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Mohamed MR, Juba K, Awad H, Flannery M, Culakova E, Wells M, Cacciatore J, Jensen-Battaglia M, Mohile S, Ramsdale E. Effect of polypharmacy and potentially inappropriate medications on physical functional decline among older adults with advanced cancer receiving systemic treatment. Support Care Cancer 2024; 32:674. [PMID: 39294452 DOI: 10.1007/s00520-024-08877-6] [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: 06/25/2024] [Accepted: 09/12/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medications (PIM) are common among older adults with advanced cancer, but their association with physical functional outcomes is understudied. This study aimed to estimate the risk of physical functional decline associated with medication measures in older adults with advanced cancer starting a new line of systemic treatment. METHODS This secondary analysis of GAP 70+ Trial (PI: Mohile) enrolled patients aged 70+ with advanced cancer, had ≥ 1 geriatric assessment domain impairment and planned to start a new antineoplastic regimen with a high risk of toxicity. Polypharmacy (concurrent use of ≥ 8 medications (meds)) was assessed before initiation of treatment. PIM were categorized using Screening Tool of Older Person's Prescriptions (STOPP) criteria and 2019 Beers criteria. Physical functional outcomes were assessed within 3 months of treatment initiation: (1) Activity of Daily Living (ADL) decline: 1-point decrease in ADL score between baseline and 3 months; (2) Instrumental ADL (IADL) decline: 1-point decrease in IADL score between baseline and 3 months; (3) Short physical performance battery (SPPB) decline, defined as 1-point decrease on SPPB; (4) ≥ 1 falls within 3 months of treatment. Separate multivariable, cluster-weighted Generalized Estimating Equations models adjusted for relevant covariates (e.g., age, baseline function/comorbidities). RESULTS Among 616 participants, mean number of meds was 6 (range 0-24); 28% received ≥ 8 meds. Polypharmacy was associated with increased risk of ADL decline (adjusted risk ratio [aRR], 1.31; 95% CI, 1.00-1.71). Taking ≥ 1 PIM per STOPP was associated with increased risk of IADL decline (aRR, 1.21; 95% CI, 1.04-1.40) and falls (aRR, 1.93; 95% CI, 1.49-2.51). CONCLUSIONS In a large cohort of vulnerable older adults with advanced cancer receiving systemic treatment, polypharmacy and PIM were independently associated with an increased risk of physical functional decline. This emphasizes the need to develop interventions to optimize medication use, intending to improve outcomes in these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02054741. Registered 01-31-2014.
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Affiliation(s)
- Mostafa R Mohamed
- Department of Public Health, University of Rochester, Rochester, NY, USA.
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
| | - Katherine Juba
- Department of Pharmacy Practice, Wegmans School of Pharmacy, Rochester, NY, USA
| | - Hala Awad
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Marie Flannery
- University of Rochester School of Nursing, Rochester, NY, USA
| | - Eva Culakova
- Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Megan Wells
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Jenna Cacciatore
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Marielle Jensen-Battaglia
- Department of Public Health, University of Rochester, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Supriya Mohile
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
| | - Erika Ramsdale
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA
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de Waal MWM, Jansen M, Bakker LM, Doornebosch AJ, Wattel EM, Visser D, Smit EB. Construct validity, responsiveness, and interpretability of the Utrecht Scale for Evaluation of Rehabilitation (USER) in patients admitted to inpatient geriatric rehabilitation. Clin Rehabil 2024; 38:98-108. [PMID: 37743801 PMCID: PMC10631283 DOI: 10.1177/02692155231203095] [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: 11/01/2022] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The Utrecht Scale for Evaluation of Rehabilitation is a multi-domain measurement with good content validity, structural validity and reliability for measuring physical functioning (mobility, selfcare) and cognitive functioning in geriatric rehabilitation. We aimed to determine the construct validity of both Utrecht Scale for Evaluation of Rehabilitation scales and the responsiveness and interpretability of the scale for physical functioning in geriatric rehabilitation. DESIGN Prospective follow-up study embedded in routine care. SETTING Four care organisations in The Netherlands. SUBJECTS Patients admitted for inpatient geriatric rehabilitation (2021-2022). MAIN MEASURES Data collection included the Utrecht Scale for Evaluation of Rehabilitation, Mini-Mental State Examination, Barthel index, and a global rating scale anchor on recovery. Hypothesis testing was used to determine construct validity and responsiveness. For interpretability, minimal important change and floor and ceiling effects were determined. RESULTS The mean age of participants (n = 211) was 77 (SD 10.4). Their mean length of stay was 38.6 days (SD 26.3), and 81% returned home. The Utrecht Scale for Evaluation of Rehabilitation showed adequate construct validity, as all three hypotheses were confirmed for both scales. The Utrecht Scale for Evaluation of Rehabilitation-physical function scale showed adequate responsiveness, with all five hypotheses confirmed. The mean change for physical function (scale range 0-70) was 15.5 points (SD 17.1). The minimal important change for Utrecht Scale for Evaluation of Rehabilitation-physical function was 14.5 points difference for improvement. This scale showed no floor (2%) and ceiling effects (14%) at admission and discharge. CONCLUSIONS The Utrecht Scale for Evaluation of Rehabilitation showed to be effective for evaluating physical functioning during geriatric rehabilitation as well as screening cognitive functioning. In total, 14.5 points difference has been established as a minimal important change for physical functioning.
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Affiliation(s)
- Margot W M de Waal
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Michael Jansen
- Faculty of Health, Physiotherapy, University of Applied Sciences Leiden, Leiden, the Netherlands
- Woon Zorgcentra Haaglanden (WZH), The Hague, the Netherlands
| | - Loes M Bakker
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Arno J Doornebosch
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- de Zorgcirkel, Purmerend, the Netherlands
| | - Dennis Visser
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- de Zorgcirkel, Purmerend, the Netherlands
| | - Ewout B Smit
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- University Network of care for Older people of Amsterdam UMC (UNO Amsterdam), Amsterdam UMC, Amsterdam, the Netherlands
- Vivium Zorggroep, Naarden, the Netherlands
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Giacomino K, Hilfiker R, Beckwée D, Taeymans J, Sattelmayer KM. Assessment tools and incidence of hospital-associated disability in older adults: a rapid systematic review. PeerJ 2023; 11:e16036. [PMID: 37872951 PMCID: PMC10590575 DOI: 10.7717/peerj.16036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/14/2023] [Indexed: 10/25/2023] Open
Abstract
Background During hospitalization older adults have a high risk of developing functional impairments unrelated to the reasons for their admission. This is termed hospital-associated disability (HAD). This systematic review aimed to assess the incidence of HAD in older adults admitted to acute care with two outcomes: firstly in at least one activity of daily living from a set of functional tasks (e.g., Katz Index) and secondly the incidence of functional decline in an individual functional task (e.g., bathing), and to identify any tools or functional tasks used to assess activities of daily living (ADL) in hospitalized older patients. Methods A rapid systematic review was performed according to the recommendations of the Cochrane Rapid Reviews Methods Group and reported the data according the PRISMA statement. A literature search was performed in Medline (via Ovid), EMBASE, and Cochrane Central Register of Controlled Trials databases on 26 August 2021. Inclusion criteria: older adults (≥65 years), assessment of individual items of activities of daily living at baseline and discharge. Exclusion criterion: studies investigating a specific condition that could affect functional decline and studies that primarily examined a population with cognitive impairment. The protocol was registered on OSF registries (https://osf.io/9jez4/) identifier: DOI 10.17605/OSF.IO/9JEZ4. Results Ten studies were included in the final review. Incidence of HAD (overall score) was 37% (95% CI 0.30-0.43). Insufficient data prevented meta-analysis of the individual items. One study provided sufficient data to calculate incidence, with the following values for patients' self-reported dependencies: 32% for bathing, 27% for dressing, 27% for toileting, 30% for eating and 27% for transferring. The proxy reported the following values for patients' dependencies: 70% for bathing, 66% for dressing, 70% for toileting, 61% for eating and 59% for transferring. The review identified four assessment tools, two sets of tasks, and individual items assessing activities of daily living in such patients. Conclusions Incidence of hospital-associated disability in older patients might be overestimated, due to the combination of disease-related disability and hospital-associated disability. The tools used to assess these patients presented some limitations. These results should be interpreted with caution as only one study reported adequate information to assess the HAD incidence. At the item level, the latter was higher when disability was reported by the proxies than when it was reported by patients. This review highlights the lack of systematic reporting of data used to calculate HAD incidence. The methodological quality and the risk of bias in the included studies raised some concerns.
