, we find that future AD patients are treated significantly more than MCI patients with most psychotropic drugs and that most studied drugs are increasingly prescribed with age. At the time of diagnosis, all psychotropic drugs except benzodiazepines show a significant increase in prescription, while other drugs are significantly less prescribed. In the 10 years after diagnosis, nearly all categories of drugs are less and less prescribed including antidementia drugs. DISCUSSION Pre-diagnosis differences between future AD patients and MCI patients may indicate that subtle cognitive changes are recognized and treated as psychiatric symptoms. The disclosure of AD diagnosis drastically changes patients' care, priority being given to the management of psychiatric symptoms. The decrease of all prescriptions in the late stages may reflect treatment discontinuation and simplification of therapeutic procedures. This study therefore provides new insights into the medical practices for management of AD.
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Affiliation(s)
- Manon Ansart
- Sorbonne UniversitésUPMC Univ Paris 06InsermCNRSInstitut du cerveau et la moelle épinière (ICM) ‐ Hôpital de la Pitié‐SalpêtrièreParisFrance
- Inria ParisAramis project‐teamParisFrance
| | - Stéphane Epelbaum
- Sorbonne UniversitésUPMC Univ Paris 06InsermCNRSInstitut du cerveau et la moelle épinière (ICM) ‐ Hôpital de la Pitié‐SalpêtrièreParisFrance
- Inria ParisAramis project‐teamParisFrance
- Department of NeurologyAP‐HPHôpital de la Pitié‐SalpêtrièreInstitut de la Mémoire et de la Maladie d'Alzheimer (IM2A)Reference Center for Rare or Early Dementias and Center of Excellence of Neurodegenerative Disease (CoEN)ParisFrance
| | - Marion Houot
- Sorbonne UniversitésUPMC Univ Paris 06InsermCNRSInstitut du cerveau et la moelle épinière (ICM) ‐ Hôpital de la Pitié‐SalpêtrièreParisFrance
- Sorbonne UniversityAlzheimer Precision Medicine (APM)AP‐HPHôpital de la Pitié‐SalpêtrièreParisFrance
| | - Thomas Nedelec
- Sorbonne UniversitésUPMC Univ Paris 06InsermCNRSInstitut du cerveau et la moelle épinière (ICM) ‐ Hôpital de la Pitié‐SalpêtrièreParisFrance
- Inria ParisAramis project‐teamParisFrance
| | | | | | - Didier Dormont
- Sorbonne UniversitésUPMC Univ Paris 06InsermCNRSInstitut du cerveau et la moelle épinière (ICM) ‐ Hôpital de la Pitié‐SalpêtrièreParisFrance
- Inria ParisAramis project‐teamParisFrance
- Department of NeuroradiologyAP‐HPHôpital de la Pitié‐SalpêtrièreParisFrance
| | - Stanley Durrleman
- Sorbonne UniversitésUPMC Univ Paris 06InsermCNRSInstitut du cerveau et la moelle épinière (ICM) ‐ Hôpital de la Pitié‐SalpêtrièreParisFrance
- Inria ParisAramis project‐teamParisFrance
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Canouï-Poitrine F, Rachas A, Thomas M, Carcaillon-Bentata L, Fontaine R, Gavazzi G, Laurent M, Robine JM. Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study. Age Ageing 2021; 50:1473-1481. [PMID: 33984133 PMCID: PMC8406878 DOI: 10.1093/ageing/afab098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objectives were to assess the excess deaths among Nursing Home (NH) residents during the first wave of the COVID-19 pandemic, to determine their part in the total excess deaths and whether there was a mortality displacement. METHODS We studied a cohort of 494,753 adults in 6,515 NHs in France exposed to COVID-19 pandemic (from 1 March to 31 May 2020) and compared with the 2014-2019 cohorts using data from the French National Health Data System. The main outcome was death. Excess deaths and standardized mortality ratios (SMRs) were estimated. RESULT There were 13,505 excess deaths. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than females (SMR: 1.51 and 1.38) and decreased with increasing age (SMRs in females: 1.61 in the 60-74 age group, 1.58 for 75-84, 1.41 for 85-94 and 1.31 for 95 or over; males: SMRs: 1.59 for 60-74, 1.69 for 75-84, 1.47 for 85-94 and 1.41 for 95 or over). No mortality displacement effect was observed up until 30 August 2020. By extrapolating to all NH residents nationally (N = 570,003), we estimated that they accounted for 51% of the general population excess deaths (N = 15,114 out of 29,563). CONCLUSION NH residents accounted for half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger than older residents.
