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Pliannuom S, Pinyopornpanish K, Buawangpong N, Wiwatkunupakarn N, Mallinson PAC, Jiraporncharoen W, Angkurawaranon C. Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49482. [PMID: 38865706 PMCID: PMC11208838 DOI: 10.2196/49482] [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: 06/06/2023] [Revised: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. OBJECTIVE This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. METHODS We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). CONCLUSIONS Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.
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Affiliation(s)
- Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Poppy Alice Carson Mallinson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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Ko Y, Hwang JM, Baek SH. Discharge transitional care programme for older adults after hip fracture surgery: a quasi-experimental study. J Res Nurs 2023; 28:582-593. [PMID: 38162723 PMCID: PMC10756176 DOI: 10.1177/17449871231204499] [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] [Indexed: 01/03/2024] Open
Abstract
Background Hip fractures require extended periods of recovery and rehabilitation, subjecting older adults to discontinuous care. Discharge transition is a critical point of heightened vulnerability for older adults. Aims This study aimed to evaluate the effectiveness of a transitional care programme on the physical functions and quality of life (QOL) of older adults after hip fracture surgery. Methods Seventy-five older adults were assessed from pre-discharge to 6 weeks after hip surgery, and their physical functions, including walking status and activities of daily living, were measured. The QOL was measured using the European Quality of life-5 Dimensions-5 Levels (EQ 5D 5L). Results There was a significant strong effect of time (B = 10.565; 95% CI = 2.584-18.547; p = 0.009) on the EuroQol Visual Analog Scale (EQ-VAS) for the experimental group. However, there were no significant effects of time on physical functions and EQ-5D-5L scores. Conclusions The discharge transitional care programme improved the EQ-VAS of older adults following hip fracture surgery 6 weeks post-surgery. However, there were no significant differences in physical functions and EQ-5D between the groups.
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Affiliation(s)
- YoungJi Ko
- Associate Professor, Department of Nursing, Daegu Haany University, South Korea
| | - Jong-Moon Hwang
- Assistant Professor, Department of Rehabilitation Medicine, Kyungpook National University Hospital, South Korea
| | - Seung-Hoon Baek
- Associate Professor, Department of Orthopedic Surgery, Kyungpook National University Hospital, South Korea
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Barake M, El Eid R, Ajjour S, Chakhtoura M, Meho L, Mahmoud T, Atieh J, Sibai AM, El-Hajj Fuleihan G. Osteoporotic hip and vertebral fractures in the Arab region: a systematic review. Osteoporos Int 2021; 32:1499-1515. [PMID: 33825915 DOI: 10.1007/s00198-021-05937-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022]
Abstract
Asia is projected to account for the largest proportion of the rising burden of osteoporotic fractures worldwide. Data from the Middle East is scarce. We performed a systematic review on the epidemiology of vertebral and hip osteoporotic fractures in 22 Arab League countries, using Scopus, PubMed, and Embase. We identified 67 relevant publications, 28 on hip and 39 on vertebral fractures. The mean age of patients was 70-74 years, female to male ratio 1.2:2.1. Age-standardized incidence rates, to the UN 2010 population, were 236 to 290/100,000 for women from Kuwait and Lebanon, lower in Morocco. Risk factors for hip fractures included lower BMD or BMI, taller stature, anxiolytics, and sleeping pills. Most patients were not tested nor treated. Mortality derived from retrospective studies ranged between 10 and 20% at 1 year, and between 25 and 30% at 2-3 years. Among 39 studies on vertebral fractures, 18 described prevalence of morphometric fractures. Excluding grade 1 fractures, 13.3-20.2% of women, mean age 58-74 years, had prevalent vertebral fractures, as did 10-14% of men, mean age 62-74 years. Risk factors included age, gender, smoking, multiparity, years since menopause, low BMD, bone markers, high sclerostin, low IgF1, hypovitaminosis D, abdominal aortic calcification score, and VDR polymorphisms. Vertebral fracture incidence in women from Saudi Arabia, mean age 61, was 6.2% at 5 years, including grade 1 fractures. Prospective population-based fracture registries, prevalence studies, predictive models, fracture outcomes, and fracture liaison services from Arab countries are still lacking today. They are the pillars to closing the care gap of this morbid disease.
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Affiliation(s)
- M Barake
- Division of Endocrinology, Clemenceau Medical Center, Beirut, Lebanon
| | - R El Eid
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Ajjour
- Calcium Metabolism & Osteoporosis Program, WHO CC in Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chakhtoura
- Calcium Metabolism & Osteoporosis Program, WHO CC in Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Meho
- American University of Beirut, Beirut, Lebanon
| | - T Mahmoud
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - J Atieh
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - A M Sibai
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - G El-Hajj Fuleihan
- Calcium Metabolism & Osteoporosis Program, WHO CC in Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon.