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Affiliation(s)
- Katia Giacomino
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Rehabilitation Research (RERE) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Valais-Wallis, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Valais-Wallis, Switzerland
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Rehabilitation Research (RERE) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Taeymans
- Division of Physiotherapy, Department of Health Professions, University of Applied Sciences Bern, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Coste J, Pérès K, Robine JM, Carcaillon-Bentata L. Dimensionality and invariance of ADL, IADL, BI-M2/WG-SS, and GALI in large surveys in France (2008-2014) and implications for measuring disability in epidemiology. Arch Public Health 2023; 81:141. [PMID: 37544985 PMCID: PMC10405560 DOI: 10.1186/s13690-023-01164-6] [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: 09/24/2022] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The epidemiological investigation and surveillance of disability requires well-constructed, invariant, and, if possible, exchangeable measures. However, the current or recommended measures have not been thoroughly investigated with respect to these issues. Here we examined the dimensional structure and invariance of four measures across sociodemographic groups: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Budapest Initiative Mark 2 (BI-M2) and Washington Group on Disability Statistics Short Set (WG-SS), and Global Activity Limitation Indicator (GALI). METHODS We used data from three large nationwide representative surveys conducted in France between 2008 and 2014. The surveys included these four measures and classical and modern approaches (correlations, principal component analysis, Rasch modeling) were used to assess their dimensional structure as well as their invariance through differential item functioning (DIF) for sociodemographic characteristics. Polytomous logistic regression models were used to assess gradients in health inequalities associated with these measures. RESULTS For many items of ADL, IADL, and BI-M2/WG-SS, we consistently observed disordered response thresholds, rejection of unidimensionality, and DIF evidence for sociodemographic characteristics across the survey samples. Health inequality gradients were erratic. In addition, it was impossible to identify a common continuum for GALI, ADL, IADL, and BI-M2/WG-SS or their constituent items. CONCLUSION This study warns against the current practice of investigating disability in epidemiology using measures that are unsuitable for epidemiological use, incommensurable, and inadequate regarding the basic requisites of dimensionality and invariance. Developing invariant measures and equating them along a common continuum to enlarge the common bases of measurement should therefore be a priority.
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Affiliation(s)
- Joël Coste
- Santé publique France (French national public health agency), Saint-Maurice, France.
| | - Karine Pérès
- University of Bordeaux, INSERM, Bordeaux Population Health, U1219, Bordeaux, France
| | - Jean-Marie Robine
- 3MMDN, University of Montpellier, EPHE, INSERM, Montpellier, France
- PSL Research University, Paris, France
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5
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Dehydration and hospital-associated disability in acute hospitalized older adults. Eur Geriatr Med 2023; 14:113-121. [PMID: 36445641 DOI: 10.1007/s41999-022-00722-5] [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: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Dehydration is highly prevalent in hospitalized older adults and has been linked to poor outcomes. It is considered a modifiable factor, so early identification and intervention may avoid adverse events and improve quality of life after discharge. Hospital-associated disability (HAD) is known to be a poor prognostic factor and can be categorized into mobility impairment and self-care impairment in setting goals for management. Few studies have directly examined the association between dehydration and HAD and therefore here we examined whether dehydration is a predictor of HAD categorized into mobility and self-care impairment among acute hospitalized older adults. METHODS Patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital were recruited for this prospective cohort study. Estimated serum osmolarity > 300 mOsm/kg was defined as current dehydration. HAD was assessed between baseline and discharge and at 3 months after discharge, and was evaluated separately for mobility and self-care impairments. RESULTS In total, 192 patients (mean age, 84.7 years; male, 41.1%; dehydration, 31.3%) were analyzed. The occurrence of HAD was significantly higher in the dehydrated group than in the non-dehydrated group (42.4% vs 26.5%) from baseline to 3 months after discharge. In multiple logistic regression analysis, dehydration was significantly associated with HAD in self-care from baseline to 3 months after discharge (odds ratio, 2.25; 95% confidence interval, 1.03-4.94). CONCLUSIONS Dehydration could predict the occurrence of HAD in acute hospitalized older adults. A multifaceted approach may be necessary to improve the management of dehydration in these patients.
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Martínez-Velilla N, Buurman BM. Editorial: Towards a Real Personalized Geriatric Medicine: The Example of the Prevention of Hospital-Acquired Disability. J Nutr Health Aging 2023; 27:411-412. [PMID: 37357323 DOI: 10.1007/s12603-023-1936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Affiliation(s)
- N Martínez-Velilla
- N. Martínez-Velilla, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain,
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Luna-Aleixos D, Llagostera-Reverter I, Castelló-Benavent X, Aquilué-Ballarín M, Mecho-Montoliu G, Cervera-Gasch Á, Valero-Chillerón MJ, Mena-Tudela D, Andreu-Pejó L, Martínez-Gonzálbez R, González-Chordá VM. Development and Validation of a Meta-Instrument for Nursing Assessment in Adult Hospitalization Units (VALENF Instrument) (Part I). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14622. [PMID: 36429341 PMCID: PMC9690557 DOI: 10.3390/ijerph192214622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Nursing assessment is the basis for performing interventions that match patient needs, but nurses perceive it as an administrative load. This research aims to develop and validate a meta-instrument that integrates the assessment of functional capacity, risk of pressure ulcers and risk of falling with a more parsimonious approach to nursing assessment in adult hospitalization units. Specifically, this manuscript presents the results of the development of this meta-instrument (VALENF instrument). A cross-sectional study based on recorded data was carried out in a sample of 1352 nursing assessments. Socio-demographic variables and assessments of Barthel, Braden and Downton indices at the time of admission were included. The meta-instrument's development process includes: (i) nominal group; (ii) correlation analysis; (iii) multiple linear regressions models; (iv) reliability analysis. A seven-item solution showed a high predictive capacity with Barthel (R2adj = 0.938), Braden (R2adj = 0.926) and Downton (R2adj = 0.921) indices. Likewise, reliability was significant (p < 0.001) for Barthel (ICC = 0.969; τ-b = 0.850), Braden (ICC = 0.943; τ-b = 0.842) and Downton (ICC = 0.905; κ = 7.17) indices. VALENF instrument has an adequate predictive capacity and reliability to assess the level of functional capacity, risk of pressure injuries and risk of falls.
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Affiliation(s)
- David Luna-Aleixos
- Hospital Universitario de La Plana, Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Irene Llagostera-Reverter
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Marta Aquilué-Ballarín
- Hospital Comarcal Universitario de Vinarós, Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Águeda Cervera-Gasch
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - María Jesús Valero-Chillerón
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Desirée Mena-Tudela
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Laura Andreu-Pejó
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
| | | | - Víctor M. González-Chordá
- Nursing Research Group (GIENF Code 241), Nursing Department, Universitat Jaume I, 12006 Castelló de la Plana, Spain
- Nursing and Healthcare Research Unit (INVESTÉN-ISCIII), Institute of Health Carlos III, 28029 Madrid, Spain
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Veldhuizen JD, Schuurmans MJ, Mikkers MC, Bleijenberg N. Exploring nurse-sensitive patient outcomes in Dutch district nursing care: A survey study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5624-e5636. [PMID: 36089814 PMCID: PMC10087021 DOI: 10.1111/hsc.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 07/04/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
There is a lack of evidence to guide district nurses in using nurse-sensitive patient outcomes as it is unclear how these outcomes are currently used in daily district nursing practice. Therefore, we aimed to explore (1) which nurse-sensitive patient outcomes are measured and how these outcomes are measured, (2) how district nurses use the outcomes to learn from and improve current practice and (3) the barriers and facilitators to using outcomes in current district nursing practice. An exploratory cross-sectional survey study was conducted. The survey was distributed online among nurses working for various district nursing care organisations across the Netherlands. The responses from 132 nurses were analysed, demonstrating that different instruments or questionnaires are available and used in district nursing care as outcome measures. The nurse-sensitive patient outcomes most often measured with validated instruments are pain using the Numeric Rating Scale or Visual Analogue Scale, delirium using the Delirium Observation Scale, weight loss using the Short Nutritional Assessment Questionnaire and caregiver burden using the Caregiver Strain Index or a Dutch equivalent. Falls and client satisfaction with delivered care are most often measured using unvalidated outcome measures. The other nurse-sensitive outcomes are measured in different ways. Outcomes are measured, reported and fed back to the nursing team multiple times and in various ways to learn from and improve current practice. In general, nurses have a positive attitude towards using nurse-sensitive outcomes in practice, but there is a lack of facilitation to support them. Because insight into how nurses can and should be supported is still lacking, exploring their needs in further research is desirable. Additionally, due to the high variation in the utilisation of outcomes in current practice, it is recommended to create more uniformity by developing (inter)national guidelines on using nurse-sensitive patient outcomes in district nursing care.
