1
|
Ziegler S, Schmoor C, Schöler LM, Schepputat S, Takem E, Grotejohann B, Steinbrenner I, Feuchtinger J. Potential for reducing immobility times of a mobility monitor in-bed sensor system - a stepped-wedge cluster-randomised trial. BMC Nurs 2023; 22:478. [PMID: 38104112 PMCID: PMC10725577 DOI: 10.1186/s12912-023-01658-2] [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: 12/21/2022] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Pressure ulcer prophylaxis is a central topic in clinical care. Pressure-relieving repositioning is strongly recommended for all pressure-sensitive patients. The Mobility Monitor (MoMo) is a technical device that records a patient's movements and transmits the data to a monitor. This study investigated the extent to which the MoMo sensor system, which records and visualises patients' movements in bed, supports nurses in performing pressure-relieving repositioning in neurological and neurosurgical intensive care units (ICU). METHODS This stepped-wedge cluster-randomised trial involved two clusters: one neurological and one neurosurgical ICU. The study was carried out in two steps over three periods between November 2018 and May 2019, with a two-month interval between each step. At the beginning of the study, we equipped 33 beds across the two ICUs with a MoMo system. Our primary endpoint was the immobility rate, which is defined as the patient's inactive time in bed exceeding two hours without pressure-relieving movements divided by the time the MoMo was in the bed. The immobility rate ranges from 0 to below 1, with higher values indicating lower mobility. Secondary endpoints were the rate of new pressure ulcers and the rate of relevant pressure-relieving repositionings. Relevant repositionings are defined as the number of repositionings identified by the MoMo as a pressure-relieving repositioning divided by the total number of repositionings, RESULTS: 808 patients were included in the study, of whom 403 were in the control group and 405 were in the intervention group. The mean immobility rate was 0.171 during the control phase and 0.144 during the intervention phase. The estimated intervention effect was -0.0018 (95% confidence interval [-0.0471, 0.0436], p=0.94). The number of new pressure ulcers was 5/405 in the intervention phase and 15/403 in the control phase. We noted a small difference in the mean rate of relevant repositioningswith an estimated intervention effect of 0.046 (95% confidence interval [-0.018, 0.110], p=0.16). CONCLUSION Our results are insufficient to recommend the standardised use of mobility monitors in neurological or neurosurgical ICUs. CLINICAL TRIAL REGISTRATION The primary analysis was prespecified and the trial was registered in the German Clinical Trials Register (DRKS) under the reference number DRKS00015492 (31/10/2018).
Collapse
Affiliation(s)
- Sven Ziegler
- Center of Implementing Nursing Care Innovations Freiburg, Nursing Direction, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Claudia Schmoor
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Lili M Schöler
- Center of Implementing Nursing Care Innovations Freiburg, Nursing Direction, Medical Center, University of Freiburg, Freiburg, Germany
| | - Sam Schepputat
- Center of Implementing Nursing Care Innovations Freiburg, Nursing Direction, Medical Center, University of Freiburg, Freiburg, Germany
| | - Eyere Takem
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Birgit Grotejohann
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Inga Steinbrenner
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Johanna Feuchtinger
- Center of Implementing Nursing Care Innovations Freiburg, Nursing Direction, Medical Center, University of Freiburg, Freiburg, Germany
| |
Collapse
|
2
|
ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
|
3
|
Staines A, Amherdt I, Burnand B, Rotzetter M, Currat P, Roux S, Lécureux E. Impact of a Swiss pressure ulcer prevention breakthrough collaborative. J Eval Clin Pract 2021; 27:1143-1153. [PMID: 33368957 DOI: 10.1111/jep.13529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Pressure ulcers may have severe impacts on the quality of life of patients, including pain, low mood and restrictions in performing daily life and social life activities. In Switzerland, 4% of patients develop hospital-acquired pressure ulcers. Six hospitals teamed up with the Vaud Hospital Federation (Switzerland) in a Breakthrough Collaborative, with the goal of reducing hospital-acquired pressure ulcers by 50%. The aim of this study was to assess the actual reduction. METHODS A multimodal set of interventions was deployed in all wards except obstetrics and gynaecology, over 18 months starting in October 2016, including systematic risk assessment, use of a prevention bundle, education through e-learning, measurement and feedback, patient engagement and promotion of a safety culture. All six hospitals monitored compliance with the use of the risk assessment, bundle application and patient involvement aspects. A safety calendar was implemented in all wards, for recording and visually displaying the numbers of new patients with pressure ulcers, as well as the presence of such ulcers upon admission and their category. RESULTS Compliance with performing Braden risk assessments rose from 39% at baseline to 61% by the end of the collaborative (P < .001), prevention bundle compliance from 2% to 30% (P < .001%) and documented patient engagement from 2% to 21% (P < .001%). The percentage of days where one or more patient was reported as having developed one or more pressure ulcers in the ward decreased from 8.21% to 4.18%, a 49% reduction (P < .001) which amounts to preventing 1124 new patients from developing one or more pressure ulcers during the collaborative. CONCLUSIONS The Breakthrough Collaborative using a multimodal improvement approach combined with measurement and feedback was associated with a statistically and clinically significant improvement in compliance to best practice and with a reduction of hospital-acquired pressure ulcers by half.
