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Barry LE, Carter L, Nianogo R, O'Neill C, O'Shea E, O'Neill S. The association of comorbid dementia with length of stay, cost and mortality among older adults in US acute hospitals: An observational study. Arch Gerontol Geriatr 2024; 125:105487. [PMID: 38788369 DOI: 10.1016/j.archger.2024.105487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Although overall health and social care expenditures among persons with dementia are larger than for other diseases, the resource and cost implications of a comorbid diagnosis of dementia in acute hospitals in the U.S. are largely unknown. We estimate the difference in inpatient outcomes between similar hospital admissions for patients with and without comorbid dementia (CD). METHODS Inpatient admissions, from the U.S. National Inpatient Sample (2016-2019), were stratified according to hospital characteristics and primary diagnosis (using ICD-10-CM codes), and entropy balanced within strata according to patient and hospital characteristics to create two comparable groups of admissions for patients (aged 65 years or older) with and without CD (a non-primary diagnosis of dementia). Generalized linear regression modeling was then used to estimate differences in length of stay (LOS), cost, absolute mortality risk and number of procedures between these two groups. RESULTS The final sample consisted of 8,776,417 admissions, comprised of 1,013,879 admissions with and 7,762,538 without CD. CD was associated with on average 0.25 (95 % CI: 0.24-0.25) days longer LOS, 0.4 percentage points (CI: 0.37-0.42) higher absolute mortality risk, $1187 (CI: -1202 to -1171) lower inpatient costs and 0.21 (CI: -0.214 to -0.210) fewer procedures compared to similar patients without CD. CONCLUSION Comorbid dementia is associated with longer LOS and higher mortality in acute hospitals but lower inpatient costs and fewer procedures. This highlights potential communication issues between dementia patients and hospital staff, with patients struggling to express their needs and staff lacking sufficient dementia training to address communication challenges.
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Affiliation(s)
- Luke E Barry
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Laura Carter
- J.E. Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland
| | - Roch Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - Eamon O'Shea
- J.E. Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland
| | - Stephen O'Neill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK.
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Harvey L, Taylor ME, Harris IA, Mitchell RJ, Cameron ID, Sarrami P, Close J. Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015-2018: a retrospective population-based study. Med J Aust 2024. [PMID: 39327746 DOI: 10.5694/mja2.52470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/06/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES To determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator. STUDY DESIGN Retrospective population-based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data. SETTING, PARTICIPANTS People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 - 31 December 2018. MAIN OUTCOME MEASURES Thirty-day (primary outcome), 120-day, and 365-day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator. RESULTS Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015-2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre-admission walking ability, and residential status, 30-day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30-0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46-0.82) than for low indicator adherence hip fractures, as was 365-day mortality (high adherence: aRR, 0.59 [95% CI, 0.51-0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63-0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61-0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67-0.83) were associated with lower mortality risk at each time point. CONCLUSIONS Clinical care for two-thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care.
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Affiliation(s)
- Lara Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW
- UNSW Sydney, Sydney, NSW
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW
- UNSW Sydney, Sydney, NSW
| | | | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Sydney, NSW
| | - Pooria Sarrami
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
- New South Wales Institute of Trauma and Injury Management, Sydney, NSW
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW
- UNSW Sydney, Sydney, NSW
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Arase H, Yamada S, Taniguchi M, Ooboshi H, Tsuruya K, Kitazono T, Nakano T. Disturbance in the potential cardiovascular-bone-skeletal muscle axis and morbidity and mortality in patients undergoing haemodialysis: the Q-Cohort Study. Clin Kidney J 2024; 17:sfae154. [PMID: 38919276 PMCID: PMC11196899 DOI: 10.1093/ckj/sfae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Indexed: 06/27/2024] Open
Abstract
Background Disturbances in the cardiovascular system, bone and skeletal muscle are independent risk factors for death among patients receiving haemodialysis (HD). However, the combined impact of disorders of these three organs on morbidity and mortality is unclear in the HD population. Methods A total of 3031 Japanese patients on maintenance HD were prospectively followed. The outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and bone fracture. Patients were divided into four groups (G1-G4) according to the baseline number of diseased organs represented as histories of cardiovascular disease and bone fractures and the presence of low skeletal muscle mass as follows: G1, no organ; G2, one organ; G3, two organs; G4, three organs. Multivariable-adjusted survival models were used to analyse associations between the number of diseased organs and outcomes. Results During a 4-year follow-up, 499 deaths, 540 MACE and 140 bone fractures occurred. In the Cox proportional hazards model, the risk for all-cause mortality was significantly higher in G2, G3 and G4 than in G1 as the reference {hazard ratio: G2, 2.16 [95% confidence interval (CI) 1.65-2.84], G3, 3.10 [95% CI 2.27-4.23] and G4, 3.11 [95% CI 1.89-5.14]}. Similarly, the risks for developing MACE and bone fractures were significantly elevated as the number of organ disorders increased. Conclusions Multiple disorders of the cardiovascular-bone-skeletal muscle axis are strong predictors of morbidity and mortality in patients undergoing HD.
