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Smeekes OS, De Boer TR, Van Der Mei RD, Buurman BM, Willems HC. Receiving home care forms and the risk for emergency department visits in community-dwelling Dutch older adults, a retrospective cohort study using national data. BMC Public Health 2024; 24:1792. [PMID: 38970060 PMCID: PMC11225288 DOI: 10.1186/s12889-024-19305-z] [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: 02/25/2024] [Accepted: 06/28/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Older adults receiving home care have a higher risk of visiting the emergency department (ED) than community-dwelling older adults not receiving home care. This may result from a higher incidence of comorbidities and reduced functional autonomy in home care recipients. Since people receive different types of home care because of their different comorbidities and autonomy profiles, it is possible that distinguishing between the form of home care can help identify subpopulations with different risks for ED visits and help develop targeted interventions. This study aimed to compare the risk of visiting the ED in older adults receiving different forms of home care with those living at home without receiving home care in a national cohort in one year. METHODS A retrospective cohort study using claims data collected in 2019 on the Dutch population aged ≥ 65 years (N = 3,314,440) was conducted. Participants were classified as follows: no claimed home care (NO), household help (HH), personal care (PC), HH + PC, and nursing home care at home (NHH). The primary outcome was the number of individuals that visited the ED. Secondary outcomes were the number of individuals whose home care changed, who were institutionalized, or who died. Exploratory logistic regression was applied. RESULTS There were 2,758,093 adults in the NO group, 131,260 in the HH group, 154,462 in the PC group, 96,526 in the HH + PC group, and 34,612 in the NHH group. More ED visits were observed in the home care groups than in the NO group, and this risk increased to more than two-fold for the PC groups. There was a significant change to a more intensive form of home care, institutionalization, or death in all groups. CONCLUSIONS Distinguishing between the form of home care older adults receive identifies subpopulations with different risks for ED visits compared with community-dwelling older adults not receiving home care on a population level. Home care transitions are frequent and mostly involve more intensive care or death. Although older adults not receiving home care have a lower risk of ED visits, they contribute most to the absolute volume of ED visits.
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Affiliation(s)
- Oscar S Smeekes
- Internal Medicine, section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| | - Tim R De Boer
- Centrum Wiskunde & Informatica, Science Park 123, Amsterdam, the Netherlands
| | | | - Bianca M Buurman
- Internal Medicine, section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medicine for Older People, Amsterdam Public Health Research Institute, De Boelelaan 117, Amsterdam, the Netherlands
| | - Hanna C Willems
- Internal Medicine, section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
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Verstraeten LMG, Kreeftmeijer J, van Wijngaarden JP, Meskers CGM, Maier AB. Geriatric Syndromes Frequently (Co)-Occur in Geriatric Rehabilitation Inpatients: Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR). Arch Phys Med Rehabil 2024:S0003-9993(24)01017-7. [PMID: 38851557 DOI: 10.1016/j.apmr.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To determine the prevalence and co-occurrence of common geriatric syndromes in geriatric rehabilitation inpatients. DESIGN Restoring Health of Acutely Unwell Adults (RESORT) and Enhancing Muscle Power in Geriatric Rehabilitation (EMPOWER-GR) are observational, longitudinal cohorts. SETTING Geriatric rehabilitation. PARTICIPANTS Geriatric rehabilitation inpatients (N=1890 and N=200). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Geriatric syndromes included polypharmacy, multimorbidity (Cumulative Illness Rating Scale), cognitive impairment, depression (Hospital Anxiety and Depression Scale/Geriatric Depression Scale), malnutrition (Global Leadership Initiative on Malnutrition), functional limitation (Katz index), falls, physical frailty (Fried), and sarcopenia (European Working Group on Sarcopenia in Older People 2). RESULTS Inpatients in RESORT (R) (N=1890, 56% females) had a median age of 83.4 years (interquartile range [IQR], 77.6-88.4) and in EMPOWER-GR (E) (N=200, 57% females) of 79.8 years (IQR, 75.0-85.9). Polypharmacy (R, 82.2%; E, 84.0%), multimorbidity (R, 90.4%; E, 85.5%), functional limitation (R, 96.0%; E, 76.5%), and frailty (R, 91.8%; E, 92.2%) were most prevalent. Most inpatients had ≥5 geriatric syndromes at admission in both cohorts (R, 70.0%; E, 72.4%); few inpatients had only 1 (R, 0.4%; E, 1.5%) or no geriatric syndrome (R, 0.2%; E, 0.0%). Geriatric syndromes did not occur in isolation (without other syndromes), except for multimorbidity (R, 1%; E, 5%), functional limitation (R, 3%; E, 2%), falls (R, 0%; E, 4%), and frailty (R, 2%; E, 5%), which occurred in isolation in some inpatients; sarcopenia did not. CONCLUSIONS Geriatric syndromes are highly prevalent at admission to geriatric rehabilitation, with a median of 5 co-occurring syndromes. Implications for diagnosis and intervention potential should be further addressed.
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Affiliation(s)
- Laure M G Verstraeten
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jos Kreeftmeijer
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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3
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Kuribara T, Asai Y, Ohmagari N, Yokota I. Status of COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation in Japan: Nationwide Database Analysis. Cureus 2024; 16:e60202. [PMID: 38868250 PMCID: PMC11168340 DOI: 10.7759/cureus.60202] [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] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Background The report of epidemiological data on coronavirus disease 2019 (COVID-19) patients treated using extracorporeal membrane oxygenation (ECMO) in Japan has been limited. Our study seeks to fill the existing gap in knowledge by providing an in-depth analysis of the clinical epidemiological characteristics and diverse medical outcomes of COVID-19 patients treated with ECMO in Japan. Methods This study used the COVID-19 Registry Japan nationwide database. We included patients aged 18 years or older enrolled between March 17, 2020, and February 1, 2022, with traceable ECMO data. The items on clinical epidemiological characteristics and various medical outcomes were collected. Statistical analysis included a median and interquartile range (IQR) for continuous variables and frequencies for categorical variables. Results The number of participating hospitals was 731, and the number of patients enrolled for analysis was 49,590. Of these, 196 (0.4%) patients received ECMO. Hospital mortality was 33.2%, and discharge to home was 23.0% in the ECMO group. The complications during hospitalization included pneumothorax (9.7%), seizures (4.1%), stroke (4.6%), and pulmonary thromboembolism (2.0%). At discharge, 38.3% had worsened self-care ability, and 38.8% had worsened ambulatory function. Conclusions The results of ECMO treatment in Japan showed that the mortality and complication rates were well-controlled compared with those worldwide.
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Affiliation(s)
- Tomoki Kuribara
- Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, JPN
- Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, JPN
| | - Yusuke Asai
- Antimicrobial Resistance (AMR) Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, JPN
| | - Norio Ohmagari
- Antimicrobial Resistance (AMR) Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, JPN
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, JPN
| | - Isao Yokota
- Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, JPN
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de Groot AJ, Wattel EM, van Balen R, Hertogh CM, van der Wouden JC. Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay. Ann Geriatr Med Res 2023; 27:301-309. [PMID: 37691483 PMCID: PMC10772331 DOI: 10.4235/agmr.23.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/18/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND We assessed the vulnerability of patients aged ≥70 years during hospital admission based on the Short Dutch Safety Management Screening (DSMS). Screening of four geriatric domains aims to prevent adverse outcomes and may support targeted discharge planning for post-acute care. We explored whether the DSMS criteria for acutely admitted patients were associated with rehabilitation-oriented care needs. METHODS This retrospective cohort study included community-dwelling patients aged ≥70 years acutely admitted to a tertiary hospital. We recorded patient demographics, morbidity, functional status, malnutrition, fall risk, and delirium and used descriptive analysis to calculate the risks by comparing the discharge destination groups. RESULTS Among 491 hospital discharges, 349 patients (71.1%) returned home, 60 (12.2%) were referred for geriatric rehabilitation, and 82 (16.7%) to other inpatient post-acute care. Non-home referrals increased with age from 21% (70-80 years) to 61% (>90 years). A surgical diagnosis (odds ratio [OR]=4.92; 95% confidence interval [CI], 2.03-11.95), functional decline represented by Katz-activities of daily living positive screening (OR=3.79; 95% CI, 1.76-8.14), and positive fall risk (OR=2.87; 95% CI, 1.31-6.30) were associated with non-home discharge. The Charlson Comorbidity Index did not differ significantly between the groups. CONCLUSION Admission diagnosis and vulnerability screening outcomes were associated with discharge to rehabilitation-oriented care in patients >70 years of age. The usual care data from DSMS vulnerability screening can raise awareness of discharge complexity and provide opportunities to support timely and personalized transitional care.