Collapse
Affiliation(s)
- Anthony Staines
- Patient Safety and Quality of Care Programme, Vaud Hospital Federation, Prilly, Switzerland.,IFROSS Institute, University of Lyon, Lyon, France
| | - Isabelle Amherdt
- Patient Safety and Quality of Care Programme, Vaud Hospital Federation, Prilly, Switzerland
| | | | - Murielle Rotzetter
- Department of Nursing, Broye Intercantonal Hospital, Payerne, Switzerland
| | - Philippe Currat
- Department of Nursing, La Côte Hospital System, Morges, Switzerland
| | - Stéphane Roux
- Department of Nursing, La Côte Hospital System, Morges, Switzerland
| | | |
Collapse
|
4
|
Marfil- Gómez RM, García- Mayor S, Morales- Asencio JM, Gómez- González AJ, Morilla- Herrera JC, Moya- Suárez AB, Aranda- Gallardo M, Rincón- López T, Lupiáñez-Pérez I. Pressure levels in the trochanter area according to repositioning at different degrees of inclination in healthy subjects. J Tissue Viability 2020; 29:125-129. [DOI: 10.1016/j.jtv.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/27/2022]
|
5
|
Rae KE, Isbel S, Upton D. Support surfaces for the treatment and prevention of pressure ulcers: a systematic literature review. J Wound Care 2018; 27:467-474. [PMID: 30086254 DOI: 10.12968/jowc.2018.27.8.467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Changes in technology have resulted in a lack of clarity regarding the comparative effectiveness between active and reactive support surfaces in the prevention and treatment of pressure ulcers (PUs). The purpose of this literature review was to evaluate the comparative effectiveness of active and reactive mattresses for prevention and treatment of PUs. METHOD A literature search was completed using CINAHL, Medline Plus, Scopus, Cochrane Library and PubMed databases, as well as reference lists. A temporal limiter was placed excluding studies published before 2000 due to changes in care standards and support surface technology. RESULTS Of the 33 articles included, nine were systematic/literature reviews and 24 were randomised controlled trials (RCTs). There was a consensus that pressure mattresses are an effective prevention and treatment strategy, however comparisons of the two types were often inconclusive or conflicting. Studies were conducted in acute, sub-acute or residential facilities, with no studies in a domiciliary setting. The majority of studies were rated as moderate quality with significant methodological limitations. CONCLUSION Further research is needed to investigate the use of support surfaces in a domiciliary setting with an appropriate methodology aimed at minimising the limitations described in the existing literature.
Collapse
Affiliation(s)
- Katherine E Rae
- Occupational Therapist, PhD Candidate, ACT Health Directorate, Canberra, Australia, University of Canberra, Canberra, Australia
| | - Stephen Isbel
- Associate Professor, Course Convenor, ACT Health Directorate, Canberra, Australia
| | - Dominic Upton
- Professor, Dean, College of Health and Human Sciences, Charles Darwin University
| |
Collapse
|
6
|
Stewart C, Subbarayan S, Paton P, Gemmell E, Abraha I, Myint PK, O’Mahony D, Cruz-Jentoft AJ, Cherubini A, Soiza RL. Non-pharmacological interventions for the improvement of post-stroke activities of daily living and disability amongst older stroke survivors: A systematic review. PLoS One 2018; 13:e0204774. [PMID: 30286144 PMCID: PMC6171865 DOI: 10.1371/journal.pone.0204774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 01/11/2023] Open
Abstract
Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is largely unknown. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [http://www.senator-project.eu]. A Delphi panel of European geriatric experts agreed activities of daily living and disability to be of critical importance as stroke rehabilitation outcomes. A comprehensive search strategy was developed and five databases (Pubmed, CINAHL, Embase, PsycInfo and Cochrane Database of Systematic Reviews) searched for eligible systematic reviews. Primary studies meeting our criteria (non-pharmacologic interventions, involving stroke survivors aged ≥65 years, assessing activities of daily living and/or disability as outcome) were then identified from these reviews. Eligible papers were double reviewed, and due to heterogeneity, narrative analysis performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence, allowing us to make recommendations regarding specific non-pharmacologic rehabilitation in older stroke survivors. In total, 72 primary articles were reviewed spanning 14 types of non-pharmacological intervention. Non-pharmacological interventions based on physiotherapy and occupational therapy techniques improved activities of daily living amongst older stroke survivors. However, no evidence was found to support use of any non-pharmacological approach to benefit older stroke survivors' disability. Evidence was limited by poor study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.