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Affiliation(s)
- Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
- Department of Nephrology, NHO Fukuokahigashi Medical Center, Koga, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
| | | | - Hiroaki Ooboshi
- Department of Internal Medicine, Fukuoka Dental College, Sawara-Ku, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan
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Taylor ME, Harvey LA, Crotty M, Harris IA, Sherrington C, Close JCT. Variation in care and outcomes for people after hip fracture with and without cognitive impairment; results from the Australian and New Zealand Hip Fracture Registry. J Nutr Health Aging 2024; 28:100030. [PMID: 38388111 DOI: 10.1016/j.jnha.2023.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/20/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND People with dementia have poorer outcomes after hip fracture and this may be due in part to variation in care. We aimed to compare care and outcomes for people with and without cognitive impairment after hip fracture. METHODS Retrospective cohort study using Australian and New Zealand Hip Fracture Registry data for people ≥50 years of age who underwent hip fracture surgery (n = 49,063). Cognitive impairment or known dementia and cognitively healthy groups were defined using preadmission cognitive status. Descriptive statistics and multivariable mixed effects models were used to compare groups. RESULTS In general, cognitively impaired people had worse care and outcomes compared to cognitively healthy older people. A lower proportion of the cognitively impaired group had timely pain assessment (≤30 min of presentation: 61% vs 68%; p < 0.0001), were given the opportunity to mobilise (89% vs 93%; p < 0.0001) and achieved day-1 mobility (34% vs 58%; p < 0.0001) than the cognitively healthy group. A higher proportion of the cognitively impaired group had delayed pain management (>30 mins of presentation: 26% vs 20%; p < 0.0001), were malnourished (27% vs 15%; p < 0.0001), had delirium (44% vs 13%; p < 0.0001) and developed a new pressure injury (4% vs 3%; p < 0.0001) than the cognitively healthy group. Fewer of the cognitively impaired group received rehabilitation (35% vs 64%; p < 0.0001), particularly patients from RACFs (16% vs 39%; p < 0.0001) and were prescribed bone protection medication on discharge (24% vs 27%; p < 0.0001). Significantly more of the cognitively impaired group had a new transfer to residential care (46% vs 11% from private residence; p < 0.0001) and died at 30-days (7% vs 3% from private residence; 15% vs 10% from RACF; both p < 0.0001). In multivariable models adjusting for covariates with facility as the random effect, the cognitively impaired group had a greater odds of being malnourished, not achieving day-1 walking, having delirium in the week after surgery, dying within 30 days, and in those from private residences, having a new transfer to a residential care facility than the cognitively healthy group. CONCLUSIONS We have identified several aspects of care that could be improved for patients with cognitive impairment - management of pain, mobility, nutrition and bone health, as well as delirium assessment, prevention and management strategies and access to rehabilitation. Further research is needed to determine whether improvements in care will reduce hospital complications and improve outcomes for people with dementia after hip fracture.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; UNSW Ageing Futures Research Institute, Sydney, New South Wales, Australia.
| | - Lara A Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Rehabilitation Unit, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool Hospital, Liverpool, NSW, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Taylor ME, Kerckhaert L, Close JCT, van Schooten KS, Lord SR. The Impact of Misaligned Perceived and Objective Fall Risk in Cognitively Impaired Older People. J Alzheimers Dis 2024; 100:1389-1398. [PMID: 39031366 DOI: 10.3233/jad-240489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. Objective We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Methods Participants (n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). Results The anxious (IRR = 1.70, 95% CI = 1.02-2.84), unaware (IRR = 2.00, 95% CI = 1.22-3.26), and aware (IRR = 2.53, 95% CI = 1.67-3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Conclusions Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Luuk Kerckhaert
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
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Santiago Martinez P, Lord SR, Close JCT, Taylor ME. Associations between psychotropic and anti-dementia medication use and falls in community-dwelling older adults with cognitive impairment. Arch Gerontol Geriatr 2023; 114:105105. [PMID: 37364485 DOI: 10.1016/j.archger.2023.105105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Evidence for effective fall prevention strategies is limited for people with cognitive impairment. Understanding what factors contribute to fall risk identifies potential intervention strategies. We aimed to determine if psychotropic and anti-dementia medication use are associated with falls in community-dwelling older people with mild-moderate cognitive impairment and dementia. DESIGN Secondary analysis of an RCT (i-FOCIS). PARTICIPANTS AND SETTING 309 community-dwelling people with mild to moderate cognitive impairment or dementia from Sydney, Australia. METHODS Demographic information, medical history, and medication use were collected at baseline and participants were followed up for 1-year for falls using monthly calendars and ancillary telephone falls. RESULTS Psychotropic medication use was associated with an increased rate of falls (IRR 1.41, 95%CI 1.03, 1.93) and slower gait speed, poor balance and reduced lower limb function when adjusting for age, sex, education and cognition, as well as RCT group allocation when examining prospective falls. Antidepressants use increased the rate of falls in a similarly adjusted model (IRR 1.54, 95%CI 1.10, 2.15), but when additionally adjusting for depressive symptoms, antidepressant use was no longer significantly associated with falls while depressive symptoms was. Anti-dementia medication use was not associated with rate of falls. CONCLUSIONS Psychotropic medication use increases fall risk, and anti-dementia medication does not reduce fall risk in older adults with cognitive impairment. Effective management of depressive symptoms, potentially with non-pharmacological approaches, is needed to prevent falls in this population. Research is also required to ascertain the risks/benefits of withdrawing psychotropic medications, particularly in relation to depressive symptoms.
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Affiliation(s)
| | - Stephen R Lord
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E Taylor
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.