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Affiliation(s)
- Aafke J. de Groot
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Elizabeth M. Wattel
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Cees M.P.M. Hertogh
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Johannes C. van der Wouden
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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Augustine MR, Intrator O, Li J, Lubetsky S, Ornstein KA, DeCherrie LV, Leff B, Siu AL. Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status: A Matched Cohort Analysis. Med Care 2023; 61:805-812. [PMID: 37733394 DOI: 10.1097/mlr.0000000000001925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of Rehabilitation-at-Home (RaH), which provides high-frequency, multidisciplinary post-acute rehabilitative services in patients' homes. DESIGN Comparative effectiveness analysis. SETTING AND PARTICIPANTS Medicare Fee-For-Service patients who received RaH in a Center for Medicare and Medicaid Innovation Center Demonstration during 2016-2017 (N=173) or who received Medicare Skilled Nursing Facility (SNF) care in 2016-2017 within the same geographic service area with similar inclusion and exclusion criteria (N=5535). METHODS We propensity-matched RaH participants to a cohort of SNF patients using clinical and demographic characteristics with exact match on surgical and non-surgical hospitalizations. Outcomes included hospitalization within 30 days of post-acute admission, death within 30 days of post-acute discharge, length of stay, falls, use of antipsychotic medication, and discharge to community. RESULTS The majority of RaH participants were older than or equal to 85 years (57.8%) and non-Hispanic white (72.2%) with mean hospital length of stay of 8.1 (SD 7.6) days. In propensity-matched analyses, 10.1% (95% CI: 0.5%, 19.8) and 4.2% (95% CI: 0.1%, 8.5%) fewer RaH participants experienced hospital readmission and death, respectively. RaH participants had, on average, 2.8 fewer days (95% CI 1.4, 4.3) of post-acute care; 11.4% (95% CI: 5.2%, 17.7%) fewer RaH participants experienced fall; and 25.8% (95% CI: 17.8%, 33.9%) more were discharged to the community. Use of antipsychotic medications was no different. CONCLUSIONS AND IMPLICATIONS RaH is a promising alternative to delivering SNF-level post-acute RaH. The program seems to be safe, readmissions are lower, and transition back to the community is improved.
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Affiliation(s)
- Matthew R Augustine
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York
- Geriatric Research Education and Clinical Center, James J Peters VA Medical Center, Bronx
| | - Orna Intrator
- Department of Public Health Sciences, University of Rochester, Rochester
- Geriatrics & Extended Care Data Analysis Center, Canandaigua VA Medical Center, Canandaigua
| | - Jiejin Li
- Department of Public Health Sciences, University of Rochester, Rochester
| | - Sara Lubetsky
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katherine A Ornstein
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Linda V DeCherrie
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bruce Leff
- Division of Geriatrics, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Albert L Siu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York
- Geriatric Research Education and Clinical Center, James J Peters VA Medical Center, Bronx
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Pijls N, Joosten H, Theunissen M, van Leendert J, Courtens A, Magdelijns F, van den Beuken-van Everdingen M. Bedside palliative care and geriatric consultations: adherence rate in hospitalised patients. BMJ Support Palliat Care 2023:spcare-2023-004453. [PMID: 37679026 DOI: 10.1136/spcare-2023-004453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES This study examined the adherence rate of recommendations of a palliative consultation team (PCT) and a geriatric consultation team (GCT). Secondary aims were to investigate which factors and/or recommendation characteristics influence adherence rates. METHODS This retrospective cohort study was performed in the Maastricht University Medical Center+ in the Netherlands and included hospitalised patients who received a consultation by the PCT or the GCT. Baseline data on consultations were collected for the total population and for the GCT and PCT separately. The adherence rate of the recommendations was evaluated by checking evidence of implementation. The nature of recommendations given (solicited or unsolicited) was documented per domain (somatic, psychological/cognitive, social, spiritual, functional, and existential). The association with adherence was evaluated for solicited and unsolicited recommendations separately. Exploration of potentially associated factors was performed using OpenEpi. RESULTS Overall, 507 consultations of individual patients were performed (n=131) by the GCT and (n=376) by the PCT. Most recommendations given were solicited (865/1201=72%). Over 80% of both solicited and unsolicited recommendations were implemented in the majority of domains. No potentially modifiable factors associated with the adherence of the advices were found. CONCLUSIONS The overall adherence rate of the GCT and PCT consultations was high. In addition, in certain domains, many recommendations were unsolicited. However, also the majority of these recommendations were implemented.
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Affiliation(s)
- Noor Pijls
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Hanneke Joosten
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Center of Expertise for Palliative Care, MUMC+, Maastricht, The Netherlands
| | - Jannic van Leendert
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Annemie Courtens
- Center of Expertise for Palliative Care, MUMC+, Maastricht, The Netherlands
| | - Fabienne Magdelijns
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
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Schelin MEC, Fürst CJ, Rasmussen BH, Hedman C. Increased patient satisfaction by integration of palliative care into geriatrics-A prospective cohort study. PLoS One 2023; 18:e0287550. [PMID: 37347730 PMCID: PMC10286968 DOI: 10.1371/journal.pone.0287550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Integration of oncology and palliative care has been shown to increase quality of life in advanced disease. To meet the needs of the growing older population, integration of palliative care and geriatrics has been proposed but scarcely described. OBJECTIVES The aim of this study was to integrate palliative care into geriatrics by a structured care guide, the Swedish Palliative Care Guide, and to evaluate its effect on patient satisfaction, health-related quality of life and symptom burden, compared to a control group. METHODS Geriatric in-patients over 65 years of age were included in the study, those with cognitive impairment were excluded. Data was collected before (baseline) and after the implementation (intervention) of the Swedish Palliative Care Guide. Patient satisfaction was evaluated two weeks after discharge with questions from a national patient survey. Health-related quality of life was measured with EQ-5D-3L and symptom burden with Edmonton Symptom Assessment Scale. RESULTS In total, 400 patients were included, 200 in the baseline- and intervention group, respectively. Mean age was 83 years in both groups. Patient satisfaction was significantly higher in nine out of ten questions (p = 0.02-<0.001) in the intervention group compared to baseline. No differences between the groups were seen in health-related quality of life or symptom burden. CONCLUSION A significant effect on patient satisfaction was seen after implementation of the Swedish Palliative Care Guide in geriatric care. Thus, integration of palliative care and geriatrics could be of substantial benefit in the growing population of older adults with multimorbidity and frailty.