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Affiliation(s)
- Jessica D. Veldhuizen
- Research Centre for Healthy and Sustainable Living, Faculty of Health CareUniversity of Applied Sciences UtrechtUtrechtThe Netherlands
| | - Marieke J. Schuurmans
- Department of General Practice, Division Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Education Center, UMC Utrecht AcademyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Dutch Healthcare Authority (NZa)UtrechtThe Netherlands
| | - Misja C. Mikkers
- Dutch Healthcare Authority (NZa)UtrechtThe Netherlands
- Department of EconomicsTilburg School of Economics and ManagementTilburgThe Netherlands
| | - Nienke Bleijenberg
- Research Centre for Healthy and Sustainable Living, Faculty of Health CareUniversity of Applied Sciences UtrechtUtrechtThe Netherlands
- Department of General Practice, Division Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
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Almeida JRDS, Solano L, Freire MAM, Oliveira LC. Health profile of the elderly person accompanied by the family health strategy in a countryside of Ceará - Brazil. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i3.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective: To evaluate the correlation between functional dependence and emotional state, cognitive function, and ambulation of the elderly people accompanied by a family health team. Methods: A cross-sectional, quantitative, and prospective study was conducted in the city of Quixeré/CE between August 2020 and April 2021. Participated in 229 elderly people registered in the Family Health Strategy teams evaluated using the Lawton scale, MMSE, GDS-15, and Tinneti test. The association of variables was verified using the chi-square or Fisher's exact tests. Odds Ratio (95%CI) were calculated, followed by logistic regression using the Hosmer and Lemeshow test. Results: The sample was primarily composed of women with low education, average age of 70 years, and a high demand for primary health services. Women were more vulnerable to depression, with no difference in falls related to sex. Age was a risk factor for all aspects evaluated. There was a correlation between functional dependence and all aspects analyzed. There was a relationship between the level of functional dependence and education (OR: 2.0; 95%CI: 0.05 - 78.32), living in the rural area (OR: 2.83; 95%CI: 1.6 - 5.1), depression (OR: 5.18; 95%CI: 1.2 – 22.8) and risk of falls (OR: 1.67 CI: 0.8 – 3.5), with the last two factors remaining significant in the logistic regression. Conclusion: Functional dependence to more complex daily activities among the elderly was significant, with an essential relationship with emotional and cognitive aspects and risk of falls.
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Nyankoué Mebouinz F, Tchakounte Youngui B. Autonomy of the elderly after a hip fracture surgery in a subsaharan country. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221085717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The aim of this study was to assess the impact of surgery on autonomy in the elderly after a fracture of the proximal femur; and the factors associated with its alteration. Materials and methods: A prospective longitudinal study was performed on 66 patients aged at least 90 years treated for a fracture of the proximal femur between 2008 and 2017. Physical autonomy was assessed using the Katz scale Results: After the surgical management, the previous level of autonomy was found progressively increasing in 9.1% at 1 month, 17.5% in the 3rd month, 23.5% in the 6th month and 22% at 1 year ( P value <0.001). The factors associated with the deterioration in patient autonomy one month postoperatively were as follows: late admission ( P = 0.02), a period of verticalization greater than 15 days ( P = 0.02), at least one complication of decubitus ( P = 0.004), anemia ( P = 0.02) and an ASA score ≥ 2 ( P = 0.05). The comparison of the autonomy between hip fixation and hip prosthetic replacement did not show a significant difference in the first postoperative month ( P = 0.83). Conclusion: Even at over 90 years of age, surgery can significantly restore previous autonomy. The early admission and management of patients, the prevention of complications in the decubitus position, the early rise after surgery and the management of anemia are key points in restoring physical autonomy.
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Geyskens L, Jeuris A, Deschodt M, Van Grootven B, Gielen E, Flamaing J. Patient-related risk factors for in-hospital functional decline in older adults: A systematic review and meta-analysis. Age Ageing 2022; 51:6527380. [PMID: 35165688 DOI: 10.1093/ageing/afac007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Functional decline (FD) is a common and serious problem among hospitalised older adults. OBJECTIVE This systematic review and meta-analysis aims to identify patient-related risk factors for in-hospital FD in older adults. METHODS Previous reviews on this topic (1970-2007) and the databases PubMed, Embase, and CINAHL (January 2007-December 2020) were searched. Reference lists of included articles were screened. Studies investigating patient-related risk factors for FD from (pre)admission to discharge in older adults admitted to an acute geriatric or internal medical unit were included. Study quality was assessed using the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. The quality of evidence was assessed using GRADE. RESULTS Twenty-nine studies met the inclusion criteria. Statistically significant risk factors were living in a nursing home (OR, 2.42; 95% CI, 1.29-4.52), impairment in instrumental activities of daily living (OR, 2.08; 95% CI, 1.51-2.86), history of falls (OR, 1.71; 95% CI, 1.00-2.92), cognitive impairment (OR, 1.83; 95% CI, 1.56-2.14), dementia (OR, 1.71; 95% CI, 1.23-2.38), delirium (OR, 2.34; 95% CI, 1.88-2.93), (risk of) malnutrition (OR, 1.76; 95% CI, 1.03-3.03), hypoalbuminemia (OR, 1.79; 95% CI, 1.36-2.36), comorbidity (OR, 1.09; 95% CI, 1.03-1.16), and the presence of pressure ulcers (OR, 3.33; 95% CI, 1.82-6.09). The narrative synthesis suggested prehospital FD, needing assistance with walking, and low body mass index as additional risk factors. CONCLUSIONS Several patient-related risk factors for in-hospital FD were identified that can be used at hospital admission to identify older patients at risk of FD.
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Affiliation(s)
- Lisa Geyskens
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
| | - Anthony Jeuris
- Department of Geriatric Medicine, Jessa Hospital, Hasselt 3500, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Leuven 3000, Belgium
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Research Foundation Flanders, Brussels 1000, Belgium
| | - Evelien Gielen
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven 3000, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven 3000, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven 3000, Belgium
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12
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Okuno S, Yamashita T, Shirado K, Kawamitsu K, Yamabe K, Onishi Y, Ogami T, Kayashima H. Effects of Early Physical Therapist-supervised Walking on Clinical Outcomes after Liver Resection: Propensity Score Matching Analysis. Phys Ther Res 2022; 24:225-231. [PMID: 35036256 DOI: 10.1298/ptr.e10107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The study aimed to demonstrate the significance of early postoperative physical therapy interventions on clinical outcomes by determining the influence of the distance walked under the supervision of a physical therapist in the early postoperative period after liver cancer. METHODS All consecutive patients who underwent surgery for liver cancer between April 2018 and March 2020 were eligible for enrollment in the study. The total walking distance during physical therapy till the third postoperative day was examined. The clinical outcomes comprised duration of postoperative hospital stay, time to independent walking, and occurrence of postoperative complications. For data analysis, the patients were divided into two groups: those who walked more than the median total distance (the long-distance group) and those who walked less than the median distance (the short-distance group). We used propensity score matching to match the background characteristics between the groups. RESULTS Of the 65 patients who were eligible, 14 patients were included in the two groups each, after matching. The long-distance walking group had a significantly shorter hospital stay (9.0 days vs. 11.0 days, p=0.008) and a shorter time to independent walking (3.5 days vs. 7.5 days, p=0.019) than the short-distance walking group. There were no significant differences in postoperative complications between the two groups (7.1% vs. 42.8%, p=0.08). CONCLUSION In the early postoperative period after liver cancer surgery, increasing the walking distance under the supervision of a physical therapist is important for improving clinical outcomes. Further prospective studies are needed to confirm the findings of this study.
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Affiliation(s)
- Shota Okuno
- Department of Rehabilitation, Aso Iizuka Hospital Co.,Ltd., Japan
| | | | - Kengo Shirado
- Department of Rehabilitation, Aso Iizuka Hospital Co.,Ltd., Japan
| | - Kenta Kawamitsu
- Department of Rehabilitation, Aso Iizuka Hospital Co.,Ltd., Japan
| | - Kaede Yamabe
- Department of Rehabilitation, Aso Iizuka Hospital Co.,Ltd., Japan
| | - Yutaro Onishi
- Department of Rehabilitation, Aso Iizuka Hospital Co.,Ltd., Japan
| | - Taichi Ogami
- Department of Rehabilitation, Aso Iizuka Hospital Co.,Ltd., Japan
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13
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Melo ATL, Menezes KVRS, Auger C, Barbosa JFDS, Menezes WRDS, Guerra RO. SPPB as a predictor of functional loss of hospitalized older adults. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Immobility is associated with adverse outcomes such as loss of functional capacity and longer hospitalization. Objective: To assess intra-hospital mobility at admission as a predictor of loss of functional capacity during older adults´ hospitalization. Methods: A prospective cohort study was conducted, and personal and hospital related risk factors were assessed at admission and discharge. To determine whether Short Physical Performance Battery (SPPB) on admission could predict loss of functional capacity during hospitalization, a ROC curve was performed and area under the curve (AUC) was calculated. Binary logistic regression models were used to identify predictors of loss of functional capacity. Model 1 contained only SPPB. Model 2 SPPB was matched with age, sex, instrumental activity of daily living (IADL), cognition, depression and surgery. Data were entered into SPSS version 18.0. Results: 1,191 patients were included with a mean age of 70.02 (± 7.34). SPPB cutoff point of 6.5 (sensitivity 62%, specificity 54%) identified 593 (49.8%) patients at risk for functional loss. In logistic regression, SPPB alone showed prediction of functional loss (p < 0.001, OR 1.8, 95% CI = 1.5-2.5) between admission and discharge. Model 1 explained between 22 to 32% of the variation in functional capacity. In Model 2, three variables contributed to the loss. SPPB 6.5 increased 1.8 times (95% CI = 1.3-2.4), being a woman increased 1.4 times (95% CI = 1.0-1.8) and not having surgery increased 2 times (95% CI = 1.4-2.8) the chance of having functional loss during hospitalization. Conclusion: SPPB is a good instrument to predict loss of functional capacity in hospitalized older adults.