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Lim SJ, Son S, Chung Y, Kim SY, Choi H, Choi J. Relationship between vestibular loss and the risk of dementia using the 2002-2019 national insurance service survey in South Korea. Sci Rep 2023; 13:16746. [PMID: 37798321 PMCID: PMC10556082 DOI: 10.1038/s41598-023-42598-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
This retrospective cross-sectional study assessed older adults aged between 40 and 80 years, registered in the Korean National Health Insurance Service database from 2002 to 2019 to investigate the association between vestibular loss and the risk of dementia. The population was divided into three groups (general, vestibular loss, and hearing loss). The hazard ratios (HRs) of dementia in the vestibular and hearing loss groups were calculated using national population data. In total, 2,347,610 individuals were identified (general: 2,145,609, vestibular loss: 60,525, hearing loss: 141,476). Mean ages were 53.29 years, 58.26 years, and 58.52 years, respectively. Dementia occurred in 127,081 (IR = 4.91 per 1000 person-years), 7705 (IR = 10.79 per 1000 person-years), and 16,116 (IR = 9.63 per 1000 person-years) patients. The vestibular and hearing loss groups had hazard ratios for dementia of 1.084 (95% CI, 1.059-1.110) and 1.074 (95% CI, 1.056-1.092), respectively, compared with the general group. The results of the current study suggest that vestibular loss increases the risk of developing dementia. Therefore, similar to hearing loss, vestibular loss should be considered a risk factor for dementia, and treatments such as adequate vestibular rehabilitation may reduce this risk.
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Affiliation(s)
- Sung Jin Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Serhim Son
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Younghan Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Sang Yeop Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Hangseok Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
- Medical Science Research Center, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
- Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
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Chang CH, Yeh CH, Chang CC, Lin YC. Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study. JMIR Serious Games 2022; 10:e38465. [PMID: 35834303 PMCID: PMC9335175 DOI: 10.2196/38465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/22/2022] [Accepted: 06/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In aging societies, dementia risk increases with advancing age, increasing the incidence of dementia-related degenerative diseases and other complications, especially fall risk. Dementia also escalates the care burden, impacting patients, their families, social welfare institutions, and the social structure and medical system. OBJECTIVE In elderly dementia, traditional card recognition rehabilitation (TCRR) does not effectively increase one's autonomy. Therefore, from the usability perspective, we used the Tetris game as a reference to develop an interactive somatosensory game rehabilitation (ISGR) with nostalgic style for elders with mild cognitive impairment (MCI). Through intuitive gesture-controlled interactive games, we evaluated subjective feelings concerning somatosensory game integration into rehabilitation to explore whether the ISGR could improve the willingness to use and motivation for rehabilitation among elders with MCI. METHODS A total of 15 elders with MCI (7 males and 8 females with an average age of 78.4 years) underwent 2 experiments for 15 minutes. During experiment 1, TCRR was performed, followed by completing the questionnaire of the System Usability Scale (SUS). After 3-5 minutes, the second experiment (the ISGR) was conducted, followed by completing another SUS. We used SUS to explore differences in impacts of TCRR and ISGR on willingness to use among elders with MCI. In addition, we further investigated whether the factor of gender or prior rehabilitation experience would affect the rehabilitation willingness or not. RESULTS The novel ISGR made the elderly feel interested and improved their willingness for continuous rehabilitation. According to the overall SUS score, the ISGR had better overall usability performance (73.7) than the TCRR (58.0) (t28=-4.62, P<.001). Furthermore, the ISGR individual item scores of "Willingness to Use" (t28=-8.27, P<.001), "Easy to Use" (t28=-3.17, P<.001), "System Integration" (t28=-5.07, P<.001), and "Easy to Learn" (t28=-2.81, P<.001) were better than TCRR. The somatosensory game was easier to learn and master for females than for males (t13=2.71, P=.02). Besides, the ISGR was easier to use (t12=-2.50, P=.02) and learn (t14=-3.33, P<.001) for those without prior rehabilitation experience. The result indicates that for elders with no rehabilitation experience ISGR was easier to use and simpler to learn than TCRR. CONCLUSIONS Regardless of prior rehabilitation experience, the ISGR developed in this study was easy to learn and effective in continuously improving willingness to use. Furthermore, the adoption of a nostalgic game design style served the function of cognitive training and escalated interest in rehabilitation. The ISGR also improved user stickiness by introducing different game scenarios and difficulties, increasing long-term interest and motivation for rehabilitation. For future research on the adoption of interactive somatosensory games in rehabilitation, additional rehabilitation movements can be developed to benefit the elderly with MCI.
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Affiliation(s)
- Chien-Hsiang Chang
- Department of Industrial Design, National Cheng Kung University, Tainan City, Taiwan
| | - Chung-Hsing Yeh
- Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Chien-Cheng Chang
- Department of Industrial Design, National United University, Miaoli, Taiwan
| | - Yang-Cheng Lin
- Department of Industrial Design, National Cheng Kung University, Tainan City, Taiwan
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Yeni C, Yilmaz M. Nurse-led home modification interventions for community-dwelling older adults with dementia and their impact on falls prevention. Br J Community Nurs 2022; 27:78-88. [PMID: 35137618 DOI: 10.12968/bjcn.2022.27.2.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This quasi-experimental study aimed to investigate the effects of nurse-led home modification interventions on the family members of home-dwelling older adults with dementia. The sample consisted of 42 older adults diagnosed with dementia and their family members. A number of validated tools were used. Three home visits were undertaken, a training package with family members was instigated, and the patients were followed up for a 6-month period. It was determined that there was a decrease in falls in the first 3-month period (p=0.002). The number of falls in the second 3-month period was lower in the older adults who had their homes modified (p=0.000). Family-centred, nurse-led home-modification interventions can be effective in the prevention and reducing of falls in older adults with dementia.