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Affiliation(s)
- Maria E. C. Schelin
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Birgit H. Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Christel Hedman
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Arslan S, Bozkurt C, Arslan M, Bulut H. Effects of adherence to the Mediterranean diet on fatigue and activities of daily living in geriatric individuals with COPD. Clin Nutr ESPEN 2023; 54:436-442. [PMID: 36963891 DOI: 10.1016/j.clnesp.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/22/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND & AIMS Fatigue is a commonly diagnosed symptom in cancers and many other chronic debilitating diseases. The second most important complaint after dyspnea in patients with Chronic Obstructive Pulmonary Disease (COPD) is the feeling of fatigue. Fatigue can have significant consequences on health status as it can limit patients' activities of daily living, lead to worsening prognosis, and is an indicator of mortality. It remains unclear how fatigue affects the daily life of COPD patients and what physical, social, and emotional challenges it brings. Some studies are showing that adhering to the Mediterranean diet significantly improves fatigue. In this study, the relationship between fatigue and adherence to a Mediterranean diet in COPD patients was investigated. METHODS The present study is a descriptive, cross-sectional, and correlational study. The study population included ≥65-year-old patients with a diagnosis of COPD who were hospitalized in Chest Diseases Clinics of İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital and Chest Diseases Clinic of Sivas Cumhuriyet University Hospital. The Personal Information Form, Mediterranean Diet Adherence Screener (MEDAS), COPD and Asthma Fatigue Scale (CAFS), and KATZ Activities of Daily Living Scale (Katz ADL) were used as data collection tools. RESULTS Of the total 526 participants, 58.7% were men, 52.1% were overweight, 54.3% were ex-smokers, and 65.8% were non-drinkers. In the variables related to the disease, the mean duration of having COPD was 16.41 (SD 5.26) years. According to the GOLD classification of the participants, the severity of the disease was determined as Stage III in 57.4% of them, and the severity of dyspnea was determined as "3" (moderate severity) in 54.5% of them according to the mMRC scale. According to the results of the analysis, the mean MEDAS score was 7.84 (SD: 2.76). According to the participants' levels of adherence to the MD, of them, 43.8% had high adherence to MD and 29% had low adherence to MD. The mean CAFS score indicating the level of disease-related fatigue was 69.17 (SD: 15.73), and the lowest and highest scores were 25 and 100 respectively. According to the independence in activities of daily living of the participants, 77.3% were semi-dependent and 6.4% were independent. The comparison of the level of the participant's adherence to the MD according to their mean CAFS scores demonstrated that those who had high adherence to the MD obtained significantly lower scores than the participants in the other groups (p < 0.05). The comparison of the participants' mean MEDAS scores according to their KATZ ADL independence status demonstrated that there was a significant difference (p < 0.001). CONCLUSIONS Adherence to the MD was associated with fatigue and independence in older COPD patients. It was found that high adherence to MD is associated with decreased fatigue and increased independence in activities of daily living in older COPD patients.
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Affiliation(s)
- Sedat Arslan
- Nutrition and Dietetics, Faculty of Health Science, Bandirma Onyedi Eylul University, Balıkesir, Turkey.
| | - Canan Bozkurt
- Nursing Department, Faculty of Health Science, Bandirma Onyedi Eylul University, Balıkesir, Turkey
| | - Mahir Arslan
- Nutrition and Dietetics, Faculty of Health Science, Sivas Cumhuriyet University, Sivas, Turkey
| | - Hülya Bulut
- Nursing Department, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
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9
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van Erck D, Dolman CD, Henriques JP, Schoufour JD, Delewi R, Scholte Op Reimer WJM, Snaterse M. Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation. Eur Geriatr Med 2023:10.1007/s41999-023-00774-1. [PMID: 37004674 DOI: 10.1007/s41999-023-00774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI). METHODS We conducted a qualitative study using semi-structured interviews with patients undergoing TAVI. Interviews were analysed by two independent researchers using thematic analysis, the capability, opportunity and motivation behaviour model was used as a framework. RESULTS The study included 13 patients (82 ± 6 years old, 6 females) until data saturation was reached. Six themes were identified, which were all applicable to both dietary intake and physical activity. Three following themes were identified as barriers: (1) low physical capability, (2) healthy dietary intake and physical activity are not a priority at an older age and (3) ingrained habits and preferences. Three following themes were identified as facilitators: (1) knowledge that dietary intake and physical activity are important for maintaining health, (2) norms set by family, friends and caregivers and (3) support from the social environment. CONCLUSION Our study found that older patients had mixed feelings about changing their behaviour. The majority initially stated that dietary intake and physical activity were not a priority at older age. However, with knowledge that behaviour could improve health, patients also stated willingness to change, leading to a state of ambivalence. Healthcare professionals may consider motivational interviewing techniques to address this ambivalence.
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Affiliation(s)
- Dennis van Erck
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Christine D Dolman
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - José P Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Josje D Schoufour
- Faculty Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Marjolein Snaterse
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Szklarzewska S, Mottale R, Engelman E, De Breucker S, Preiser JC. Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis. Clin Nutr 2023; 42:309-336. [PMID: 36731161 DOI: 10.1016/j.clnu.2023.01.013] [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: 08/10/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Raphael Mottale
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Medical Direction, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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11
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Ullrich P, Werner C, Schönstein A, Bongartz M, Eckert T, Beurskens R, Abel B, Bauer JM, Lamb SE, Hauer K. Effects of a Home-Based Physical Training and Activity Promotion Program in Community-Dwelling Older Persons with Cognitive Impairment after Discharge from Rehabilitation: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2022; 77:2435-2444. [PMID: 35022728 DOI: 10.1093/gerona/glac005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status. METHODS Patients with mild to moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance, and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time). RESULTS Among 118 randomized participants (82.3 ± 6.0 years) with CI (MMSE: 23.3 ± 2.4) and high levels of multimorbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95% CI: 1.0-2.8; p < .001), with persistent benefits over the follow-up (1.3 points; 95% CI: 0.4-2.2; p < .001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term. CONCLUSIONS The results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multimorbid population. CLINICAL TRIAL REGISTRATION ISRCTN82378327.
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Affiliation(s)
- Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Christian Werner
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Anton Schönstein
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Martin Bongartz
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Tobias Eckert
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Rainer Beurskens
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany.,FHM Bielefeld, University of Applied Sciences, Bielefeld, Germany
| | - Bastian Abel
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Jürgen M Bauer
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg/Center for Geriatric Medicine at Heidelberg University, Heidelberg, Germany
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12
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Barba KA, Gautam R, Knotts P. Late Life Depression Education: Impact on Acute Care Nurses' Knowledge, Attitude, and Screening Practices. J Gerontol Nurs 2022; 48:43-51. [DOI: 10.3928/00989134-20221108-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Geelen SJG, Giele BM, Veenhof C, Nollet F, Engelbert RHH, van der Schaaf M. Physical dependence and urinary catheters both strongly relate to physical inactivity in adults during hospital stay: a cross-sectional, observational study. Disabil Rehabil 2022; 44:6684-6691. [PMID: 34528861 DOI: 10.1080/09638288.2021.1970257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine which factors are associated with physical inactivity in hospitalized adults of all ages. METHODS A cross-sectional sample of 114 adults admitted to a gastrointestinal surgery, internal medicine or cardiology hospital ward (median age 60, length of stay 13 days) were observed during one random day from 8 am to 8 pm using wireless accelerometers and behavioral mapping protocols. Factors (e.g., comorbidities, self-efficacy, independence in mobility, functional restraints) were collected from medical records, surveys, and observations. RESULTS Patients were physically active for median(IQR) 26 (13-52.3) min and were observed to lie in bed for 67.3%, sit for 25.2%, stand for 2.5%, and walk for 5.0% of the time. Multivariable regression analysis revealed that physical inactivity was 159.87% (CI = 89.84; 255.73) higher in patients dependent in basic mobility, and 58.88% (CI = 10.08; 129.33) higher in patients with a urinary catheter (adjusted R2 = 0.52). The fit of our multivariable regression analysis did not improve after adding hospital ward to the analysis (p > 0.05). CONCLUSIONS Independence in mobility and urine catheter presence are two important factors associated with physical inactivity in hospitalized adults of all ages, and these associations do not differ between hospital wards. Routine assessments of both factors may therefore help to identify physically inactive patients throughout the hospital.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be aware that physical inactivity during hospital stay may result into functional decline.Regardless of which hospital ward patients are admitted to, once patients require assistance in basic mobility or have a urinary catheter they are at risk of physical inactivity during hospital stay.Implementing routine assessments on the independence of basic mobility and urine catheter presence may therefore assist healthcare professionals in identifying physically inactive patients before they experience functional decline.