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14
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Nagae M, Umegaki H, Yoshiko A, Fujita K, Komiya H, Watanabe K, Yamada Y, Sakai T. Muscle Evaluation and Hospital-Associated Disability in Acute Hospitalized Older Adults. J Nutr Health Aging 2022; 26:681-687. [PMID: 35842758 PMCID: PMC9194346 DOI: 10.1007/s12603-022-1814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to examine the association of muscle evaluation, including muscle ultrasound, with hospital-associated disability (HAD), focusing on ADL categories. DESIGN A prospective observational cohort study. SETTING AND PARTICIPANTS We recruited patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital between October 2019 and September 2021. MEASUREMENTS Handgrip strength, bioimpedance analyzer-determined skeletal muscle mass, bilateral thigh muscle thickness (BATT), and the echo intensity of the rectus femoris on muscle ultrasound were performed as muscle assessments. HAD was evaluated separately for mobility impairments and self-care impairments. RESULTS In total, 256 individuals (mean age, 85.2 years; male sex, 41.8%) were analyzed. HAD in mobility was more common than HAD in self-care (37.5% vs. 30.0%). Only BATT was independently associated with HAD in mobility in multiple logistic regression analysis. There was no significant association between muscle indicators and HAD in self-care. CONCLUSION A lower BATT was associated with a higher prevalence of HAD in mobility, suggesting the need to reconsider muscle assessment methods in hospitalized older adults. In addition, approaches other than physical may be required, such as psychosocial and environmental interventions to improve HAD in self-care.
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Affiliation(s)
- M Nagae
- Hiroyuki Umegaki. Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. E-mail:
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15
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Levin C, Rand D, Gil E, Agmon M. The relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults - A systematic review. J Clin Nurs 2021. [PMID: 34741360 DOI: 10.1111/jocn.16085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Although low ambulation among older adults has been linked to a broad range of adverse outcomes during and after acute hospitalisation, a systematic inquiry of the link between step count and these consequences is required. Therefore, the main purpose of this study is to systematically review the relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults. METHODS The electronic databases MEDLINE, CINAHL, and Embase were searched for studies including older adults (above age 65) hospitalised in acute internal wards. The search included the following key terms: 'accelerometer', 'step count', 'hospital', 'internal ward', and 'older adults'. Step count measurement linked to short- and/or long-term outcome(s) during and/or after hospitalisation. All types of articles (except reviews) in English from 1990 to May 2020 were considered. The Newcastle-Ottawa Scale was used to assess the quality of the included observational studies. Randomised controlled trials (RCT) were evaluated using the PEDro scale. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. RESULTS The search yielded 1340 articles, and of those, the inclusion criteria were met by 12 studies: eight prospective, three interventional (one randomised controlled trial), and one case-control. These studies included three major adverse hospitalisation outcomes associated with step count: functional decline, longer length of stay, and higher re-hospitalisation rate; however, the large heterogeneity in the studies' methodology makes meta-analysis impossible. CONCLUSIONS Daily step count during hospitalisation of older adults is negatively associated with adverse outcomes, but causation cannot be inferred due to inconsistent outcomes and various methodological limitations. More studies are needed to illuminate causal pathways and mechanisms underlying these relationships, especially to differentiate between the relative contribution of personal versus environmental factors.
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Affiliation(s)
- Chedva Levin
- Nursing Department, Faculty of School of Life and Health Sciences, The Jerusalem College of Technology-Lev Academic Center, Jerusalem, Israel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Debbie Rand
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Gil
- Clalit Health Services, Faculty of Medicine, Haifa and West Galilee and Carmel Hospital, Technion, Haifa, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Bruijnen CP, de Groot LGR, Vondeling AM, de Bree R, van den Bos F, Witteveen PO, Emmelot-Vonk MH. Functional decline after surgery in older patients with head and neck cancer. Oral Oncol 2021; 123:105584. [PMID: 34742007 DOI: 10.1016/j.oraloncology.2021.105584] [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: 09/02/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important endpoints, especially for elderly patients. However, little is known about the long-term effect of surgery with regard to these other outcomes. Our aim is to investigate the functional status and self-reported health status of patients ≥ 70 years one year after surgery for head and neck cancer. METHODS We present one-year follow-up data of patients ≥ 70 year who underwent surgery for HNC. During an interview by telephone, functional status was evaluated by using the Katz-15 Index of Independence questionnaire including six items covering basic Activities of Daily Living (ADL) and nine items covering Instrumental Activities of Daily Living (IADL). Measurements were compared with those obtained preoperatively. RESULTS In total, 126 patients were included and eventually we collected follow-up data of 68 patients. There was a statistically significant decrease in functional status on the total Katz-15 and on the IADL questionnaire scores one year after surgery (mean 1.34 versus 2.42,p-value 0.00 and mean 1.21 versus 1.94,p-value 0.00). There was no significant change concerning ADL dependence (p-value 0.18) and cognitive status (p-value 0.11). The self-reported health status improved postoperatively, although not statistically significantly so (mean 67.36 versus 71.25,p-value 0.12). CONCLUSION Approximately-one year after surgery for HNC, there is a significant decline in functional status indicating a higher level of dependency.
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Affiliation(s)
- Cheryl P Bruijnen
- The department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Lotte G R de Groot
- The department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ariel M Vondeling
- The department of Geriatrics, Diakonessenhuis, Utrecht, the Netherlands
| | - Remco de Bree
- The department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frederiek van den Bos
- The department of Geriatrics, Leids University Medical Center, Leiden, the Netherlands
| | - Petronella O Witteveen
- The department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Jansen M, Doornebosch AJ, de Waal MW, Wattel EM, Visser D, Spek B, Smit EB. Psychometrics of the observational scales of the Utrecht Scale for Evaluation of Rehabilitation (USER): Content and structural validity, internal consistency and reliability. Arch Gerontol Geriatr 2021; 97:104509. [PMID: 34509903 DOI: 10.1016/j.archger.2021.104509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Establish content and structural validity, internal consistency, inter-rater reliability, and measurement error of the physical and cognitive scales of the Utrecht Scale for Evaluation clinical Rehabilitation (USER) in geriatric rehabilitation. MATERIAL AND METHODS First, an expert consensus-meeting (N=7) was organised for content validity wherein scale content validity index (CVI) was measured. Second, in a sample of geriatric rehabilitation patient structural validity (N=616) was assessed by confirmatory factor analyses for exploring unidimensionality. Cut-off criteria were: Root Mean Square Error of Approximation (RMSEA) ≤0.08; Comparative Fit Index (CFI) and Tucker Lewis Index (TLI) ≥0.95. Local independence (residual correlation<0.20) and monotonicity (Hi-coefficient ≥0.30 and Hs-coefficient ≥0.50) were also calculated. Cronbach alphas were calculated for internal consistency. Alpha's > 0.7 was considered adequate. Third, two nurses independently administered the USER to 37 patients. Intraclass-correlation coefficients (ICC) were calculated for inter-rater reliability (IRR), standard error of measurement (SEM) and Smallest Detectable Change (SDC). RESULTS The CVI for physical functioning was moderate (0.73) and excellent for cognitive functioning (0.97). Structural validity physical scale was acceptable (CFI;0.95, TLI;0.93, RMSEA;0.07, ECV;0.78, OmegaH;0.87; Monotonicity;(Hi;0.52-0.75 and Hs;0.63)). Cognitive scale was good (CFI;0.98, TLI;0.96, RMSEA;0.05, ECV;0.66 and OmegaH;0.90. Monotonicity;(Hi;0.30 -0.70 and Hs;0.61)). Cronbach's alpha were high: physical scale;0.92 and cognitive scale;0.94. Reliability physical scale ICC;0.94, SEM;5 and SDC;14 and cognitive scale ICC;0.88, SEM;5 and SDC;13. CONCLUSION The observational scales of the USER have shown sufficient content and structural validity, internal consistency, and interrater reliability for measuring physical and cognitive function in geriatric rehabilitation. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Michael Jansen
- Faculty of health, Physiotherapy, University of applied sciences Leiden, Leiden, The Netherlands; Woon Zorgcentra Haaglanden (WZH), The Hague, The Netherlands.
| | - Arno J Doornebosch
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherland
| | - Margot Wm de Waal
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherland
| | - Elizabeth M Wattel
- Department of Medicine for Older People Amsterdam University Medical Centres - VU Amsterdam, Amsterdam, The Netherlands
| | - Dennis Visser
- Department of Medicine for Older People Amsterdam University Medical Centres - VU Amsterdam, Amsterdam, The Netherlands
| | - Bea Spek
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Ewout B Smit
- Department of Medicine for Older People Amsterdam University Medical Centres - VU Amsterdam, Amsterdam, The Netherlands; Vivium Zorggroep Naarden, The Netherlands.