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Min K, Beom J, Kim BR, Lee SY, Lee GJ, Lee JH, Lee SY, Won SJ, Ahn S, Bang HJ, Cha Y, Chang MC, Choi JY, Do JG, Do KH, Han JY, Jang IY, Jin Y, Kim DH, Kim DH, Kim IJ, Kim MC, Kim W, Lee YJ, Lee IS, Lee IS, Lee J, Lee CH, Lim SH, Park D, Park JH, Park M, Park Y, Ryu JS, Song YJ, Yang S, Yang HS, Yoo JS, Yoo JI, Yoo SD, Choi KH, Lim JY. Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures. Ann Rehabil Med 2021; 45:225-259. [PMID: 34233406 PMCID: PMC8273721 DOI: 10.5535/arm.21110] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. METHODS Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. RESULTS A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. CONCLUSION This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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Affiliation(s)
- Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | | | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sangwoo Ahn
- Physical Therapy, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youri Jin
- Department of Food and Nutrition Services, Hanyang University Hospital, Seoul, Korea
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Jong Kim
- Howareyou Rehabilitation Clinic, Seoul, Korea
| | - Myung Chul Kim
- Department of Physical Therapy, Eulji University, Seongnam, Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Jung Lee
- Department of Physical Medicine and Rehabilitation, Myongji Hospital, Goyang, Korea
| | - In Seok Lee
- Nutrition Team, Kyung Hee University Medical Center, Seoul, Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - JungSoo Lee
- Department of Rehabilitation Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Chang-Hyung Lee
- Department of Physical Medicine and Rehabilitation, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Myungsook Park
- Department of Nursing, Konkuk University, Chungju, Korea
| | - Yongsoon Park
- Department of Food and Nutrition, Hanyang University, Seoul, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Jin Song
- Occupational Therapy, Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman’s University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji Sung Yoo
- Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jun-il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Abdelnasser MK, Khalifa AA, Amir KG, Hassan MA, Eisa AA, El-Adly WY, Ibrahim AK, Farouk OA, Abubeih HA. Mortality incidence and its determinants after fragility hip fractures: a prospective cohort study from an Egyptian level one trauma center. Afr Health Sci 2021; 21:806-816. [PMID: 34795739 PMCID: PMC8568210 DOI: 10.4314/ahs.v21i2.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Fragility hip fracture is a common condition with serious consequences. Most outcomes data come from Western and Asian populations. There are few data from African and Middle Eastern countries. Objective The primary objective was to describe mortality rates after fragility hip fracture in a Level-1 trauma centre in Egypt. The secondary objective was to study the causes of re-admissions, complications, and mortality. Methods A prospective cohort study of 301 patients, aged > 65 years, with fragility hip fractures. Data collected included sociodemographic, co-morbidities, timing of admission, and intraoperative,ostoperative, and post-discharge data as mortality, complications, hospital stay, reoperation, and re-admission. Cox regression analysis was conducted to investigate factors associated with 1-year mortality. Results In-hospital mortality was 8.3% (25 patients) which increased to 52.8% (159 patients) after one year; 58.5% of the deaths occurred in the first 3-months. One-year mortality was independently associated with increasing age, ASA 3–4, cardiac or hepatic co-morbidities, trochanteric fractures, total hospital stay, and postoperative ifection and metal failure. Conclusion Our in-hospital mortality rate resembles developed countries reports, reflecting good initial geriatric healthcare. However, our 3- and 12-months mortality rates are unexpectedly high. The implementation of orthogeriatric care after discharge is mandatory to decrease mortality rates.
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Affiliation(s)
| | - Ahmed A Khalifa
- Orthopedic Department, Qena faculty of medicine and its University Hospital, South valley university, Qena, Egypt
| | - Khaled G Amir
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | | | - Amr A Eisa
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Wael Y El-Adly
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed K Ibrahim
- Public Health and Community Medicine Department, faculty of medicine, Assiut University, Assiut, Egypt
| | - Osama A Farouk
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Hossam A Abubeih
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
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Li Z, Lin H, Wang X, Huang M, Feng J, Feng J, Gao J, Wu J, Jiang Z. Intelligent rehabilitation assistant system to promote the early functional recovery of the elderly patients with femoral neck fracture after hemiarthroplasty (HA): A protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e23078. [PMID: 33181672 PMCID: PMC7668524 DOI: 10.1097/md.0000000000023078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Femoral neck fracture is a common type of hip fracture, which has a high morbidity and mortality. Surgical treatment is the first choice. However, the functional rehabilitation after operation has not been paid enough attention. In addition, the quality of exercise is difficult to quantify, and the rehabilitation is lack of standards. Therefore, the intelligent rehabilitation assistant system which could record exercise details, might be used to evaluate the quality and adherence to the prescribed exercise to this fragile group of patients has great relevance, so as to provide new ideas for postoperative rehabilitation of hip fracture. METHODS This is an opening, prospective, double-dummy RCT. Fifty femoral neck fractures patients, older than 65 years and are about to hospitalize for HA, will be invited to study. The sample will be divided into monitoring group and control group randomly at a 1:1 ratio. The prescribed exercises need to be done continuously for 2 weeks. The monitoring group needs additional use intelligent rehabilitation assistant system. Each subject will receive a total of 4 follow-up visits at the designated time (2 weeks, 4 weeks, 12 weeks, and 24 weeks). The following factors will be talked as dependent variables:Each subject will receive a total of 4 follow-up visits at the designated time, and the findings will be analyzed statistically considering a 5% significance level (P < .05). DISCUSSION Exercise under monitor may improve patients compliance and exercise quality, and accelerate the rehabilitation process. This protocol reported in accordance with the CONSORT 2010 checklist and SPIRIT 2013 Checklist. TRIAL REGISTRATION The trial is registered at Chinese Clinical Trials Registry (ChiCTR2000033213, May 24, 2020).
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Affiliation(s)
- Zige Li
- The First School of Clinical Medicine
| | | | - Xiaotong Wang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine
| | | | | | | | | | | | - Ziwei Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
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CAUSES, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015. Arch Gerontol Geriatr 2020; 89:104035. [PMID: 32325305 DOI: 10.1016/j.archger.2020.104035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/11/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. MATERIALS AND METHODS It is a prospective population-based cohort study of adults living in the community, 2013-15 N = 48,691, age ≥50; deceased = 1,944. Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe SHARE: Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living ADL, and Frailty. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios. RESULTS The crude mortality rate was 18.39 (1000 person-years at risk), (99 % CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). CONCLUSIONS The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms, with a different influence in the European regions. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed.
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