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Affiliation(s)
- Cansu Yeni
- Associate Professor, Department of Public Health Nursing, Faculty of Health Sciences, İzmir Kâtip Çelebi University, Izmir, Turkey
| | - Medine Yilmaz
- Associate Professor, Department of Public Health Nursing, Faculty of Health Sciences, İzmir Kâtip Çelebi University, Izmir, Turkey
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Yang S, Cheng J, Man C, Jiang L, Long G, Zhao W, Zheng D. Effects of exogenous nerve growth factor on the expression of BMP-9 and VEGF in the healing of rabbit mandible fracture with local nerve injury. J Orthop Surg Res 2021; 16:74. [PMID: 33478541 PMCID: PMC7818757 DOI: 10.1186/s13018-021-02220-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mandibular fracture healing is a complex process involving nerves and growth factors. Nerve growth factor (NGF) not only facilitates the maintenance of sympathetic neurite growth but also stimulates other growth factors that can promote the essential osteogenesis and angiogenesis for fracture healing. Therefore, it is necessary to analyze the combined effects of NGF, bone morphogenic protein-9 (BMP-9), and vascular endothelial growth factor (VEGF) to accelerate the healing of mandible fractures. METHODS The models of mandible fracture with local nerve injury established in 48 rabbits were randomly divided into nerve growth factor group (NGF group), gelatin sponge group (GS group), blank group, and intact group. The recovery of nerve reflex was assessed by observing the number of rabbits with lower lip responses to acupuncture. The fracture healing was observed with visual and CBCT, and then callus tissues from the mandibular fracture area were collected for hematoxylin and eosin (HE) staining observation, and the expression of BMP-9 and VEGF in callus at different stages was detected by quantitative real-time PCR (qRT-PCR). RESULTS Needling reaction in the lower lip showed the number of animals with nerve reflex recovery was significantly higher in the NGF group than that in the GS and blank groups at the 2nd and 4th weeks after the operation. The combined results of macroscopic observation, CBCT examination, and histological analysis showed that a large number of osteoblasts and some vascular endothelial cells were found around the trabecular bone in the NGF group and the amount of callus formation and reconstruction was better than that in the GS group at the 2nd week after the operation. The qRT-PCR results indicated that the expression levels of BMP-9 and VEGF in the four groups reached the highest values at the 2nd week, while the expression levels of both in the NGF group were significantly higher than that in the GS group. CONCLUSION The exogenous NGF could accelerate the healing of mandible fractures. This work will provide a new foundation and theoretical basis for clarifying the mechanism of fracture healing, thereby promoting fracture healing and reducing the disability rate of patients.
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Affiliation(s)
- Sen Yang
- Oral Maxillofacial Trauma and Orthognathic Surgery, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jiao Cheng
- Oral Maxillofacial Trauma and Orthognathic Surgery, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
| | - Cheng Man
- Oral Maxillofacial Trauma and Orthognathic Surgery, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Lian Jiang
- Oral Maxillofacial Trauma and Orthognathic Surgery, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Guogeng Long
- Oral Maxillofacial Trauma and Orthognathic Surgery, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wenjun Zhao
- Oral Maxillofacial Trauma and Orthognathic Surgery, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Dexin Zheng
- Oral Maxillofacial Trauma and Orthognathic Surgery, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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11
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Chang YS, Rah YC, Lee MK, Park S, Kim B, Han K, Choi J. Association between the severity of hearing loss and the risk of dementia within the 2010-2017 national insurance service survey in South Korea. Sci Rep 2020; 10:20679. [PMID: 33244106 PMCID: PMC7693323 DOI: 10.1038/s41598-020-77752-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/13/2020] [Indexed: 11/15/2022] Open
Abstract
Hearing loss and dementia are highly prevalent neurologic conditions in older adults that can considerably impact the quality of life and create social and familial burdens. To investigate the impact of hearing loss on the risk of developing dementia in a nationwide long-term follow-up study using data obtained from the South Korean National Health Information Database. Retrospective medical data for patients of all ages were extracted from the database between January 2010 and December 2017. According to the national disability registry, the degree of severe-profound hearing loss is classified into six grades. We categorized hearing loss into three groups based on the disability registry severity: (1) severe hearing disability (HD), defined as 1st to 3rd grade disabling hearing loss; (2) non-severe HD, 4th and 5th grade disabling hearing loss; and (3) ipsilateral HD, 6th grade disabling hearing loss. After adjusting for potential confounding variables, the hazard ratio (HR) for all dementia types was 1.336 (95% CI 1.306–1.367) in the severe HD group, 1.312 (95% CI 1.286–1.338) in the non-severe HD group, and 1.257 (95% CI 1.217–1.299) in the ipsilateral HD group. On assessing by the age group, the risk of all dementia types in patients younger than 65 years was as follows: HR 1.933 (95% CI 1.779–2.101), 1.880 (95% CI 1.732–2.041), and 1.601 (95% CI 1.435–1.787) in the severe, non-severe, and ipsilateral HD groups, respectively. This study demonstrates that the impact of hearing loss on dementia incidence is severity-dependent, and the risk increases in patients younger than 65 years of age.