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18
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Nielsen LM, Oestergaard LG, Kirkegaard H, Maribo T. Construct Validity and Clinical Utility of World Health Organization Disability Assessment Schedule 2.0 in Older Patients Discharged From Emergency Departments. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:710137. [PMID: 36188825 PMCID: PMC9397984 DOI: 10.3389/fresc.2021.710137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022]
Abstract
Introduction: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is designed to measure functioning and disability in six domains. It is included in the International Classification of Diseases 11th revision (ICD-11). The objective of the study was to examine the construct validity of WHODAS 2.0 and describe its clinical utility for the assessment of functioning and disability among older patients discharged from emergency departments (EDs). Material and Methods: This cross-sectional study is based on data from 129 older patients. Patients completed the 36-item version of WHODAS 2.0 together with the Barthel-20, the Assessment of Motor and Process Skills (AMPS), Timed Up and Go (TUG), and the 30-Second Chair Stand Test (30 s-CST). Construct validity was examined through hypothesis testing by correlating the WHODAS with the other instruments and specifically the mobility domain in WHODAS 2.0 with the TUG and 30 s-CST tests. The clinical utility of WHODAS 2.0 was explored through floor/ceiling effect and missing item responses. Results: WHODAS 2.0 correlated fair with Barthel-20 (r = -0.49), AMPS process skills (r = -0.26) and TUG (r=0.30) and correlated moderate with AMPS motor skills (r = -0.58) and 30s-CST (r = -0.52). The WHODAS 2.0 mobility domain correlated fair with TUG (r = 0.33) and moderate with 30s-CST (r = -0.60). Four domains demonstrated floor effect: D1 "Cognition," D3 "Self-care," D4 "Getting along," and D5 "Household." Ceiling effect was not identified. The highest proportion of missing item responses were present for Item 3.4 (Staying by yourself for a few days), Item 4.4 (Making new friends), and Item 4.5 (Sexual activities). Conclusion: WHODAS 2.0 had fair-to-moderate correlations with Barthel-20, AMPS, TUG, and 30s-CST and provides additional aspects of disability compared with commonly used instruments. However, the clinical utility of WHODAS 2.0 applied to older patients discharged from EDs poses some challenges due to floor effect and missing item responses. Accordingly, patient and health professional perspectives need further investigation.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Occupational Therapy, Research Centre for Health and Welfare Technology, VIA University College, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine, Emergency Department, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
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Nagano A, Takeuchi M, Horita N, Teshigawara T, Kawagoe T, Mizuki Y, Meguro A, Nakano H, Kirino Y, Takase-Minegishi K, Yoshimi R, Kurosawa M, Fukumoto T, Takeno M, Kaneko T, Mizuki N. Behçet's disease and activities of daily living. Rheumatology (Oxford) 2021; 61:1133-1140. [PMID: 34146088 DOI: 10.1093/rheumatology/keab499] [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: 01/18/2021] [Revised: 06/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES No large-scale registration study has comprehensively evaluated the activities of daily living (ADL) in patients with Behçet's disease (BD). METHODS The Japanese government provided us with a dataset of confirmed or suspected BD cases derived from ongoing national registration. ADL were categorized and analyzed into four categories in patients who satisfied the international criteria for BD. RESULTS Data from 2960 patients (men, 38.9%; women, 61.1%; median age 39 years) were assessed. While 1767 patients (59.7%) had normal ADL, the others had impaired ADL comprising: limited but not assisted, 1058 (35.7%); partially assisted, 116 (3.9%); and fully assisted, 19 (0.6%). Logistic regression analysis showed that chronic ocular lesions (odds ratio (OR) 1.85, 95% confidence interval (CI) 1.46-2.35, p< 0.001), paralysis (OR 2.51, 95% CI 1.58-3.97, p< 0.001), psychosis (OR 3.16, 95% CI 2.02-4.95, p< 0.001), and arthritis (OR 1.69, 95% CI 1.44-1.99, p< 0.001) led to the risk of impaired ADL (not normal ADL). Chronic ocular lesions (OR 3.61, 95% CI 2.27-5.72, p< 0.001), paralysis (OR 3.43, 95% CI 1.87-6.30, p< 0.001), and psychosis (OR 3.60, 95% CI 2.00-6.50, p< 0.001) were related to the requirement of physical assistance (partially or fully assisted), although arthritis (OR 1.39, 95% CI 0.93-2.06, p= 0.108) was not a significant factor in this model. CONCLUSION Ocular lesion, neurological manifestations, and arthritis affected ADL. Patients with ocular lesion or neurological manifestations more frequently required physical assistance.
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Affiliation(s)
- Aoi Nagano
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Takeshi Teshigawara
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Tatsukata Kawagoe
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Yuki Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Akira Meguro
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Hiroto Nakano
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, Tokyo, Japan)
| | - Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan)
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan)
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan)
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20
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Böhmer MN, Valstar MJ, Aarts MPJ, Bindels PJE, Oppewal A, van Someren EJW, Festen DAM. Shedding light on light exposure in elderly with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:361-372. [PMID: 33594722 PMCID: PMC7986740 DOI: 10.1111/jir.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Light exposure affects mood and sleep regulation. Sleep problems and mood complaints are common in elderly with intellectual disabilities (ID) living in care facilities. Insufficient light exposure is hypothesised to contribute to the high prevalence of these problems. The current study is the first to describe the personal light exposure pattern during the waking day in elderly with ID. METHODS The study sample consists of 82 elderly with ID (aged 62.3 ± 9.4 years) living in 16 residential homes of three care organisations in the Netherlands. Personal light exposure was measured continuously for 7-10 days using a HOBO data logger light sensor, measuring illuminance at chest height. Participants wore a wrist-worn accelerometer (Actiwatch or Geneactiv) to indicate the bedtimes to determine the waking day. RESULTS The variation in illuminance is small during the waking day. Elderly with ID spend most of their waking day (mean duration = 14:32:43 h) in dim light (1-500 lux) environment and spend a median of 32 min in light > 1000 lux. Within participants, the threshold associated with better sleep (>50 min of light > 1000 lux) was reached for 34% of the days, and the threshold associated with less depressive symptoms (>30 min of light > 1000 lux) was reached in 46% of the days. Exposure > 1000 lux was lower during weekends than during weekdays. CONCLUSION Elderly with ID spend most of their waking day in low light levels and did not meet the proposed values associated with better sleep and mood. Given the importance of adequate light exposure for regulation of sleep and mood, and the prevalence of sleep and mood problems in elderly with ID, the current study suggests that the lit environment for this already frail population should be given more attention.
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Affiliation(s)
- M. N. Böhmer
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical CenterRotterdamThe Netherlands
- Middin, Care Organization for People with Intellectual DisabilitiesRijswijkThe Netherlands
| | - M. J. Valstar
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical CenterRotterdamThe Netherlands
- Medical Department, Care and Service Centre for People with Intellectual DisabilitiesASVZSliedrechtThe Netherlands
| | - M. P. J. Aarts
- Building Lighting GroupEindhoven University of TechnologyEindhovenThe Netherlands
| | - P. J. E. Bindels
- Department of General PracticeErasmus MC, University Medical CenterRotterdamThe Netherlands
| | - A. Oppewal
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical CenterRotterdamThe Netherlands
| | - E. J. W. van Someren
- Department of Sleep and CognitionNetherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
- Dept. of Integrative Neurophysiology, Centre for Neurogenomics and Cognitive ResearchVrije University, Neuroscience Campus AmsterdamAmsterdamThe Netherlands
- Dept. of PsychiatryAmsterdam Public Health Research Institute, Amsterdam UMC, Vrije University, and GGZ inGeestAmsterdamThe Netherlands
| | - D. A. M. Festen
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical CenterRotterdamThe Netherlands
- Ipse de Bruggen, Care Organization for People with Intellectual DisabilitiesZoetermeerThe Netherlands
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Martínez-Velilla N, Sáez de Asteasu ML, Ramírez-Vélez R, Zambom-Ferraresi F, García-Hermoso A, Izquierdo M. Recovery of the Decline in Activities of Daily Living After Hospitalization Through an Individualized Exercise Program: Secondary Analysis of a Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2021; 76:1519-1523. [PMID: 33522565 DOI: 10.1093/gerona/glab032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND During the period of hospitalization, patients can develop functional decline. The main aim of our study was to assess the natural trajectory of each activity of daily living (ADL) and to assess how in-hospital exercise could influence short-term trajectory of ADLs. METHOD Acutely hospitalized patients (n = 297, 56.5% women) were randomly assigned to the intervention or control (usual care) group within the first 48 hours of admission. An exercise training program was prescribed in 2 daily sessions (morning and evening) of 20 minutes duration during 5-7 consecutive days for the intervention group. The primary endpoint was the change in every ADL (assessed with the Barthel Index) from 2 weeks before admission to hospital discharge. RESULTS Acute hospitalization per se led to significant in-patient's functional ability impairment in ADLs during hospitalization, whereas the exercise intervention reversed this trend (3.7 points; 95% CI: 0.5-6.8 points). After analyzing the trajectory of each one of the ADLs, patients in the control group significantly worsened all activities, but with a different degree of loss. For the between-group analysis, significant differences were obtained in many ADLs including bathing, dressing, grooming, bladder control, toilet use, transfers, mobility, and climbing stairs (p < .05). The control group had the greatest impairment in all domains analyzed (ie, feeding, bathing, dressing, grooming, bowel control, bladder control, toilet use, transfers, mobility, and climbing stairs; p < .05). CONCLUSIONS An individualized multicomponent exercise training program in older adults is effective to reverse the loss of specific ADLs that frequently occurs during hospitalization. Each patient profile should receive an individualized prescription of exercise during hospitalizations. CLINICAL TRIALS REGISTRATION NUMBER NCT02300896.