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Affiliation(s)
- Florence Canouï-Poitrine
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Public Health Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
| | - Antoine Rachas
- Direction de la Stratégie, des Etudes et des Statistiques, CNAM, F-75000 Paris, France
| | - Martine Thomas
- Direction de la Stratégie, des Etudes et des Statistiques, CNAM, F-75000 Paris, France
| | | | - Roméo Fontaine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
| | - Gaëtan Gavazzi
- Geriatric Department, Grenoble Alpes University Hospital, F-38000 Grenoble, France
- University of Grenoble-Alpes, GREPI TIMC-IMAG, CNRS UMR 552, F-38000 Grenoble, France
| | - Marie Laurent
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Geriatric Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
| | - Jean-Marie Robine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
- Univ Paris, INSERM, CNRS, EHSS, CERMES3, F-75000 Paris, France
- Univ Montpellier, EPHE, INSERM, MMDN, F-34000 Montpellier, France
- PSL Research University, F-75000 Paris, France
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10
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Key Experimental Factors of Machine Learning-Based Identification of Surgery Cancellations. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6247652. [PMID: 33688420 PMCID: PMC7914093 DOI: 10.1155/2021/6247652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/21/2020] [Accepted: 02/13/2021] [Indexed: 02/05/2023]
Abstract
This study aimed to provide effective methods for the identification of surgeries with high cancellation risk based on machine learning models and analyze the key factors that affect the identification performance. The data covered the period from January 1, 2013, to December 31, 2014, at West China Hospital in China, which focus on elective urologic surgeries. All surgeries were scheduled one day in advance, and all cancellations were of institutional resource- and capacity-related types. Feature selection strategies, machine learning models, and sampling methods are the most discussed topic in general machine learning researches and have a direct impact on the performance of machine learning models. Hence, they were considered to systematically generate complete schemes in machine learning-based identification of surgery cancellations. The results proved the feasibility and robustness of identifying surgeries with high cancellation risk, with the considerable maximum of area under the curve (AUC) (0.7199) for random forest model with original sampling using backward selection strategy. In addition, one-side Delong test and sum of square error analysis were conducted to measure the effects of feature selection strategy, machine learning model, and sampling method on the identification of surgeries with high cancellation risk, and the selection of machine learning model was identified as the key factors that affect the identification of surgeries with high cancellation risk. This study offers methodology and insights for identifying the key experimental factors for identifying surgery cancellations, and it is helpful to further research on machine learning-based identification of surgeries with high cancellation risk.
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11
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Zhu S. Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment. Clin Nurs Res 2021; 30:59-69. [PMID: 30943786 PMCID: PMC6776729 DOI: 10.1177/1054773819838678] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study described current use and predictors of psychotropics among residents with moderate to severe cognitive impairment. This was a secondary data analysis using baseline data from the first 341 residents in an ongoing trial. Predictive measures included age, gender, race, depressive symptoms, agitation, resistiveness to care, depression, cognition, pain, comorbidities, facility factors, and state. Overall 63% (n = 211) received at least one psychotropic medication, 16% (n = 52) an anti-seizure medication, 23% (n = 77) an anxiolytic, 30% (n = 99) an antidepressant, 2% (n = 8) a sedative hypnotic, 28% (n = 93) an antipsychotic medication, and 9% (n = 29) an opioid. Testing of models explained 9% to 15% of psychotropic medication use. There were high rates of psychotropic medication use and a limited association between demographic factors, behavioral symptoms, and psychotropic medication use. Continued research is needed to explore the impact of deprescribing, person-centered behavioral interventions, and beliefs of providers on psychotropic medication use.