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences and Sports, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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14
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Abstract
OBJECTIVES Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD). METHODS We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen's d = -0.25, 95% CI [-0.02, -0.49] I2 35%). CONCLUSIONS There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.
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15
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Damanti S, Cilla M, Cilona M, Fici A, Merolla A, Pacioni G, De Lorenzo R, Martinenghi S, Vitali G, Magnaghi C, Fumagalli A, Gennaro Mazza M, Benedetti F, Tresoldi M, Rovere Querini P. Prevalence of Long COVID-19 Symptoms After Hospital Discharge in Frail and Robust Patients. Front Med (Lausanne) 2022; 9:834887. [PMID: 35911387 PMCID: PMC9329529 DOI: 10.3389/fmed.2022.834887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background A motley postacute symptomatology may develop after COVID-19, irrespective of the acute disease severity, age, and comorbidities. Frail individuals have reduced physiological reserves and manifested a worse COVID-19 course, during the acute setting. However, it is still unknown, whether frailty may subtend some long COVID-19 manifestations. We explored the prevalence of long COVID-19 disturbs in COVID-19 survivals. Methods This was an observational study. Patients aged 65 years or older were followed-up 1, 3, and 6 months after hospitalization for COVID-19 pneumonia. Results A total of 382 patients were enrolled. Frail patients were more malnourished (median Mini Nutritional Assessment Short Form score 8 vs. 9, p = 0.001), at higher risk of sarcopenia [median Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) score 3 vs. 1.5, p = 0.003], and manifested a worse physical performance [median Short Physical Performance Battery (SPPB) score 10 vs. 11, p = 0.0007] than robust individuals, after hospital discharge following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Frailty was significantly associated with: (i) confusion, as a presenting symptom of COVID-19 [odds ratio (OR) 77.84, 95% CI 4.23–1432.49, p = 0.003]; (ii) malnutrition (MNA-SF: adjusted B –5.63, 95% CI –8.39 to –2.87, p < 0.001), risk of sarcopenia (SARC-F: adjusted B 9.11, 95% CI 3.10–15.13, p = 0.003), impaired muscle performance (SPPB: B –3.47, 95% CI –6.33 to –0.61, p = 0.02), complaints in mobility (adjusted OR 1674200.27, 95% CI 4.52–619924741831.25, p = 0.03), in self-care (adjusted OR 553305.56, 95% CI 376.37–813413358.35, p < 0.001), and in performing usual activities of daily living (OR 71.57, 95% CI 2.87–1782.53, p = 0.009) at 1-month follow-up; (iii) dyspnea [modified Medical Research Council (mMRC): B 4.83, 95% CI 1.32–8.33, p = 0.007] and risk of sarcopenia (SARC-F: B 7.12, 95% CI 2.17–12.07, p = 0.005) at 3-month follow-up; and (iv) difficulties in self-care (OR 2746.89, 95% CI 6.44–1172310.83, p = 0.01) at the 6-month follow-up. In a subgroup of patients (78 individuals), the prevalence of frailty increased at the 1-month follow-up compared to baseline (p = 0.009). Conclusion The precocious identification of frail COVID-19 survivors, who manifest more motor and respiratory complaints during the follow-up, could improve the long-term management of these COVID-19 sequelae.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
- *Correspondence: Sarah Damanti,
| | - Marta Cilla
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
| | - Maria Cilona
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Aldo Fici
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Aurora Merolla
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Pacioni
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Sabina Martinenghi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giordano Vitali
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristiano Magnaghi
- Department of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Fumagalli
- COVID Trial Unit, Department of Internal Medicine, IRCCS San Raffaele Institute, Milan, Italy
| | - Mario Gennaro Mazza
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Department of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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16
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Lekan D, Yasin R. Using the ModSPICES Geriatric Assessment Tool in Undergraduate Nursing Education. J Nurs Educ 2022; 61:338-344. [PMID: 35667113 DOI: 10.3928/01484834-20220404-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trends in aging demographics for a growing older adult population highlights the need for Gerontologic nursing competencies to prepare future nurses to provide safe and effective person-centered care. METHOD A geriatric assessment learning module incorporated the ModSPICES assessment tool based on geriatric syndromes in a didactic and clinical course in a prelicensure baccalaureate nursing program to facilitate nursing students' critical thinking and clinical judgment in the care of hospitalized older adults. RESULTS The ModSPICES tool fostered nursing students' critical thinking for data collection with attention to geriatric syndromes, which are highly prevalent and associated with numerous adverse outcomes but are also preventable and treatable. The tool helped to aggregate diverse clinical information and establish priorities in care. CONCLUSION The learning module strengthened the linkage between the classroom and clinical setting, enhanced the student's capacity and confidence in the promotion of function-focused care, and facilitated refinement of their evolving assessment skills. [J Nurs Educ. 2022;61(6):338-344.].
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Tago M, Katsuki NE, Nakatani E, Tokushima M, Dogomori A, Mori K, Yamashita S, Oda Y, Yamashita SI. External validation of a new predictive model for falls among inpatients using the official Japanese ADL scale, Bedriddenness ranks: a double-centered prospective cohort study. BMC Geriatr 2022; 22:331. [PMID: 35428196 PMCID: PMC9013105 DOI: 10.1186/s12877-022-02871-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
Background Several reliable predictive models for falls have been reported, but are too complicated and time-consuming to evaluate. We recently developed a new predictive model using just eight easily-available parameters including the official Japanese activities of daily living scale, Bedriddenness ranks, from the Ministry of Health, Labour and Welfare. This model has not yet been prospectively validated. This study aims to prospectively validate our new predictive model for falls among inpatients admitted to two different hospitals. Methods A double-centered prospective cohort study was performed from October 1, 2018, to September 30, 2019 in an acute care hospital and a chronic care hospital. We analyzed data from all adult inpatients, for whom all data required by the predictive model were evaluated and recorded. The eight items required by the predictive model were age, gender, emergency admission, department of admission, use of hypnotic medications, previous falls, independence of eating, and Bedriddenness ranks. The main outcome is in-hospital falls among adult inpatients, and the model was assessed by area under the curve. Results A total of 3,551 adult participants were available, who experienced 125 falls (3.5%). The median age (interquartile range) was 78 (66–87) years, 1,701 (47.9%) were men, and the incidence of falls was 2.25 per 1,000 patient-days and 2.06 per 1,000 occupied bed days. The area under the curve of the model was 0.793 (95% confidence interval: 0.761–0.825). The cutoff value was set as − 2.18, making the specificity 90% with the positive predictive value and negative predictive value at 11.4% and 97%. Conclusions This double-centered prospective cohort external validation study showed that the new predictive model had excellent validity for falls among inpatients. This reliable and easy-to-use model is therefore recommended for prediction of falls among inpatients, to improve preventive interventions. Trial registration UMIN000040103 (2020/04/08) Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02871-5.