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Affiliation(s)
- Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Department of Geriatric Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Effects of a nursing care program focused on basic self-care in older acute medical in-patients: a randomized controlled trial. Porto Biomed J 2020; 5:e086. [PMID: 33532653 PMCID: PMC7846415 DOI: 10.1097/j.pbj.0000000000000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Acute illness and hospitalization are often associated with decreased independence in basic activities of daily living. The aim of this study was to test the hypothesis that a nursing care program focused on basic self-care (N_BSC) improves functional outcomes in older patients admitted to an acute medical unit. Methods This was a 2-group randomized controlled trial with repeated measures: 182 older patients admitted to an acute medical unit were randomly allocated to the usual care group (n = 91) and intervention group (n = 91). The intervention consisted of nursing care centered on basic self-care that includes promotion of daily walking and all daytime meals seated, out of bed. The main outcome was changes in the number of independent basic activities of daily living (BADL) from 2 weeks before admission (baseline) to discharge. Results There was significant effect of the N_BSC on the outcomes. Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, whereas usual care patients performed independently 1.90 BADL (P < .001). Conclusions N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients.
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23
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Zisberg A, Shulyaev K, Gur-Yaish N, Agmon M, Pud D. Symptom clusters in hospitalized older adults: Characteristics and outcomes. Geriatr Nurs 2020; 42:240-246. [PMID: 32891441 DOI: 10.1016/j.gerinurse.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Hospital care in medical patients relies mostly on objective measures with limited assessment of subjective symptoms. We subgrouped 331 hospitalized older adults with medical diagnosis (age 75.5 ± 7.1) according to the severity of multiple symptoms to explore if these subgroups differed in health-related characteristics on admission and functional outcomes one month post-discharge. Cluster analysis identified three subgroups based on experiences with five highly distressing symptoms (fatigue, dyspnea, dizziness, sleep disturbance, pain): low levels of all symptoms, high levels of all symptoms; moderate levels of four symptoms with high dyspnea. Belonging in different subgroups was accompanied by different levels of cognitive and mental, but not physical or health status. Patients in the subgroup "Moderate Levels with High Dyspnea" had significantly lower risk of decline in post-discharge instrumental activities of daily living than other subgroups. Better understanding of older hospitalized adults' symptom profiles may yield important information on health condition and recovery.
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Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel.
| | - Ksenya Shulyaev
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel
| | | | - Maayan Agmon
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel
| | - Dorit Pud
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel.
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24
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Heldmann P, Werner C, Belala N, Bauer JM, Hauer K. Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures. BMC Geriatr 2019; 19:189. [PMID: 31288750 PMCID: PMC6617943 DOI: 10.1186/s12877-019-1201-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/02/2019] [Indexed: 01/11/2023] Open
Abstract
Background Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The aim of this review was to describe primary outcome measures that have been used in randomized controlled trials (RCTs) on early rehabilitation in acutely hospitalized older patients, to analyze their matching, and to evaluate the effects of matching on the main findings of these RCTs. Methods A systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Additional studies were identified through reference and citation tracking. Inclusion criteria were: RCT, patients aged ≥65 years, admission to an acute hospital medical ward (but not to an intensive medical care unit), physical exercise intervention (also as part of multidisciplinary programs), and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure. Results Twenty-eight articles reporting on 24 studies were included. A total of 33 different primary outcome measures were identified, which were grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category and showed a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits. Conclusions This review highlights that the selection of outcome measures has to be highly specific to the intervention contents as this is a key factor to reveal benefits attributable to early rehabilitation in acutely hospitalized older patients. Inappropriate selection of outcome measures may represent a major cause of inconsistent findings reported on the effectiveness of early rehabilitation in this setting. Trial registration PROSPERO CRD42017063978. Electronic supplementary material The online version of this article (10.1186/s12877-019-1201-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Christian Werner
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany.,Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Nacera Belala
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Jürgen M Bauer
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany.,Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
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25
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Rodrigues C, Mendonça D, Martins MM. Functional trajectories of older acute medical inpatients. ENFERMERIA CLINICA 2019; 30:260-268. [PMID: 31076259 DOI: 10.1016/j.enfcli.2019.03.001] [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: 07/11/2018] [Revised: 02/16/2019] [Accepted: 03/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the changes in basic activities of daily living (BADL) function before and during hospital admission in older patients admitted to an acute medical unit and to assess the effect of age on loss of BADL function. METHODS Prospective observational study. The study included 91 patients aged 65 and older consecutively admitted to an acute medical unit of an urban public teaching hospital in Portugal, between May and September 2017. Functional status was measured at three times: at hospital admission; at about 2 weeks before hospital admission (baseline); an on the discharge day. The functional condition was evaluated using the Katz index. Differences in scores for BADL between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline. RESULTS Pre-admission, in-hospital and overall functional decline occurred in 78.0%, 4.4% and 63.7% of the participants, respectively. In contrast, in-hospital functional improvement occurred in a minority of the patients (14.3%). Hospitalized older people are discharged with BADL function that is worse than their baseline function. The oldest patients are at high risk of poorer functional outcomes because they are less likely to recover BADL function lost before admission. CONCLUSION These results emphasize the overriding need for implementing in-hospital processes to prevent functional decline and enhance functional recovery. This study also highlights the need for nurses to closely monitor the functional status of hospitalized older people, particularly in oldest-old patients.
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Affiliation(s)
- Cecília Rodrigues
- Doutoramento em Ciências de Enfermagem, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Medicina C, Departamento de Medicina, Centro Hospitalar do Porto, Porto, Portugal; Gabinete de Governação Clínica, Departamento da Qualidade, Centro Hospitalar do Porto, Porto, Portugal.
| | - Denisa Mendonça
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Maria Manuela Martins
- Escola Superior de Enfermagem do Porto, Porto, Portugal; Grupo de Investigação NursID: Inovação e Desenvolvimento em Enfermagem - Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Universidade do Porto, Porto, Portugal
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26
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Cohen Y, Zisberg A, Chayat Y, Gur-Yaish N, Gil E, Levin C, Rand D, Agmon M. Walking for Better Outcomes and Recovery: The Effect of WALK-FOR in Preventing Hospital-Associated Functional Decline Among Older Adults. J Gerontol A Biol Sci Med Sci 2019; 74:1664-1670. [DOI: 10.1093/gerona/glz025] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program’s effects on HAFD prevention.
Methods
A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton’s IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 ± 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer.
Results
Decline in BADL occurred among 33% of the CG versus 23% of the IG (p = .02) at discharge, and among 43% of the CG versus 30% in the IG (p = .01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p = .01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p = .05) at discharge and by 49% at 1-month follow-up (p = .01), and in community mobility by 63% (p = .02). There was no significant effect of the intervention on IADL decline (p = .19).
Conclusions
The WALK-FOR intervention is effective in reducing HAFD.
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Affiliation(s)
- Yaniv Cohen
- Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
| | - Yehudit Chayat
- HaEmek Medical Center, Clalit Health Services, Afula, Israel
| | - Nurit Gur-Yaish
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
| | - Efrat Gil
- Clalit Health Services, Haifa and West Galilee and Carmel Hospital, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Chedva Levin
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
- Department of Nursing, Faculty of School of Life and Health Sciences, The Jerusalem College of Technology – Lev Academic Center, Jerusalem, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
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Abstract
PURPOSE/OBJECTIVES The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. PRIMARY PRACTICE SETTING(S) This article focuses on case management of older adults transitioning from hospital to home. FINDINGS/CONCLUSIONS There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.
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28
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Matos FS, Jesus CSD, Carneiro JAO, Coqueiro RDS, Fernandes MH, Brito TA. Redução da capacidade funcional de idosos residentes em comunidade: estudo longitudinal. CIENCIA & SAUDE COLETIVA 2018; 23:3393-3401. [DOI: 10.1590/1413-812320182310.23382016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/12/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo deste estudo foi identificar a incidência e fatores de risco para a redução da capacidade funcional de idosos residentes em comunidade. Foi conduzido estudo de coorte prospectivo em duas fases, 2011 e 2014. A população do estudo foi composta por 202 idosos inicialmente independentes para as atividades básicas da vida diária. Utilizou-se como medida de associação o risco relativo (RR) e seus respectivos intervalos de confiança (IC) 95%, que foram estimados por regressão log-binomial com variância robusta. A incidência da redução de capacidade funcional foi de 15,3%. Os fatores de risco para o declínio funcional foram: estado civil sem união (RR aj = 2,75; IC95%: 1,15 – 6,57) e presença de sintomas de depressão (RR aj = 2,41; IC95%: 1,15 – 5,06), mesmo após ajuste por sexo, faixa etária, renda familiar per capita, diabetes, uso de medicamentos e nível de atividade física. A elevada incidência da redução de capacidade funcional e sua associação com aspectos da relação conjugal e de saúde mental revela a necessidade de considerar tais fatores no planejamento de ações em saúde voltadas à manutenção e recuperação da capacidade funcional dos idosos.