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Affiliation(s)
| | - Ann Kolanowski
- Pennsylvania State University College of Nursing, University Park, USA
| | | | | | - Marie Boltz
- Pennsylvania State University College of Nursing, University Park, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, USA
| | - Liza Behrens
- Pennsylvania State University College of Nursing, University Park, USA
| | - Karen Eshraghi
- Pennsylvania State University College of Nursing, University Park, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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12
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Kabeshova A, Yu Y, Lukacs B, Bacry E, Gaïffas S. ZiMM: A deep learning model for long term and blurry relapses with non-clinical claims data. J Biomed Inform 2020; 110:103531. [PMID: 32818667 DOI: 10.1016/j.jbi.2020.103531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/25/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
This paper considers the problems of modeling and predicting a long-term and "blurry" relapse that occurs after a medical act, such as a surgery. We do not consider a short-term complication related to the act itself, but a long-term relapse that clinicians cannot explain easily, since it depends on unknown sets or sequences of past events that occurred before the act. The relapse is observed only indirectly, in a "blurry" fashion, through longitudinal prescriptions of drugs over a long period of time after the medical act. We introduce a new model, called ZiMM (Zero-inflated Mixture of Multinomial distributions) in order to capture long-term and blurry relapses. On top of it, we build an end-to-end deep-learning architecture called ZiMM Encoder-Decoder (ZiMM ED) that can learn from the complex, irregular, highly heterogeneous and sparse patterns of health events that are observed through a claims-only database. ZiMM ED is applied on a "non-clinical" claims database, that contains only timestamped reimbursement codes for drug purchases, medical procedures and hospital diagnoses, the only available clinical feature being the age of the patient. This setting is more challenging than a setting where bedside clinical signals are available. Our motivation for using such a non-clinical claims database is its exhaustivity population-wise, compared to clinical electronic health records coming from a single or a small set of hospitals. Indeed, we consider a dataset containing the claims of almost all French citizens who had surgery for prostatic problems, with a history between 1.5 and 5 years. We consider a long-term (18 months) relapse (urination problems still occur despite surgery), which is blurry since it is observed only through the reimbursement of a specific set of drugs for urination problems. Our experiments show that ZiMM ED improves several baselines, including non-deep learning and deep-learning approaches, and that it allows working on such a dataset with minimal preprocessing work.
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Affiliation(s)
| | | | | | | | - Stéphane Gaïffas
- LPSM, Université de Paris, France; DMA, Ecole normale supérieure, Paris, France.
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13
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Rajabali Beglou R, Akhshik SS. Improving and extending activities of university and research libraries in Iran: the role of Iranian Research Institute for Information Science and Technology (Irandoc). LIBRARY MANAGEMENT 2020. [DOI: 10.1108/lm-01-2019-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to define the need to a center for improving and extending university and research libraries in Iran, and identifying capabilities and position of Iranian Research Institute for Science and Technology (Irandoc) for accepting possible roles.Design/methodology/approachThis research was documentary with scoping review in which the scope of research defined with internal and external organizational documents, related research studies in National Information System (NATIS) and international successful organizations in this field.FindingsFindings show that Irandoc can play roles in developing a standard, establishing experts and professional network, developing information and knowledge sharing process, facilitating access to the scholarly contents, leadership and change management, developing infrastructures for research data management, gathering information and statistics of these libraries and developing interlibrary collaborations in these libraries.Originality/valueThis research is one of the seldom research studies related to clarification of an organization' role and position in NATIS in universities and improving and also extending activities of university and research libraries in Iran.