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Affiliation(s)
- Young-Soo Chang
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Min Kyu Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Seongbin Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea.
| | - June Choi
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
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12
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Welberry HJ, Brodaty H, Hsu B, Barbieri S, Jorm LR. Impact of Prior Home Care on Length of Stay in Residential Care for Australians With Dementia. J Am Med Dir Assoc 2020; 21:843-850.e5. [DOI: 10.1016/j.jamda.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 02/02/2023]
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13
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Welberry HJ, Brodaty H, Hsu B, Barbieri S, Jorm LR. Measuring dementia incidence within a cohort of 267,153 older Australians using routinely collected linked administrative data. Sci Rep 2020; 10:8781. [PMID: 32472058 PMCID: PMC7260191 DOI: 10.1038/s41598-020-65273-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/28/2020] [Indexed: 12/29/2022] Open
Abstract
To estimate dementia incidence rates using Australian administrative datasets and compare the characteristics of people identified with dementia across different datasets. This data linkage study used a cohort of 267,153 from the Australian 45 and Up Study. Participants completed a survey in 2006-2009 and subsequent dementia was identified through pharmaceutical claims, hospitalisations, aged care eligibility assessments, care needs at residential aged care entry and death certificates. Age-specific, and age-standardised incidence rates, incidence rate ratios and survival from first dementia diagnosis were estimated. Estimated age-standardised dementia incidence rates using all linked datasets was 16.8 cases per 1000 person years for people aged 65+. Comparing incidence rates to the global published rates suggested 77% of cases were identified but this varied by age with highest coverage among those aged 80-84 years (92%). Incidence rate ratios were inconsistent across datasets for: sex, socio-economic disadvantage, size of support network, marital status, functional limitations and diabetes. Median survival from first dementia diagnosis ranged from 1.80 years in the care needs dataset to 3.74 years in the pharmaceutical claims dataset. Characteristics of people identified with dementia in different administrative datasets reflect the factors that drive interaction with specific services; this may introduce bias in observational studies using a single data-source to identify dementia.
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Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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14
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Suzuki M, Yamamoto R, Ishiguro Y, Sasaki H, Kotaki H. Deep learning prediction of falls among nursing home residents with Alzheimer's disease. Geriatr Gerontol Int 2020; 20:589-594. [PMID: 32267067 DOI: 10.1111/ggi.13920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/29/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to use a convolutional neural network (CNN) to investigate the associations between the time of falling and multiple complicating factors, including age, dementia severity, lower extremity strength and physical function, among nursing home residents with Alzheimer's disease. METHODS A total of 42 people with Alzheimer's disease were enrolled. We evaluated falling events from nursing home admission (baseline) to 300 days later. We assessed the knee extension strength and Functional Independence Measure locomotion item and carried out the Mini-Mental State Examination at baseline. To predict falling, participants were categorized into three classes: those who fell within the first 150 (or 300) days from baseline or those who did not experience a fall within the study period. For each class, 1000 bootstrap datasets were generated using 42 actual sample datasets, and were used to propose a CNN algorithm and cross-validate the algorithm. RESULTS Eight (19.0%), 11 (26.2%) and 31 participants (73.8%) fell within 150 or 300 days after the baseline assessment or did not fall until 300 days or later, respectively. The highest accuracy rate of the CNN classification was 0.647 in the factor combination extracted from the Mini-Mental State Examination score, knee extension strength and Functional Independence Measure locomotion item score. CONCLUSIONS A CNN based on multiple complicating factors could predict the time of falling in nursing home residents with Alzheimer's disease. Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- Makoto Suzuki
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Ryosuke Yamamoto
- Department of Health Support, Setagaya Municipal Kitazawa En, Setagaya, Japan
| | - Yuko Ishiguro
- Department of Health Support, Setagaya Municipal Kitazawa En, Setagaya, Japan
| | - Hironori Sasaki
- Department of Rehabilitation, Hatsutomi Hoken Hospital, Chiba, Japan
| | - Harumi Kotaki
- Department of Rehabilitation, Hatsutomi Hoken Hospital, Chiba, Japan
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15
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Mitchell R, Draper B, Brodaty H, Close J, Ting HP, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporos Int 2020; 31:465-474. [PMID: 31897545 DOI: 10.1007/s00198-019-05260-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
UNLABELLED This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. INTRODUCTION To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. METHODS A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. RESULTS Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. CONCLUSION Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. HIGHLIGHTS • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - B Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - H Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - H P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - R Lystad
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - I Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - C Sherrington
- School of Public Health, University of Sydney, Sydney, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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16
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Baydan M, Caliskan H, Balam-Yavuz B, Aksoy S, Böke B. The Interaction Between Mild Cognitive Impairment with Vestibulo-ocular Reflex, Dynamic Visual Acuity and Postural Balance in Older Adults. Exp Gerontol 2020; 130:110785. [DOI: 10.1016/j.exger.2019.110785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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17
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Tapiainen V, Lavikainen P, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen A. The Risk of Head Injuries Associated With Antipsychotic Use Among Persons With Alzheimer's disease. J Am Geriatr Soc 2020; 68:595-602. [DOI: 10.1111/jgs.16275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Vesa Tapiainen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
| | - Piia Lavikainen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
| | - Marjaana Koponen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
| | - Heidi Taipale
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of Forensic PsychiatryNiuvanniemi Hospital, University of Eastern Finland Kuopio Finland