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Rodrigues C, Mendonça D, Martins MM. Effects of a nursing care program on functional outcomes in older acute medical in-patients: protocol for a randomized controlled trial. Porto Biomed J 2018; 4:e24. [PMID: 31595258 PMCID: PMC6726295 DOI: 10.1016/j.pbj.0000000000000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/11/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Hospitalization often leads to long periods of bed rest and inactivity which is associated with an increase in length of hospital stay, loss of capacity for basic self-care and discharge into a nursing home. Objective: This trial aims to verify if a nursing care program centered on basic self-care and predefined physical activity, improves functional outcomes in older hospitalized patients. Methods: This is a 2-group randomized controlled trial with repeated measures: 182 older acute medical patients will be blindly randomly allocated to the control group (n = 91) or intervention group (n = 91). The intervention will consist of nursing care intervention centered on basic self-care that includes a twice daily walking training, plus privileging pre-established trips to the toilet by walking and all daytime meals seated, off the bed. The main outcome was changes in the number of independent activities of daily living from 2 weeks before admission (baseline) to discharge. Trial registration: ClinicalTrials.gov (Identifier NCT03106064). Results: This intervention has the potential to change the outcomes of the older patient in the acute setting. Conclusion: The loss of independence in self-care is determinant in future health care needs. If our hypothesis is correct and demonstrate that this nursing care program centered on basic self-care for older acute medical patients improves functional outcomes, a change in the paradigmatic organization of hospital care may be justifiable.
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Affiliation(s)
- Cecília Rodrigues
- Doutoramento em Ciências de Enfermagem, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto.,Medicina C, Departamento de Medicina, Centro Hospitalar do Porto.,Gabinete de Governação Clínica, Departamento da Qualidade, Centro Hospitalar do Porto
| | - Denisa Mendonça
- Doutoramento em Ciências de Enfermagem, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto
| | - Maria Manuela Martins
- Escola Superior de Enfermagem do Porto.,Grupo de Investigação NursID: Inovação e Desenvolvimento em Enfermagem - Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Universidade do Porto, Porto, Portugal
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30
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Siemonsma PC, Blom JW, Hofstetter H, van Hespen ATH, Gussekloo J, Drewes YM, van Meeteren NLU. The effectiveness of functional task exercise and physical therapy as prevention of functional decline in community dwelling older people with complex health problems. BMC Geriatr 2018; 18:164. [PMID: 30016948 PMCID: PMC6050649 DOI: 10.1186/s12877-018-0859-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/09/2018] [Indexed: 12/05/2022] Open
Abstract
Background A physically active lifestyle in older people contributes to the preservation of good health. We assessed the influence of physiotherapy on daily functioning among community dwelling older people (75+) with complex health problems identified with screening, versus usual care. We also compared functional task exercise (FTE), with problems prioritized by older people, trained in the home environment, versus usual preventive physical therapy (PPT). Methods Design: FTE and PPT were compared in a randomized controlled trial (RCT). Both interventions were compared with daily functioning in an observational study: control group. Setting/Participants: Community-dwelling persons aged ≥75 years with daily activity limitations enlisted in 83 general practices (n = 155). Interventions: Both intervention groups (FTE, n = 76 and PPT, n = 79) received individual, 30 min treatments. The control group (n = 228) did not get any experimental intervention offered. Measurements: Groningen Activities of Daily Living Restriction Scale (GARS). Statistical analyses: Linear Mixed Model analysis, correcting for age, sex, baseline scores and clustering by physiotherapist were used to compare the different groups. Results At baseline, 74% percent of the intervention trial group was female vs 79% in the control group. Median ages were 83.9 and 84.7 respectively. The median baseline GARS-score for the control group was 41.0 (25 and 75 percentile): 35.0; 48.0) and 40.0 (25 and 75 percentile: 32.3; 46.0) for the intervention group (FTE + PPT). The mean change over time was 3.3 (2.5; 4.1) for the control group. Mean difference in change over time between the intervention (FTE + PPT) and the control group was − 2.5 (− 4.3; − 0.6) (p = .009). Between FTE and PPT the difference in change was − 0.4 (95% CI: -2.3; 3.0, p = 0.795). Conclusion An exercise intervention led by physiotherapists may slow down decline in self-reported daily functioning in older persons with daily activity limitations, identified by pro-active case finding. Trial registration Netherlands trial register (NTR2407). Registered 6th of July 2010. Electronic supplementary material The online version of this article (10.1186/s12877-018-0859-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Petra C Siemonsma
- TNO Healthy Living, Leiden, Schipholweg 77-89, 2316, ZL, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Postbox 9600, 2300, RC, Leiden, The Netherlands.
| | - Hedwig Hofstetter
- TNO Healthy Living, Leiden, Schipholweg 77-89, 2316, ZL, Leiden, The Netherlands
| | | | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne M Drewes
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico L U van Meeteren
- TNO Healthy Living, Leiden, Schipholweg 77-89, 2316, ZL, Leiden, The Netherlands.,Topsector Life Sciences and Health (Health~Holland), The Hague, the Netherlands.,CAPHRI, Maastricht University, Maastricht, the Netherlands
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31
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Rodrigues C, Mendonça D, Martins MM. Basic self-care in older acute medical in-patients: a retrospective cohort study. Porto Biomed J 2018; 3:e1. [PMID: 31595230 PMCID: PMC6726298 DOI: 10.1016/j.pbj.0000000000000001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022] Open
Abstract
Background: Older patients hospitalized for acute illness are vulnerable to decline in basic self-care. This functional decline determines future health needs and can lead to negative health outcomes. Aim: To compare basic self-care needs in older acute medical in-patients between admission and discharge using the Nursing Patient Classification System data. Design: Single-center, observational, and retrospective cohort study. Methods: Data were collected between April 2015 and April 2016 and included 384 patients aged 65 or older admitted to a medical ward of a 580-bed teaching hospital in Portugal. Significant differences between groups of patients were assessed by analysis of variance and Kruskal–Wallis for continuous variables and by chi-squared test for categorical variables. Significant changes in the level of dependence were analyzed using McNemar–Bowker test. Results: The mean age of the patients was 79.93 years (SD = 7.49) and the majority were women (57.3%). There were no gender differences in length of stay. Oldest-old patients presented higher percentages of dependence on basic self-care, both at admission and at discharge. Younger-old patients improves in hygiene and personal care, toilet use, and movement (P < .01). However, it is also this group of patients who have the highest percentages of deterioration in eating (P = .129), toilet use, and movement (P < .001). Conclusion: All patients are vulnerable to decline in basic self-care regardless their age. Use Nursing Patient Classification Systems to track progress in basic self-care between admission and discharge in older acute medical patients is an innovative and valid methodology. Based on the needs of nursing care, we were able to characterize older patients’ needs and achieve health outcomes.
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Affiliation(s)
- Cecília Rodrigues
- Doutoramento em Ciências de Enfermagem, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto.,Medicina C, Departamento de Medicina, Centro Hospitalar do Porto.,Gabinete de Governação Clínica, Departamento da Qualidade, Centro Hospitalar do Porto
| | - Denisa Mendonça
- Doutoramento em Ciências de Enfermagem, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto
| | - Maria Manuela Martins
- Escola Superior de Enfermagem do Porto.,Grupo de Investigação NursID: Inovação e Desenvolvimento em Enfermagem-Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Universidade do Porto, Porto, Portugal
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Ayatollahi Y, Liu X, Namazi A, Jaradat M, Yamashita T, Shen JJ, Lee YJ, Upadhyay S, Kim SJ, Yoo JW. Early Readmission Risk Identification for Hospitalized Older Adults With Decompensated Heart Failure. Res Gerontol Nurs 2018; 11:190-197. [PMID: 29634848 DOI: 10.3928/19404921-20180322-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/06/2018] [Indexed: 12/25/2022]
Abstract
The current study evaluated risk factors of early hospital readmission in geriatric patients with acute heart failure (HF) and analyzed 2,279 consecutively hospitalized older adults with decompensated HF from November 2013 to October 2014 across 15 U.S. hospitals. The eTracker-HF was designed to make risk factors known to treating clinicians in electronic health records. Multilevel multivariate logistic regression was applied to examine the association between risk factors and all-cause and HF 30-day readmission rates. All-cause and HF 30-day readmission rates were 22.3% and 9.8%, respectively. Old age, non-White ethnicity, delirium, physical impairment, ejection fraction <40%, advanced chronic kidney disease, and previous myocardial infarction were associated with all-cause and HF readmission. Home health care use was inversely associated with early readmission. In addition to demographic and cardiovascular risk factors, geriatric syndromes were associated with early readmission. Discharge to home health care may reduce early readmission in these patients. [Res Gerontol Nurs. 2018; 11(4):190-197.].