Collapse
Affiliation(s)
- Carrie Stewart
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Selvarani Subbarayan
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Pamela Paton
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Elliot Gemmell
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Iosief Abraha
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Phyo Kyaw Myint
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Denis O’Mahony
- Department of Geriatric Medicine, University College Cork, Cork, Ireland
| | - Alfonso J. Cruz-Jentoft
- Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roy L. Soiza
- Department of Old Age Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| |
Collapse
|
7
|
ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 652] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
Collapse
|
8
|
Relevant outcomes for nutrition interventions to treat and prevent malnutrition in older people: a collaborative senator-ontop and manuel delphi study. Eur Geriatr Med 2018; 9:243-248. [DOI: 10.1007/s41999-018-0024-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022]
|
9
|
Non-pharmacological interventions to prevent falls in older patients: Clinical practice recommendations – the SENATOR ONTOP Series. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
10
|
Predictors of Intraoperative Pressure Injury in Patients Undergoing Major Hepatobiliary Surgery. J Wound Ostomy Continence Nurs 2017; 44:445-449. [DOI: 10.1097/won.0000000000000356] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Phillips SM. Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults. Front Nutr 2017; 4:13. [PMID: 28534027 PMCID: PMC5420553 DOI: 10.3389/fnut.2017.00013] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/18/2017] [Indexed: 12/21/2022] Open
Abstract
Protein needs for otherwise healthy individuals older than 19 years are defined by the recommended dietary allowance (RDA) at 0.80 g protein/kg/day. There is no recommendation in the current RDA for subpopulations of older adults or people in various pathological situations. Despite the lack of a separate recommendation, there exists a growing body of evidence that is strongly suggestive of an increased need and/or benefit for protein in older persons. That is, intakes beyond the RDA are, in older persons, associated with benefits. In addition, a number of catabolic states including critical illness also result in a sharp elevation in the needs for protein and amino acids. An underappreciated issue in protein nutrition is the impact of protein quality on clinically relevant outcomes. The introduction of a new protein scoring system—the digestible indispensable amino acid score (DIAAS)—for protein quality has raised a forgotten awareness of protein quality. The DIAAS, which replaces the protein digestibility-corrected amino acid score (PDCAAS), is based on ileal digestibility of protein and a different test protein than PDCAAS and has values greater than 1.0. The aim of this article is a brief review and summary recommendations for protein nutrition and protein requirements in populations who would benefit from more protein than the RDA. The emphasis of the review is on muscle protein turnover, and there is a discussion of the impact of protein quality, particularly as it applies to commercially available protein sources. The evidence for more optimal protein intakes is considered in light of the potential health risks of consumption of protein at levels greater than the RDA.
Collapse
|
12
|
Lozano-Montoya I, Correa-Pérez A, Abraha I, Soiza RL, Cherubini A, O'Mahony D, Cruz-Jentoft AJ. Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview - the SENATOR Project ONTOP Series. Clin Interv Aging 2017; 12:721-740. [PMID: 28490866 PMCID: PMC5413484 DOI: 10.2147/cia.s132496] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Physical frailty (PF) and sarcopenia are predictors of negative health outcomes such as falls, disability, hospitalization, and death. Some systematic reviews (SRs) have been published on different nonpharmacological treatments of frailty and sarcopenia using heterogeneous definitions of them. Objective To critically appraise the evidence from SRs of the primary studies on nonpharmacological interventions to treat PF (defined by Fried’s frailty phenotype) and sarcopenia (defined by the EWGSOP) in older patients. Design Overview of SRs and meta-analysis of comparative studies. Data sources PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched in October 2015. Eligibility criteria for selecting studies SRs that included at least one comparative study evaluating any nonpharmacological intervention to treat PF or sarcopenia in older patients in any health care setting. Any primary study described in these SRs with experimental design was included. Data extraction and management Two reviewers independently screened titles, abstracts, and full-texts of articles. Quality assessment was carried out by using criteria from the Cochrane Collaboration and the GRADE working group. Results Ten SRs with 5 primary studies satisfied the inclusion criteria. The most frequent interventions in the included studies were physical exercise (4) and nutritional supplementation (2). Muscle strength (MS; except for one study in a frail population) and physical performance (PP; except for another study in a frail population) improved with exercise and amino acid supplementation in frail and sarcopenic old adults. Falls and activities of daily living were assessed in two studies with opposite results. The overall quality of the evidence was low. Conclusion This overview of SRs highlights the importance of exercise interventions with or without nutritional supplementation to improve the PP in community-dwelling patients aged >65 years with PF and sarcopenia. MS improved with multidisciplinary treatment and exercise interventions in this population.