| | - Antti Tanskanen
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of Forensic PsychiatryNiuvanniemi Hospital, University of Eastern Finland Kuopio Finland
- Impact Assessment UnitNational Institute for Health and Welfare Helsinki Finland
| | - Jari Tiihonen
- Department of Clinical NeuroscienceKarolinska Institutet Stockholm Sweden
- Department of Forensic PsychiatryNiuvanniemi Hospital, University of Eastern Finland Kuopio Finland
| | - Sirpa Hartikainen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
| | - Anna‐Maija Tolppanen
- School of PharmacyUniversity of Eastern Finland Kuopio Finland
- Kuopio Research Centre of Geriatric CareUniversity of Eastern Finland Kuopio Finland
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18
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Soh Z, Wang W, Png GK, Hassan N, Wu VX. Risk of skin tears and its predictors among hospitalized older adults in Singapore. Int J Nurs Pract 2019; 25:e12790. [PMID: 31793134 DOI: 10.1111/ijn.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/31/2019] [Accepted: 09/07/2019] [Indexed: 11/29/2022]
Abstract
AIM To identify the characteristics that may be predictive of development of risk of skin tears among hospitalized older adults in Singapore. BACKGROUND Skin tears are wounds that are partial or full-thickness separation of skin layers, which are common in older adults. Skin tears can result from shearing, friction, and/or blunt force. Skin tears have correlated with prolonged hospitalization, raised health-care costs and poorer quality of life. METHODS This cross-sectional descriptive correlational study recruited a convenience sample of 140 patients aged 65 years or above from a Singapore acute hospital. A modified International Skin Tear Advisory Panel (ISTAP) Skin Tear Risk Assessment Pathway was used for data collection; this is a validated instrument to assess patients for risks of skin tears in clinical settings. RESULTS The results of the multiple linear regression analysis indicated that increasing age, being underweight, caregiver-dependence and dementia predicted higher levels of risk of skin tears among hospitalized older adults in Singapore. These factors accounted for 33.6% of the variance. CONCLUSION This study can aid health-care professionals assess patients' risk of skin tears and implement appropriate interventions to minimize risks of skin tears.
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Affiliation(s)
- Zann Soh
- Changi General Hospital, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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19
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Mitchell R, Draper B, Close J, Harvey L, Brodaty H, Do V, Driscoll TR, Braithwaite J. Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury. Osteoporos Int 2019; 30:1995-2008. [PMID: 31342137 DOI: 10.1007/s00198-019-05096-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively. INTRODUCTION To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership. METHOD A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership. RESULTS There were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living. CONCLUSIONS Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - B Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - H Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - V Do
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - T R Driscoll
- School of Public Health, University of Sydney, Camperdown, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia
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20
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Taylor ME, Close JCT, Lord SR, Kurrle SE, Webster L, Savage R, Delbaere K. Pilot feasibility study of a home-based fall prevention exercise program (StandingTall) delivered through a tablet computer (iPad) in older people with dementia. Australas J Ageing 2019; 39:e278-e287. [PMID: 31538401 DOI: 10.1111/ajag.12717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of StandingTall-an individually tailored, progressive exercise program delivered through tablet computers-in community-dwelling older people with dementia. METHODS Fifteen community-dwelling older people with dementia (mean age = 83 ± 8 years; Montreal Cognitive Assessment 16 ± 5) received StandingTall for 12 weeks with caregiver assistance. Feasibility and safety were assessed using the System Usability Scale (SUS; scores = 0-100; a priori target >65), Physical Activity Enjoyment Scale (PACES-8; scores = 8-56), adherence (exercise minutes) and adverse events. RESULTS Mean SUS scores were 68 ± 21/69 ± 15 (participants/caregivers). The mean PACES-8 score was 44 ± 8. In week 2, week 7 and week 12, mean (bias-corrected and accelerated 95% CI) exercise minutes were 37 (25-51), 49 (30-69) and 65 (28-104), respectively. In week 12, five participants exercised >115 minutes. One participant fell while exercising, without sustained injury. CONCLUSIONS StandingTall had acceptable usability, scored well on enjoyment and was feasible for participants. These results provide support for further evaluation of StandingTall in a randomised controlled trial with falls as the primary outcome.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,Cognitive Decline Partnership Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia
| | - Susan E Kurrle
- Cognitive Decline Partnership Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lyndell Webster
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia
| | - Roslyn Savage
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia.,School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia
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21
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Kim HJ, Jang SN, Lee JK, Ha YC. Fracture Experiences and Long-Term Care Initiation among Older Population: Analysis of Korean National Health Insurance Service-Senior Cohort Study. Ann Geriatr Med Res 2019; 23:115-124. [PMID: 32743299 PMCID: PMC7370766 DOI: 10.4235/agmr.19.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Long-term care is a burden on individuals, families, and society. It is important to find ways to delay the onset of disability to lessen the burden of long-term care in aging societies. Fracture is one of the risk factors that affect physical functions and make older people dependent. This study aimed to examine how much more often older adults who experienced fractures initiated long-term care compared to those who did not, and whether the risk of entering long-term care differed significantly by fracture site. METHODS The analyses included insurants aged 65 years and over from the Korean National Health Insurance Service-senior cohort study (2002-2013). Cox proportional hazard models were used to calculate the hazard ratios of the first certification of initiation of long-term care after fracture, by fracture site, and for multiple recurrent fractures. RESULTS The incidence rate of initial long-term care beneficiaries was approximately 2.5 times higher when older people had experienced fractures; these individuals entered long-term care beneficiary status 3 years earlier compared to those who had no fracture events. Lower extremity fracture and multiple recurrent fractures more than doubled the risk for long-term care. CONCLUSION Additional attention to fracture sites in prevention and rehabilitation settings is warranted to reduce disability and the related long-term care burden.