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18
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Examining a Fatigue Management Model in Older Individuals. Rehabil Nurs 2022; 47:50-59. [DOI: 10.1097/rnj.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Feenstra M, van Munster BC, Smidt N, de Rooij SE. Determinants of trajectories of fatigability and mobility among older medical patients during and after hospitalization; an explorative study. BMC Geriatr 2022; 22:12. [PMID: 34979955 PMCID: PMC8721977 DOI: 10.1186/s12877-021-02714-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fatigability is an important marker of functional decline in community dwelling older people, yet its relationship with functional decline after hospitalization is unclear. The objectives of this study were to identify trajectories of fatigability and mobility over time and to examine the association between demographic and clinical characteristics and these trajectories in medical patients aged 70 years and older admitted to a Dutch tertiary care teaching hospital. Methods In this prospective cohort study with baseline (in-hospital), discharge, three-, and six-months post discharge follow-up measurements, fatigability was assessed by the physical subscale of the Pittsburgh Fatigability Scale (PFS). Mobility was assessed by the De Morton Mobility Index (DEMMI). Group-based trajectory modeling was used to identify joint trajectories of fatigability and mobility. Covariates included demographic (age, sex, living situation, education) and clinical characteristics (functional status, frailty status, depression, comorbidity, length of hospital stay). Results Among 44 patients, three distinct fatigability trajectories and two mobility trajectories were identified over the course from hospital admission up to six months after discharge. Subsequently, three joint trajectories were identified, including low fatigability and high mobility (11%), improving fatigability and high mobility (52%), and high fatigability and low mobility (36%). Controlling for baseline functional status, patients with a lower comorbidity score (OR: 0.27, 95%CI 0.10; 0.74) and higher frailty status (OR: 1.36, 95%CI: 1.07; 1.74) were more likely to be a member of the high fatigability and low mobility trajectories. Conclusions From hospital admission up to six months after discharge, three distinct trajectories of fatigability and mobility were identified among older medical patients. Our results should be interpreted with caution due to the small sample size, but may inspire other researchers to determine the value of fatigability assessment in identifying older medical patients at risk for developing mobility problems. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02714-9.
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Affiliation(s)
- Marlies Feenstra
- Department of Internal Medicine and Geriatrics, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands.
| | - Barbara C van Munster
- Department of Internal Medicine and Geriatrics, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands.,Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophia E de Rooij
- Department of Internal Medicine and Geriatrics, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700, RB, Groningen, The Netherlands
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Redley B, Douglas T, Hoon L, White K, Hutchinson A. Nursing guidelines for comprehensive harm prevention strategies for adult patients in acute hospitals: An integrative review and synthesis. Int J Nurs Stud 2022; 127:104178. [DOI: 10.1016/j.ijnurstu.2022.104178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/05/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
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Shaw A, Cabrejo PT, Adamczyk A, Mulcahey MJ. Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review. Am J Occup Ther 2022; 76:23144. [PMID: 34997839 DOI: 10.5014/ajot.2022.049082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear. OBJECTIVE To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice. DATA SOURCES We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. FINDINGS Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. CONCLUSIONS AND RELEVANCE Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.
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Affiliation(s)
- Antoinette Shaw
- Antoinette Shaw, OTD, OTR/L, is Director of Rehabilitation Services, Genesis Healthcare Corporation, Catonsville, MD;
| | - Pamela Talero Cabrejo
- Pamela Talero Cabrejo, OTD, OTR/L, is Adjunct Assistant Professor, Post-Professional Occupational Therapy Program, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Abby Adamczyk
- Abby Adamczyk, MLIS, AHIP, is Professional Librarian, Thomas Jefferson University, Philadelphia, PA
| | - M J Mulcahey
- MJ Mulcahey, PhD, OTR/L, is Professor of Occupational Therapy, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
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22
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The association between fear of falling and orthostatic hypotension in older adults. Aging Clin Exp Res 2021; 33:3199-3204. [PMID: 32394371 DOI: 10.1007/s40520-020-01584-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/27/2020] [Indexed: 01/23/2023]
Abstract
The aim of this study was to determine the relationship between the fear of falling/the degree of fear of falling (FoF) and orthostatic hypotension (OH) in older adults. This cross-sectional study was conducted with 314 older outpatients. If the total score of the Falls Efficacy Scale-International scale was 16-19, 20-27 and ≥ 28, it was assumed that there was low FoF, moderate FoF and high FoF, respectively. OH was evaluated for the 1st (OH1) and 3rd (OH3) minutes, after transitioning from the supine position to standing. Participants were aged 65-93 years (mean age 74.2 ± 8.5 years) and 193 (61.5%) were female. Among the FoF groups, significant differences were found for age, gender, education, marital status, who the patient lived with, the history of falling and hypertension, Timed Up-Go test score and hemoglobin levels (p < 0.005). The prevalence of OH1 and OH3 was found to be significantly higher in those with an FoF score of 20 and above than those below 20 (p < 0.005). After adjustment for potential confounders, participants who reported a high FoF had higher risk for OH1 and OH3 (OR 2.14, 95% CI 1.14-4.0, p = 0.017; and OR 2.72, 95% CI 1.46-5.09, p = 0.002, respectively), but those with moderate FoF had no increased risk of having OH compared to low FoF (p > 0.05). There is a close relationship between high FoF and OH in older adults. Therefore, when evaluating an older patient with OH, FoF should be evaluated, or FoF should also be questioned in older patients with OH.
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23
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van Doorne I, van Rijn M, Dofferhoff SM, Willems DL, Buurman BM. Patients' preferred place of death: patients are willing to consider their preferences, but someone has to ask them. Age Ageing 2021; 50:2004-2011. [PMID: 34473834 PMCID: PMC8581384 DOI: 10.1093/ageing/afab176] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background end-of-life care is not always in line with end-of-life preferences, so patients do not always die at their preferred place of death (PPD). This study aims to identify factors associated with patients’ PPD and changes in PPD. Methods we prospectively collected data on PPD at four time points within 6 months from 230 acutely hospitalised older patients who were part of the control group in a stepped-wedge randomised controlled trial. Associations between patient characteristics and preferences were calculated using multivariable (multinomial) logistic regression analysis. Results the mean age of participants was 80.7 years. 47.8% of the patients had no PPD at hospital admission. Patients previously admitted to hospital preferred to die at home (home versus no preference: odds ratio [OR] 2.38, 95% confidence interval [CI] 1.15–4.92; home versus healthcare facility: OR 3.25, 95% CI 1.15–9.16). Patients with more chronic diseases preferred the healthcare facility as their PPD (healthcare facility versus no preference: OR 1.33, 95% CI 1.09–1.61; healthcare facility versus home: OR 1.21, 95% CI 1.00–1.47). 32 of 65 patients changed their preference during follow-up, and most of these had no PPD at hospital admission (home versus no preference: OR 0.005, 95% CI ≤0.001–0.095) and poorer self-rated well-being (OR 1.82, 95% CI 1.07–3.08). Conclusions almost half of the patients had no PPD at baseline. Previous hospital admission, having more chronic diseases and living alone are associated with having a PPD. Introducing PPD could make older people aware of PPD and facilitate optimal palliative care.
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Affiliation(s)
- Iris van Doorne
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marjon van Rijn
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sjoerd M Dofferhoff
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Bianca M Buurman
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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24
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Kolk D, Kruiswijk AF, MacNeil-Vroomen JL, Ridderikhof ML, Buurman BM. Older patients' perspectives on factors contributing to frequent visits to the emergency department: a qualitative interview study. BMC Public Health 2021; 21:1709. [PMID: 34544405 PMCID: PMC8454044 DOI: 10.1186/s12889-021-11755-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] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to describe older patients' perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits. METHODS This was a qualitative description study. We performed semi-structured individual interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached. RESULTS In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients' untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit. CONCLUSIONS This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.