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14
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Hamada S, Kojima T, Maruoka H, Ishii S, Hattori Y, Okochi J, Akishita M. Utilization of drugs for the management of cardiovascular diseases at intermediate care facilities for older adults in Japan. Arch Gerontol Geriatr 2020; 88:104016. [PMID: 32045709 DOI: 10.1016/j.archger.2020.104016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES No established approaches exist for the pharmacological management of cardiovascular diseases (CVDs) in residents of long-term care facilities (LTCFs). This study aimed to evaluate the use of drugs for CVD prevention and treatment (CVD-related drugs) in a major type of LTCF in Japan. METHODS This study included 1318 randomly selected residents at 349 intermediate care facilities for older adults (called Roken). Prescriptions were investigated at admission and two months after admission according to therapeutic categories. Logistic regression was used to identify residents' characteristics that were associated with prescriptions of CVD-related drugs. RESULTS Prescriptions of all types of drugs and CVD-related drugs decreased in 36 % and 16 % of residents, respectively. Half of the residents received antihypertensives, a quarter received antiplatelets and diuretics, whereas one-tenth received antidiabetics, oral anticoagulants, and lipid-modifying drugs. The prevalence of most of individual drug categories were similar among residents with different physical or cognitive function, except for fewer antihypertensive and lipid-modifying drugs in those with severe cognitive disability. Adjusted analyses for prescriptions at two months after admission revealed that bedridden residents were more likely to be prescribed diuretics but less likely to be prescribed antihypertensives, antiplatelets, or lipid-modifying drugs. Residents with severe cognitive disability were less likely to be prescribed antihypertensives or lipid-modifying drugs. A known history of cardiovascular events was associated with greater use of CVD-related drugs. CONCLUSION CVD-related drugs were commonly prescribed for Roken residents, including those with low physical and cognitive functions. Deprescribing may contribute to the optimization of pharmacotherapy in LTCF residents.
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Affiliation(s)
- Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Maruoka
- Yokohama Aobanosato Geriatric Health Services Facility, Yokohama, Japan
| | - Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jiro Okochi
- Tatsumanosato Geriatric Health Services Facility, Daito, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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15
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Czwikla J, Schulz M, Heinze F, Kalwitzki T, Gand D, Schmidt A, Tsiasioti C, Schwinger A, Kloep S, Schmiemann G, Wolf-Ostermann K, Gerhardus A, Rothgang H. Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study. BMJ Open 2019; 9:e025614. [PMID: 31471429 PMCID: PMC6720143 DOI: 10.1136/bmjopen-2018-025614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/11/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Nursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate. METHODS AND ANALYSIS First, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER DRKS00012383.
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Affiliation(s)
- Jonas Czwikla
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Maike Schulz
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Thomas Kalwitzki
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Daniel Gand
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Annika Schmidt
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | | | | | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Competence Center for Clinical Trials (KKSB), University of Bremen, Bremen, Germany
| | - Guido Schmiemann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Karin Wolf-Ostermann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Ansgar Gerhardus
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
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16
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Kalinowski S, Dräger D, Kuhnert R, Kreutz R, Budnick A. Pain, Fear of Falling, and Functional Performance Among Nursing Home Residents: A Longitudinal Study. West J Nurs Res 2018; 41:191-216. [DOI: 10.1177/0193945918759958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to analyze the impact of being pain-affected and fear of falling on functional performance among nursing home residents, longitudinally. We used 6-month follow-up data from a cluster-randomized trial of 12 nursing homes (cluster level) with 239 nursing home residents at baseline (mean age, 95% confidence interval [CI] = 83.04 [81.40, 84.69], 70% women). The longitudinal analysis provided data on pain, fear of falling, functional mobility, and activities of daily living (individual level). The data revealed a trend indicating that pain-relieved nursing home residents showed better functional mobility over time. The results on fear of falling demonstrate obvious differences in the functional performance of nursing home residents cross-sectionally but not longitudinally. Nevertheless, the results underline the importance of an effective pain treatment to prevent decline in functional mobility among nursing home residents. Further longitudinal surveys are needed to verify the findings on functional performance.
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Affiliation(s)
- Sonja Kalinowski
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
| | - Dagmar Dräger
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
| | - Ronny Kuhnert
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité–Universitätsmedizin Berlin, Germany
| | - Andrea Budnick
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
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