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Affiliation(s)
- Hye-jin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Soong-nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Ja-kyung Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Harvey L, Toson B, Brodaty H, Draper B, Kochan N, Sachdev P, Mitchell R, Close J. Injury-related hospitalisation in community-dwelling older people across the cognitive spectrum: A population based study. Arch Gerontol Geriatr 2019; 83:155-160. [DOI: 10.1016/j.archger.2019.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022]
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Ilmaniemi S, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. Incidence of head injury and traumatic brain injury among people with Alzheimer’s disease. J Epidemiol Community Health 2019; 73:451-454. [DOI: 10.1136/jech-2018-211960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Abstract
BackgroundInjuries caused by falling are a major health concern among older population. For older people, falls are the leading cause of head injuries; especially, persons with cognitive disorders have an increased risk of falling.ObjectiveTo compare the incidence of head injury and traumatic brain injury (TBI) among persons with Alzheimer’s disease (AD) with persons without AD.MethodsThis register-based study was conducted on a nationwide cohort, which includes all community-dwelling persons diagnosed with AD in Finland in 2005–2011. Persons with previous head injuries were excluded, leaving 67 172 persons with AD. For each person with AD, a matching person without AD and previous head injury were identified with respect to age, sex and university hospital district. The Cox proportional hazard model and competing risk analyses were used to estimate HR for head injury and TBI.ResultsPersons with AD had 1.34-fold (95% CI 1.29 to 1.40) risk of head injuries and 1.49-fold (95% CI 1.40 to 1.59) risk of TBIs after accounting for competing risks of death and full adjustment by socioeconomic status, drug use and comorbidities.ConclusionPersons with AD are more likely to have a head injury or TBI incident than persons without AD.
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Möllers T, Perna L, Ihle P, Schubert I, Bauer J, Brenner H. Factors Associated with Length of Stay in Hospital Patients with and Without Dementia. J Alzheimers Dis 2019; 67:1055-1065. [DOI: 10.3233/jad-180593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Tobias Möllers
- Network Aging Research, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Wuerttemberg, Germany
- Medical Faculty, University of Heidelberg, Baden-Wuerttemberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Wuerttemberg, Germany
| | - Peter Ihle
- PMV Research Group, Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Ingrid Schubert
- PMV Research Group, Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Jürgen Bauer
- Network Aging Research, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
- Center for Geriatric Medicine, University of Heidelberg, Agaplesion Bethanien Krankenhaus Heidelberg, Baden-Wuerttemberg, Germany
| | - Hermann Brenner
- Network Aging Research, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Wuerttemberg, Germany
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Mitchell R, Draper B, Harvey L, Wadolowski M, Brodaty H, Close J. Comparison of hospitalised trends, treatment cost and health outcomes of fall-related hip fracture for people aged ≥ 65 years living in residential aged care and the community. Osteoporos Int 2019; 30:311-321. [PMID: 30569228 DOI: 10.1007/s00198-018-4800-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
UNLABELLED This study compared hip fracture rates and health outcomes of older people living in residential aged care facilities (RACFs) to the community. The RACF resident age-standardised hospitalisation rate was five times higher than the community rate and declining. RACF residents experience overall worse health outcomes and survival post-hip fracture. INTRODUCTION To compare hospitalisation trends, characteristics and health outcomes following a fall-related hip fracture of older people living in residential aged care facilities (RACFs) to older people living in the community. METHODS A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥ 65 years during 1 July 2008 and 30 June 2013 in New South Wales (NSW), Australia's largest populated state. Linked hospitalisation, RACF and Aged Care Assessment Appraisal data collections were examined. Negative binomial regression examined the significance of hospitalisation temporal trends. RESULTS There were 28,897 hip fracture hospitalisations. One-third were of older people living in RACFs. The hospitalisation rate was 2180 per 100,000 (95%CI: 2097.0-2263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for older people living in the community. The hospitalisation rate for RACF residents was estimated to decline by 2.9% annually (95%CI: - 4.3 to - 1.5). Hospital treatment cost for hip fractures was AUD$958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥ 90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had > 1 Charlson comorbidity (37.6% vs 35.6%) and 58.2% had dementia (vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community. CONCLUSIONS RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve their health outcomes should be examined.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - B Draper
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - M Wadolowski
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - H Brodaty
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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26
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Möllers T, Stocker H, Wei W, Perna L, Brenner H. Length of hospital stay and dementia: A systematic review of observational studies. Int J Geriatr Psychiatry 2019; 34:8-21. [PMID: 30260050 DOI: 10.1002/gps.4993] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. METHODS A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. RESULTS Fifty-two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was -2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was -2.9 to +12.4 and -11.2 to +21.8 days, respectively. CONCLUSIONS The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.