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Affiliation(s)
- Daisy Kolk
- Amsterdam UMC, University of Amsterdam, Emergency Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands. .,Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands.
| | - Anton F Kruiswijk
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands.,OLVG Hospital, Department of Geriatric Medicine, Amsterdam, the Netherlands
| | - Janet L MacNeil-Vroomen
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands
| | - Milan L Ridderikhof
- Amsterdam UMC, University of Amsterdam, Emergency Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - Bianca M Buurman
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health, Meibergdreef 9, Amsterdam, Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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25
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Abstract
BACKGROUND Fatigue is a symptom experienced by 40%-74% of older individuals in the United States. Despite its significance, clinicians face challenges helping individuals to manage or reduce fatigue levels. Some management issues are attributable to the ambiguity around the risk factors, consequences, and the effect of fatigue management strategies. METHODS A literature review was conducted using four databases to identify themes in relation to risk factors, consequences, and management strategies from research studies about fatigue in older individuals with chronic diseases. RESULTS Findings on fatigue risk factors, such as age, body mass index, and marital status, were contradictory. There was a positive association between fatigue and comorbidities, depression, and anxiety and a negative relationship between fatigue and physical activity, sleep, educational status, and socioeconomic status. Fatigue was perceived as a state of "feebleness" and negatively impacted individuals' quality of life. Consequences of fatigue included tiredness, sleepiness, depression, anxiety, worse sense of purpose in life, poor self-care, and an increased β-amyloid load. Predictors of worse fatigue consequences included functional health, symptom burden, subjective health, and self-acceptance. Fatigue management strategies included physical activity, rest, sleep, maintaining normal hemoglobin levels, and acetyl-l-carnitine supplementation. CONCLUSION This systematic review is of value to older individuals with chronic illnesses, researchers, and clinicians who strive to improve the quality of life of individuals experiencing fatigue. To prevent undesirable consequences of fatigue, older individuals should be screened for the discussed modifiable risk factors of fatigue. The inconsistencies in the studies reviewed can guide researchers to potential research areas that require further inquiry and exploration to ground future practice on best scientific evidence.
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26
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Jepma P, Latour CHM, Ten Barge IHJ, Verweij L, Peters RJG, Scholte Op Reimer WJM, Buurman BM. Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study. BMC Health Serv Res 2021; 21:786. [PMID: 34372851 PMCID: PMC8353821 DOI: 10.1186/s12913-021-06719-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/29/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients' participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. METHODS A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. RESULTS Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants' recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. CONCLUSION Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients' needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.
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Affiliation(s)
- Patricia Jepma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Corine H M Latour
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Iris H J Ten Barge
- Nursing Sciences, Program of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lotte Verweij
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Research Group Chronic Diseases, Utrecht, The Netherlands
| | - Bianca M Buurman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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27
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Jepma P, Verweij L, Tijssen A, Heymans MW, Flierman I, Latour CHM, Peters RJG, Scholte Op Reimer WJM, Buurman BM, Ter Riet G. The performance of the Dutch Safety Management System frailty tool to predict the risk of readmission or mortality in older hospitalised cardiac patients. BMC Geriatr 2021; 21:299. [PMID: 33964888 PMCID: PMC8105911 DOI: 10.1186/s12877-021-02243-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Early identification of older cardiac patients at high risk of readmission or mortality facilitates targeted deployment of preventive interventions. In the Netherlands, the frailty tool of the Dutch Safety Management System (DSMS-tool) consists of (the risk of) delirium, falling, functional impairment, and malnutrition and is currently used in all older hospitalised patients. However, its predictive performance in older cardiac patients is unknown. Aim To estimate the performance of the DSMS-tool alone and combined with other predictors in predicting hospital readmission or mortality within 6 months in acutely hospitalised older cardiac patients. Methods An individual patient data meta-analysis was performed on 529 acutely hospitalised cardiac patients ≥70 years from four prospective cohorts. Missing values for predictor and outcome variables were multiply imputed. We explored discrimination and calibration of: (1) the DSMS-tool alone; (2) the four components of the DSMS-tool and adding easily obtainable clinical predictors; (3) the four components of the DSMS-tool and more difficult to obtain predictors. Predictors in model 2 and 3 were selected using backward selection using a threshold of p = 0.157. We used shrunk c-statistics, calibration plots, regression slopes and Hosmer-Lemeshow p-values (PHL) to describe predictive performance in terms of discrimination and calibration. Results The population mean age was 82 years, 52% were males and 51% were admitted for heart failure. DSMS-tool was positive in 45% for delirium, 41% for falling, 37% for functional impairments and 29% for malnutrition. The incidence of hospital readmission or mortality gradually increased from 37 to 60% with increasing DSMS scores. Overall, the DSMS-tool discriminated limited (c-statistic 0.61, 95% 0.56–0.66). The final model included the DSMS-tool, diagnosis at admission and Charlson Comorbidity Index and had a c-statistic of 0.69 (95% 0.63–0.73; PHL was 0.658). Discussion The DSMS-tool alone has limited capacity to accurately estimate the risk of readmission or mortality in hospitalised older cardiac patients. Adding disease-specific risk factor information to the DSMS-tool resulted in a moderately performing model. To optimise the early identification of older hospitalised cardiac patients at high risk, the combination of geriatric and disease-specific predictors should be further explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02243-5.
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Affiliation(s)
- Patricia Jepma
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands. .,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Lotte Verweij
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Arno Tijssen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | - Isabelle Flierman
- Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Corine H M Latour
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.,Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Bianca M Buurman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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28
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Hogervorst VM, Buurman BM, De Jonghe A, van Oppen JD, Nickel CH, Lucke J, Blomaard LC, Thaur A, Mooijaart SP, Banerjee J, Wallace J, de Groot B, Conroy SP. Emergency department management of older people living with frailty: a guide for emergency practitioners. Emerg Med J 2021; 38:724-729. [PMID: 33883216 DOI: 10.1136/emermed-2020-210014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022]
Abstract
Emergency Departments (EDs) are increasingly seeing more seriously unwell older people living with frailty. In the context of limited resources and increasing demand it's the ED practitioner's challenge to unpick this constellation of physical, psychological, functional and social issues.To properly assess older people living with frailty at the ED it is crucial to use an holistic approach. This consists of triage with algorithms sensitive to the higher risk of older people living with frailty, a frailty assessment, and an assessment with the help of the principles of Comprehensive Geriatric Assessment. Multi-disciplinary care, a tailor-made treatment plan, based on what the person values most, will help the ED practitioner to deliver appropriate and valuable care during the ED stay, but also in transition from hospital to home.
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Affiliation(s)
- Vera M Hogervorst
- Department of Geriatric Medicine, Tergooi Hospital, Hilversum, The Netherlands .,Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | | | - James David van Oppen
- Department of Health Sciences, University of Leicester, Leicester, UK.,Emergency & Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Jacinta Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Laura C Blomaard
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjun Thaur
- Department of Emergency Medicine, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jay Banerjee
- Department of Health Sciences, University of Leicester, Leicester, UK.,Department of Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Wallace
- Department of Emergency Medicine, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Bas de Groot
- Department of Emergency Medicine, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Simon Paul Conroy
- Department of Health Sciences, University of Leicester, Leicester, UK
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29
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Verweij L, Spoon DF, Terbraak MS, Jepma P, Peters RJG, Scholte Op Reimer WJM, Latour CHM, Buurman BM. The Cardiac Care Bridge randomized trial in high-risk older cardiac patients: A mixed-methods process evaluation. J Adv Nurs 2021; 77:2498-2510. [PMID: 33594695 PMCID: PMC8048800 DOI: 10.1111/jan.14786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/05/2021] [Accepted: 01/16/2021] [Indexed: 12/28/2022]
Abstract
Aim To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design A mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
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Affiliation(s)
- Lotte Verweij
- Department of Cardiology, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Denise F Spoon
- Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michel S Terbraak
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Patricia Jepma
- Department of Cardiology, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Corine H M Latour
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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30
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van Seben R, Covinsky KE, Reichardt LA, Aarden JJ, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Insight Into the Posthospital Syndrome: A 3-Month Longitudinal Follow up on Geriatric Syndromes and Their Association With Functional Decline, Readmission, and Mortality. J Gerontol A Biol Sci Med Sci 2021; 75:1403-1410. [PMID: 32072168 PMCID: PMC7302165 DOI: 10.1093/gerona/glaa039] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Acute hospitalization may lead to posthospital syndrome, but no studies have investigated how this syndrome manifests and geriatric syndromes are often used as synonym. However, studies on longitudinal associations between syndromes and adverse outcomes are scarce. We aimed to analyze longitudinal associations between geriatric syndromes and functional decline (FD), readmission, and mortality. Methods Prospective cohort study, including 401 acutely hospitalized patients (aged ≥ 70). We performed: (i) logistic regression analyses to assess associations between patterns of geriatric syndromes as they develop over time (between admission and 1 month postdischarge), and FD and readmission; (ii) generalized estimating equations to assess longitudinal associations between geriatric syndromes over five time points (admission, discharge, 1, 2, and 3 months postdischarge) and FD, mortality, and readmission at 3 months postdischarge. Results After syndrome absent, syndrome present at both admission and 1 month postdischarge was most prevalent. Persistent patterns of apathy (odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.54–12.30), pain (OR = 3.26, 95% CI = 1.21–8.8), malnutrition (OR = 3.4, 95% CI = 1.35–8.56), mobility impairment (OR = 6.65, 95% CI = 1.98–22.38), and fear of falling (OR = 3.17, 95% CI = 1.25–8.02) were associated with FD. Developing cognitive impairment (OR = 6.40, 95% CI = 1.52–26.84), fatigue (OR = 4.71, 95% CI = 1.03–21.60), and fall risk (OR = 4.30, 95% CI = 1.21–16.57) postdischarge, was associated with readmission; however, only 4%–6% developed these syndromes. Over the course of five time points, mobility impairment, apathy, and incontinence were longitudinally associated with FD; apathy, malnutrition, fatigue, and fall risk with mortality; malnutrition with readmission. Conclusion Most geriatric syndromes are present at admission and patients are likely to retain them postdischarge. Several geriatric syndromes are longitudinally associated with mortality and, particularly, persistently present syndromes place persons are at risk of FD. Although few persons develop syndromes postdischarge, those developing cognitive impairment, fatigue, and fall risk were at increased readmission risk.