Collapse
Affiliation(s)
| | - Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Roy L Soiza
- Department of Medicine for the Elderly, National Health Service Grampian, Aberdeen, UK
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | | |
Collapse
|
13
|
Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Arch Orthop Trauma Surg 2017; 137:507-515. [PMID: 28233062 DOI: 10.1007/s00402-017-2646-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course. METHODS We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1-2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course. RESULTS The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01-1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22-5.91, p ≤ 0.001). CONCLUSIONS After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important.
Collapse
|
14
|
Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, Gudmundsson A, Soiza R, O'Mahony D, Guaita A, Cherubini A. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open 2017; 7:e012759. [PMID: 28302633 PMCID: PMC5372076 DOI: 10.1136/bmjopen-2016-012759] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/05/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). DESIGN Systematic overview of reviews. DATA SOURCES PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015). ELIGIBILITY CRITERIA Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD. DATA EXTRACTION Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs. DATA ANALYSIS Extracted data were synthesised using a narrative approach. RESULTS 38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. CONCLUSIONS A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.
Collapse
Affiliation(s)
- Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Joseph M Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Fabiana Mirella Trotta
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Giuseppina Dell'Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | | | - Mirko Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University,Ghent, Belgium
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | | | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| |
Collapse
|
15
|
Predictive Factors for Pressure Ulcers in an Older Adult Population Hospitalized for Hip Fractures: A Prognostic Cohort Study. PLoS One 2017; 12:e0169909. [PMID: 28068425 PMCID: PMC5222344 DOI: 10.1371/journal.pone.0169909] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022] Open
Abstract
Background Older adult patients with fragility hip fractures constitute a population at high risk for complications, in particular pressure ulcers. The aim was to evaluate the incidence of pressure ulcers and potential predictive factors. Methods and Findings A prospective multicentric prognostic cohort study in orthopedic wards in three Italian public hospitals. Participants were all consecutive patients 65 years of age or older diagnosed with a fragility hip fracture. Outcomes were incidence of pressure ulcers. The exposure variables were grouped into three macro areas in order to facilitate reading: “intrinsic” variables, “extrinsic” variables and variables linked to the organization of patient care. One thousand eighty-three older adult patients with fragility hip fractures were enrolled from October 1st, 2013 to January 31st, 2015, and pressure ulcers developed in 22.7%. At multivariate analysis, the following were found to be risk factors: age> 80 years (odds ratio (OR) 1.03; p = 0.015), the length of time a urinary catheter was used (OR 1.013; p<0.001), the length of time pain was present (OR 1.008; p = 0.008), the absence of side rails on the bed (OR 1.668; p = 0.026) and the use of a foam position valve (OR 1.025; p<0.001). Instead, the protective factors were the presence of a caregiver for at least half a day daily (OR 0.994; p = 0.012) and the number of positionings during the postoperative period (OR 0.897; p = 0.008). Conclusions The study allowed the identification of the patients most at risk for developing pressure ulcers, and the construction of a pragmatic predictive model using significant risk or protective factors in order to reduce the number of pressure ulcers.
Collapse
|
16
|
Soiza RL, Subbarayan S, Antonio C, Cruz-Jentoft AJ, Petrovic M, Gudmundsson A, O'Mahony D. The SENATOR project: developing and trialling a novel software engine to optimize medications and nonpharmacological therapy in older people with multimorbidity and polypharmacy. Ther Adv Drug Saf 2016; 8:81-85. [PMID: 28382196 DOI: 10.1177/2042098616675851] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roy L Soiza
- Department of Medicine for the Elderly, NHS Grampian, Wards 303/4, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, UK
| | | | - Cherubini Antonio
- Italian National Research Centre on Aging, (IRCCS-INRCA), Ancona, Italy
| | | | | | | | | |
Collapse
|
17
|
Rimland JM, Abraha I, Dell’Aquila G, Cruz-Jentoft A, Soiza R, Gudmusson A, Petrovic M, O’Mahony D, Todd C, Cherubini A. Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series. PLoS One 2016; 11:e0161579. [PMID: 27559744 PMCID: PMC4999091 DOI: 10.1371/journal.pone.0161579] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. OBJECTIVES To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. METHODS We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. RESULTS Fifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. CONCLUSIONS The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.
Collapse
Affiliation(s)
- Joseph M. Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Giuseppina Dell’Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, United Kingdom
| | | | | | - Denis O’Mahony
- Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland
| | - Chris Todd
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| |
Collapse
|