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Affiliation(s)
- Tobias Möllers
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Stocker
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Wenjia Wei
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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27
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Taylor ME, Butler AA, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JC. Inaccurate judgement of reach is associated with slow reaction time, poor balance, impaired executive function and predicts prospective falls in older people with cognitive impairment. Exp Gerontol 2018; 114:50-56. [DOI: 10.1016/j.exger.2018.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/26/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022]
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28
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Hsu B, Bleicher K, Waite LM, Naganathan V, Blyth FM, Handelsman DJ, Le Couteur DG, Seibel MJ, Cumming RG. Community-dwelling older men with dementia are at high risk of hip fracture, but not any other fracture: The Concord Health and Aging in Men Project. Geriatr Gerontol Int 2018; 18:1479-1484. [DOI: 10.1111/ggi.13516] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/03/2018] [Accepted: 07/14/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Benjumin Hsu
- Center for Big Data Research in Health; UNSW Sydney; Sydney Australia
- ANZAC Research Institute, University of Sydney and Concord Hospital; Sydney Australia
- Center for Education and Research on Aging; University of Sydney and Concord Hospital; Sydney Australia
- School of Public Health; University of Sydney; Sydney Australia
| | - Kerrin Bleicher
- Center for Education and Research on Aging; University of Sydney and Concord Hospital; Sydney Australia
| | - Louise M Waite
- Center for Education and Research on Aging; University of Sydney and Concord Hospital; Sydney Australia
| | - Vasi Naganathan
- Center for Education and Research on Aging; University of Sydney and Concord Hospital; Sydney Australia
| | - Fiona M Blyth
- Center for Education and Research on Aging; University of Sydney and Concord Hospital; Sydney Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital; Sydney Australia
| | - David G Le Couteur
- ANZAC Research Institute, University of Sydney and Concord Hospital; Sydney Australia
- Center for Education and Research on Aging; University of Sydney and Concord Hospital; Sydney Australia
| | - Markus J Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital; Sydney Australia
| | - Robert G Cumming
- ANZAC Research Institute, University of Sydney and Concord Hospital; Sydney Australia
- Center for Education and Research on Aging; University of Sydney and Concord Hospital; Sydney Australia
- School of Public Health; University of Sydney; Sydney Australia
- ARC Center of Excellence in Population Aging Research; University of Sydney; Sydney Australia
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Petersen JD, Siersma VD, Christensen RD, Storsveen MM, Nielsen CT, Waldorff FB. The risk of fall accidents for home dwellers with dementia-A register- and population-based case-control study. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:421-428. [PMID: 30151421 PMCID: PMC6107894 DOI: 10.1016/j.dadm.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Institutionalized people with dementia have an increased risk of fall accidents, but little is known about whether this increased risk holds for home dwellers. Methods This register- and population-based study comprised 115,584 cases and 394,679 controls. Cases were individuals with any fall between 2009 and 2014, and matched with up to six controls on age, sex, and geographic location. Individuals were excluded if they (1) had any fall in 2008, or (2) lived in a nursing home on the date of the fall. Dementia, other chronic diseases, and sedative medicines were assessed from Danish national registers. Results After adjusting for potential confounders, older people with dementia living at home had a 1.89-fold higher risk of fall (odds ratio = 1.89, 95% confidence interval [1.84–1.94], P < .001). Discussion Dementia almost doubles the risk of fall for older Danish people living at home. This highlights the need for effective fall preventions that target people with dementia.
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Affiliation(s)
- Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Mental Health Services in the Region of Southern Denmark, Department of Mental Health, Kolding-Vejle, Denmark
- Corresponding author. Tel.: +45 6550 9531; Fax: +45 6591 8296.
| | - Volkert Dirk Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - René dePont Christensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Maria Munch Storsveen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Connie Thurøe Nielsen
- Mental Health Services in the Region of Southern Denmark, Department of Mental Health, Kolding-Vejle, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Robalino S, Nyakang’o SB, Beyer FR, Fox C, Allan LM. Effectiveness of interventions aimed at improving physical and psychological outcomes of fall-related injuries in people with dementia: a narrative systematic review. Syst Rev 2018; 7:31. [PMID: 29463292 PMCID: PMC5819703 DOI: 10.1186/s13643-018-0697-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/13/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The annual prevalence of falls in people with dementia ranges from 47 to 90%. Falls are a common reason for hospital admission in people with dementia, and there is limited research evidence regarding the care pathways experienced by this population. In addition to immediate management of an injury, prevention of further falls is likely to be an important part of any successful intervention. This review aims to assess the effectiveness of interventions for improving the physical and psychological wellbeing of people with dementia who have sustained a fall-related injury. METHODS Systematic review methodologies were employed utilising searches across multiple databases (MEDLINE, CENTRAL, Health Management Information Consortium, EMBASE, CINAHL, Web of Science, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro)) and citation chaining. Studies including people with a known diagnosis of dementia living in the community and who present at health services with a fall, with or without injury, were included. Outcomes of interest included mobility, recurrent falls, activities of daily living, length of hospital stay, and post-discharge residence. Results were independently reviewed and quality assessed by two researchers, and data extracted using a customised form. A narrative synthesis was performed due to heterogeneity of the included studies. RESULTS Seven studies were included. Interventions clustered into three broad categories: multidisciplinary in-hospital post-surgical geriatric assessment; pharmaceuticals; and multifactorial assessment. Multidisciplinary care and early mobilisation showed short-term improvements for some outcomes. Only an annual administration of zoledronic acid showed long-term reduction in recurrent falls. CONCLUSIONS Due to high heterogeneity across the studies, definitive conclusions could not be reached. Most post-fall interventions were not aimed at patients with dementia and have shown little efficacy regardless of cognitive status. Minor improvements to some quality of life indicators were shown, but these were generally not statistically significant. Conclusions were also limited due to most studies addressing hip fracture; the interventions provided for this type of injury may not be suitable for other types of fractures or soft tissue injuries, or for use in primary care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016029565 .
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Affiliation(s)
- Shannon Robalino
- Present Address: Kaiser Permanente Research Affiliates, Evidence-based Practice Center, Center for Health Research, Portland, OR USA
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Fiona R. Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Fox
- Dementia Research Collaborative Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Louise M. Allan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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