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Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | | | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Martin van der Esch
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, The Netherlands
| | - Raoul H H Engelbert
- ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
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31
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Aarden JJ, Reijnierse EM, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, Twisk JWR, Maier AB, Engelbert RHH, Buurman BM. Longitudinal Changes in Muscle Mass, Muscle Strength, and Physical Performance in Acutely Hospitalized Older Adults. J Am Med Dir Assoc 2021; 22:839-845.e1. [PMID: 33428891 DOI: 10.1016/j.jamda.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Acute hospitalization may lead to a decrease in muscle measures, but limited studies are reporting on the changes after discharge. The aim of this study was to determine longitudinal changes in muscle mass, muscle strength, and physical performance in acutely hospitalized older adults from admission up to 3 months post-discharge. DESIGN A prospective observational cohort study was conducted. SETTING AND PARTICIPANTS This study included 401 participants aged ≥70 years who were acutely hospitalized in 6 hospitals. All variables were assessed at hospital admission, discharge, and 1 and 3 months post-discharge. METHODS Muscle mass in kilograms was assessed by multifrequency Bio-electrical Impedance Analysis (MF-BIA) (Bodystat; Quadscan 4000) and muscle strength by handgrip strength (JAMAR). Chair stand and gait speed test were assessed as part of the Short Physical Performance Battery (SPPB). Norm values were based on the consensus statement of the European Working Group on Sarcopenia in Older People. RESULTS A total of 343 acute hospitalized older adults were included in the analyses with a mean (SD) age of 79.3 (6.6) years, 49.3% were women. From admission up to 3 months post-discharge, muscle mass (-0.1 kg/m2; P = .03) decreased significantly and muscle strength (-0.5 kg; P = .08) decreased nonsignificantly. The chair stand (+0.7 points; P < .001) and gait speed test (+0.9 points; P < .001) improved significantly up to 3 months post-discharge. At 3 months post-discharge, 80%, 18%, and 43% of the older adults scored below the cutoff points for muscle mass, muscle strength, and physical performance, respectively. CONCLUSIONS AND IMPLICATIONS Physical performance improved during and after acute hospitalization, although muscle mass decreased, and muscle strength did not change. At 3 months post-discharge, muscle mass, muscle strength, and physical performance did not reach normative levels on a population level. Further research is needed to examine the role of exercise interventions for improving muscle measures and physical performance after hospitalization.
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Affiliation(s)
- Jesse J Aarden
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Marike van der Schaaf
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Martin van der Esch
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Lucienne A Reichardt
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rosanne van Seben
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Amsterdam UMC, Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Geelen SJG, Giele BM, Nollet F, Engelbert RHH, van der Schaaf M. Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study. JMIR Res Protoc 2020; 9:e19000. [PMID: 33185561 PMCID: PMC7695526 DOI: 10.2196/19000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. Objective This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. Methods The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. Results This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. Conclusions This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. Trial Registration Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480 International Registered Report Identifier (IRRID) DERR1-10.2196/19000
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Anzuoni K, Field TS, Mazor KM, Zhou Y, Garber LD, Kapoor A, Gurwitz JH. Recruitment Challenges for Low-Risk Health System Intervention Trials in Older Adults: A Case Study. J Am Geriatr Soc 2020; 68:2558-2564. [PMID: 32710671 DOI: 10.1111/jgs.16696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess factors associated with trial participation in the context of a low-risk intervention intended to reduce adverse drug events in recently hospitalized older adults. DESIGN Mixed methods: analysis of data collected during enrollment efforts and focus groups. SETTING A large, multispecialty group practice. PARTICIPANTS Individuals 50 years and older, recently discharged from the hospital and prescribed at least one high-risk medication, were eligible for the trial. Enrollees, decliners, and their caregivers were eligible to participate in focus groups. MEASUREMENTS Reasons for declining to participate during the initial invitation as well as reasons for not providing consent were recorded. Focus groups were conducted with eligible individuals to explore reasons for enrolling or declining. We conducted multivariable logistic regression to compare characteristics (including sex, age, healthcare proxy, number and type of medications, visiting nurse services, reason for admission, and length of hospital stay) of those who enrolled with those who did not enroll. RESULTS Of 3,606 individuals determined eligible, 3,147 (87%) declined, 98 (3%) verbally consented to participate but did not complete written consent, and 361 (10%) provided written consent and were considered enrolled. Individuals 80 year and older (odds ratio (OR) = 0.44; 95% confidence interval (CI) = 0.30-0.65) and those with visiting nurse services (OR = 0.64; 95% CI = 0.48-0.85) were least likely to enroll. Among those who provided a reason for declining (2,473), the most common was the belief they did not need additional medication assistance (18%). Another 332 (11%) declined because they were receiving visiting nurse services. CONCLUSION Recruiting older adults recently discharged from the hospital to participate in trials of low-risk, system-level interventions is challenging and may underenroll the oldest individuals and those potentially at the highest risk for adverse events, limiting generalizability of study findings. Alternative study designs may be more effective than individually randomized trials in assessing low-risk, system-level interventions.
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Affiliation(s)
- Kathryn Anzuoni
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
| | - Terry S Field
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kathleen M Mazor
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Yanhua Zhou
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA
| | - Lawrence D Garber
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Reliant Medical Group, Worcester, Massachusetts, USA
| | - Alok Kapoor
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Reliant Medical Group, Worcester, Massachusetts, USA
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Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study. J Am Med Dir Assoc 2020; 22:425-432. [PMID: 32713773 DOI: 10.1016/j.jamda.2020.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. DESIGN Prospective observational cohort study conducted in 2015-2017. SETTING AND PARTICIPANTS Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. METHODS Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. RESULTS The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250-1146] at the last day of hospitalization. This increased to 1750 (IQR 675-4114) steps 1 day postdischarge, and to 1997 (IQR 938-4098) steps 7 days postdischarge. Age [β = -57.93; 95% confidence interval (CI) -111.15 to -4.71], physical performance (β = 224.95; 95% CI 117.79-332.11), and steps in hospital (β = 0.76; 95% CI 0.46-1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = -1400; 95% CI -2380 to -420; P = .005). CONCLUSIONS AND IMPLICATIONS Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.
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Inzitari M, Udina C, Len O, Ars J, Arnal C, Badani H, Davey V, Risco E, Ayats P, de Andrés AM, Mayordomo C, Ros FJ, Morandi A, Cesari M. How a Barcelona Post-Acute Facility became a Referral Center for Comprehensive Management of Subacute Patients With COVID-19. J Am Med Dir Assoc 2020; 21:954-957. [PMID: 32674827 PMCID: PMC7287444 DOI: 10.1016/j.jamda.2020.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
The COVID-19 pandemic's greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become sites to treat older patients with COVID-19. Referrals come from the emergency department or COVID-19 wards of the acute reference hospitals, nursing homes, or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, health care, communication, psychological support, and ethical frameworks. We believe that the strategies we used and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.
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Affiliation(s)
- Marco Inzitari
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Cristina Udina
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Oscar Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Ars
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Cristina Arnal
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Hugo Badani
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Vanessa Davey
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ester Risco
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Pere Ayats
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ana M de Andrés
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Cristina Mayordomo
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Francisco J Ros
- Medical Oncology Department, Vall d'Hebron University Hospital and, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alessandro Morandi
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Ospedale Le Ancelle, Fondazione Teresa Camplani, Cremona, Italy
| | - Matteo Cesari
- Università Statale and Policlinico Maggiore, Milan, Italy
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Valenzuela PL, Ortiz-Alonso J, Bustamante-Ara N, Vidán MT, Rodríguez-Romo G, Mayordomo-Cava J, Javier-González M, Hidalgo-Gamarra M, López-Tatis M, Valadés-Malagón MI, Santos-Lozano A, Serra-Rexach JA, Lucia A. Individual Responsiveness to Physical Exercise Intervention in Acutely Hospitalized Older Adults. J Clin Med 2020; 9:E797. [PMID: 32183381 PMCID: PMC7141266 DOI: 10.3390/jcm9030797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/16/2022] Open
Abstract
We analyzed inter-individual variability in response to exercise among acutely hospitalized oldest-old adults. In this ancillary analysis of a randomized controlled trial, 268 patients (mean age 88 years) were assigned to a control (n = 125, usual care) or intervention group (n = 143, supervised exercise, i.e., walking and rising from a chair [1-3 sessions/day]). Intervention group patients were categorized as responders, non-responders, or adverse responders (improved, no change, or impaired function in activities of daily living [ADL, Katz index] from hospital admission to discharge, respectively). We analyzed the association between responsiveness to exercise and variables assessed at baseline (2 weeks pre-admission), admission, during hospitalization, at discharge, and during a subsequent 3-month follow-up. An impaired ADL function and worse nutritional status at admission were associated to a greater responsiveness, whereas a better ADL function at admission, longer hospitalization and lower comorbidity index were associated with a poorer response (p < 0.05). Adverse responders had worse outcomes at discharge and during the follow-up (e.g., impaired physical performance and greater fall number) (p < 0.05). Although exercise intervention helps to prevent ADL function decline in hospitalized oldest-old people, a number of them-particularly those with a better functional/health status at admission and longer hospitalization-are at higher risk of being adverse responders, which can have negative short/middle-term consequences.
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Affiliation(s)
| | - Javier Ortiz-Alonso
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
| | | | - María T. Vidán
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Gabriel Rodríguez-Romo
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- Sports Department, Instituto Nacional de Educación Física, Universidad Politécnica de Madrid, 20040 Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
| | - Marianna Javier-González
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Mercedes Hidalgo-Gamarra
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Myriel López-Tatis
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Maria Isabel Valadés-Malagón
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, 47012 Valladolid, Spain;
- Research Institute Hospital 12 de Octubre (‘imas12′), 28041 Madrid, Spain
| | - José Antonio Serra-Rexach
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.O.-A.); (M.T.V.); (M.J.-G.); (M.H.-G.); (M.L.-T.); (M.I.V.-M.); (J.A.S.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Alejandro Lucia
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, 28029 Madrid, Spain;
- Research Institute Hospital 12 de Octubre (‘imas12′), 28041 Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
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Kim H, Son H. Fatigue-Related Factors for Community-Dwelling Older Adults with Diabetes: A Theory-Guided Multi-Dimensional Approach Using the Dynamic Biopsychosocial Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4502. [PMID: 31731588 PMCID: PMC6887975 DOI: 10.3390/ijerph16224502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 01/10/2023]
Abstract
Older adults with diabetes appear more susceptible to fatigue compared to younger adults with diabetes or healthy older adults, since aging and diabetes independently and synergistically influence fatigue. Few studies have investigated fatigue in older adults with diabetes using a multidimensional approach. This study explored the influences of physical, psychological, interpersonal, and contextual factors on diabetes fatigue using a dynamic biopsychosocial model. Face-to-face surveys were administered to community-dwelling older adults with diabetes and included variables across four domains (i.e., physical, psychological, interpersonal, and contextual factors). Univariate analyses and multiple linear regression were used. The mean fatigue score was 3.94 (standard deviation (SD) = 1.81) out of 7, and the prevalence of fatigue was 48.8%. Significant differences in fatigue severity by psychological, interpersonal, and contextual factors were found. Comorbidity and psychological factors were significant predictors of fatigue in the model, explaining 31.9% of the variance. As nearly half the sample experienced moderate or severe fatigue, which was significantly influenced by both comorbidity and psychological factors, including depression, sleep quality, and diet-related psychological characteristics, assessing patients' psychological status may be important. Awareness of fatigue could be incorporated into dietary interventions for older adults with diabetes.
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Affiliation(s)
| | - Heesook Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
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Stam H, van Vugt VA, Twisk JWR, Finne-Soveri H, Garms-Homolová V, Declercq A, Jónsson PV, Onder G, van der Roest HG, van Hout H, Maarsingh OR. The Prevalence and Persistence of Dizziness in Older European Home Care Recipients: A Prospective Cohort Study. J Am Med Dir Assoc 2019; 21:338-343.e1. [PMID: 31672569 DOI: 10.1016/j.jamda.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/25/2019] [Accepted: 09/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The prevalence of different geriatric syndromes in older home care (HC) recipients is yet to be determined. Dizziness is often regarded as a geriatric syndrome. The natural course of dizziness in older people is still unknown, because of a lack of longitudinal studies. The objective of this study was to investigate the prevalence and persistence of dizziness in HC recipients. DESIGN Prospective cohort study. SETTING Home care organizations in 6 European countries participating in the EU-funded Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. PARTICIPANTS 2616 community-dwelling long-term HC recipients aged 65 years or older. METHODS Data were collected at baseline and 6 and 12 months by using the interRAI Home Care instrument (interRAI-HC). Dizziness status was assessed by the number of days people experienced dizziness in the last 3 days (0-3) and later dichotomized for analyses (present or not in the last 3 days). Dizziness persistence was defined as the odds for dizzy people at baseline to also report dizziness at subsequent follow-up moments, compared with people who were not dizzy at baseline. The pattern of dizziness was descriptively analyzed in recipients who completed all measurements. Generalized estimating equations analysis was used to determine the persistence of dizziness symptoms. RESULTS The prevalence of dizziness of 2616 eligible HC recipients at baseline was 25.1%, ranging from 16.2% (Belgium) to 39.7% (Italy). The majority of dizzy recipients at baseline also experienced dizziness after 6 and 12 months (79.1%). Dizziness persistence was high at 6 months [odds ratio (OR) 57.8, 95% confidence interval (CI) 43.1-77.5] and at 12 months (OR 30.2, 95% CI 22.3-41.1). CONCLUSIONS AND IMPLICATIONS Dizziness in older HC recipients in Europe is common, and dizziness persistence is high. This warrants a more active approach in treating dizziness in older HC recipients.
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Affiliation(s)
- Hanneke Stam
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Vincent A van Vugt
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Vjenka Garms-Homolová
- Department of Economics and Law, HTW Berlin University of Applied Sciences, Berlin, Germany
| | - Anja Declercq
- LUCAS & Centre for Sociological Research, KU Leuven, Belgium
| | - Pálmi V Jónsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hein van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Otto R Maarsingh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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