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Devi J. The scales of functional assessment of Activities of Daily Living in geriatrics. Age Ageing 2018; 47:500-502. [PMID: 29608661 DOI: 10.1093/ageing/afy050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Josep Devi
- Department of Health and Clinical Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
- Grup Mutuam—Care for the Unit Sant Cugat del Vallés, Barcelona, Spain
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Özkan Pehlivanoğlu EF, Özkan MU, Balcıoğlu H, Bilge U, Ünlüoğlu İ. Adjustment and Reliability of Katz Daily Life Activity Measures for Elderly in Turkish. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.435264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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van Blijswijk SCE, Blom JW, de Craen AJM, den Elzen WPJ, Gussekloo J. Prediction of functional decline in community-dwelling older persons in general practice: a cohort study. BMC Geriatr 2018; 18:140. [PMID: 29898672 PMCID: PMC6001140 DOI: 10.1186/s12877-018-0826-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline. METHODS In this cohort study, embedded within the ISCOPE-trial, participants (≥75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants. Functional status was measured at baseline and 12 months (Groningen Activities Restriction Scale [GARS]). The outcome was functional decline (death, nursing home admission, 10% with greatest functional decline). The predictive value of pre-selected variables (age, sex, polypharmacy, multimorbidity, living situation; GPs' opinion on vulnerability, number of domains with problems [ISCOPE-score]) was compared with the area under the curves (AUC) for logistic regression models. RESULTS 2018 of the 2211 participants (median age 82.1 years [IQR 78.8-86.5], 68.0% female, median GARS 31 [IQR 24-41]) were visited at 12 months (median GARS 34 [IQR 26-44]). 394 participants (17.8%) had functional decline (148 died, 45 nursing home admissions, 201 with greatest functional decline). The AUC for age and sex was 0.602, increasing to 0.620 (p = 0.029) with polypharmacy, multimorbidity and living situation. The GPs' opinion added more (AUC 0.672, p < 0.001) than the ISCOPE-score (AUC 0.649, p = 0.007). AUC with all variables was 0.686 (p = 0.016), and 0.643 for GPs' opinion alone. CONCLUSIONS The GPs' opinion and ISCOPE-score improve this prediction model for functional decline based on readily available variables. GPs could identify older patients for further assessment with their clinical judgement. TRIAL REGISTRATION Netherlands trial register, NTR1946 . Registered 10 August 2009.
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Affiliation(s)
- Sophie C E van Blijswijk
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Verweij L, van de Korput E, Daams JG, Ter Riet G, Peters RJG, Engelbert RHH, Scholte Op Reimer WJM, Buurman BM. Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2018; 100:530-550. [PMID: 29902471 DOI: 10.1016/j.apmr.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on mobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic. DATA SOURCES Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018. STUDY SELECTION OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age ≥65y) after discharge from hospital after an acute illness. DATA EXTRACTION Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital readmission within 3 months of discharge. DATA SYNTHESIS A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7 assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]=: -1.34 to 48.32; I2: 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly. CONCLUSION OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge. However, the wide 95% CIs indicate that the evidence is not robust.
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Affiliation(s)
- Lotte Verweij
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Eva van de Korput
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost G Daams
- Research Support, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron J G Peters
- Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Raoul H H Engelbert
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bianca M Buurman
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Storeng SH, Sund ER, Krokstad S. Factors associated with basic and instrumental activities of daily living in elderly participants of a population-based survey: the Nord-Trøndelag Health Study, Norway. BMJ Open 2018; 8:e018942. [PMID: 29530908 PMCID: PMC5857703 DOI: 10.1136/bmjopen-2017-018942] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate factors associated with the need for assistance in basic and instrumental activities of daily living in Norwegian elderly. DESIGN Prospective cohort study. SETTING The Nord-Trøndelag Health Study (HUNT), a large population-based health survey in Norway. PARTICIPANTS 5050 individuals aged 60-69 years old at baseline in HUNT2 (1995-1997) who also participated in HUNT3 (2006-2008) were included in the study. 676/693 individuals were excluded in the analyses due to missing outcomes. OUTCOMES Needing assistance in one or more basic or instrumental activities of daily living reported in HUNT3. RESULTS In adjusted multinomial logistic regression analyses, poor self-rated health and depression were the strongest risk factors for needing assistance in one or more basic activities of daily living in HUNT3, with ORs of 2.13 (1.35 to 3.38) and 1.58 (0.91 to 2.73). Poor self-rated health and poor life satisfaction were the strongest risk factors for needing assistance in one or more instrumental activities of daily living in HUNT3, with ORs of 2.30 (1.93 to 2.74) and 2.29 (1.86 to 2.81), respectively. Excessive sitting time, short or prolonged sleeping time, and physical inactivity seemed to be the most important lifestyle risk factors for basic/instrumental activities of daily living (ADL/IADL) disability. The studied factors were, in general, greater risk factors for mortality during follow-up than for ADL/IADL disability. Smoking was the strongest risk factor for mortality during follow-up and non-participation in HUNT3. Smoking and low social participation were the strongest risk factors for non-participation in HUNT3. CONCLUSIONS Subjective health perception, life satisfaction and depression were the strongest risk factors for needing assistance in one or more basic/instrumental activities of daily living later in life. These factors could be possible targets for prevention purposes.
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Affiliation(s)
- Siri Høivik Storeng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik R Sund
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Wang XX, Chen ZB, Chen XJ, Huang LL, Song XY, Wu X, Fu LY, Wang PX. Functional status and annual hospitalization in multimorbid and non-multimorbid older adults: a cross-sectional study in Southern China. Health Qual Life Outcomes 2018; 16:33. [PMID: 29433527 PMCID: PMC5809886 DOI: 10.1186/s12955-018-0864-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/07/2018] [Indexed: 12/17/2022] Open
Abstract
Background Hospitalization over the last one year, an indicator of health service utilization, is an important and costly resource in older adult care. However, data on the relationship between functional status and annual hospitalization among older Chinese people are sparse, particularly for those with and without multimorbidity. In this study,we aimed to examine the association between functional status and annual hospitalization among community-dwelling older adults in Southern China, and to explore the independent contributions of socio-demographic variables, lifestyle and health-related factors and functional status to hospitalization in multimorbid and non-multimorbid groups. Methods This cross-sectional, community-based survey, studied 2603 older adults aged 60 years and above. Functional status was assessed by Functional Independence Measure (FIM). The outcome variable was any hospitalization over the last one year (annual hospitalization). Clustered logistic regression was used to analyze the independent contributions of FIM domains to annual hospitalization. Results Only in the multimorbid group, did the risk of annual hospitalization decrease significantly with increasing FIM score in walk domain (adjusted OR = 0.80 per SD increase, 95% CI = 0.70–0.91, P = 0.001) and its independent contribution accounted for 24.62%, more than that of socio-demographic variables (18.46%). However, among individuals without multimorbidity, there were no significant associations between FIM domains and annual hospitalization; thus, no independent contribution to the risk of hospitalization was observed. Conclusions There exist some degree of correlation between functional status and annual hospitalization among older adults in Southern China, which might be due to the presence of multimorbidity with advanced age.
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Affiliation(s)
- Xiao-Xiao Wang
- Institute of Public Health, School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Zhao-Bin Chen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, 610041, China.,Shenzhen Nanshan Center for Disease Control and Prevention, Shenzhen, 518054, China
| | - Xu-Jia Chen
- Community health service management center, Luohu hospital group, Shenzhen, 518007, China
| | - Ling-Ling Huang
- Institute of Public Health, School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Xiao-Yue Song
- The Nursing College Of Zhengzhou University, Zhengzhou, 450001, China
| | - Xiao Wu
- Institute of Public Health, School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Li-Ying Fu
- Institute of Public Health, School of Nursing and Health, Henan University, Kaifeng, 475004, China
| | - Pei-Xi Wang
- Institute of Public Health, School of Nursing and Health, Henan University, Kaifeng, 475004, China. .,Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China.
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Pol M, Buurman B, Kröse B, Robben S. Expert Knowledge for Modeling Functional Health from Sensor Data. Methods Inf Med 2018; 55:516-524. [DOI: 10.3414/me15-01-0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 03/02/2016] [Indexed: 11/09/2022]
Abstract
Summary
Background: ICT based solutions are increasingly introduced for active and healthy ageing. In this context continuous monitoring of older adults with domestic sensor systems has been suggested to provide important information about their functional health. However, there is not yet a solid model for the interpretation of the sensor data.
Objectives: The aim of our study is to define a set of predictors of functional health that can be measured with domestic sensors and to determine thresholds that identify relevant changes in these predictors.
Methods: On the basis of literature we develop a model that relates functional health predictors to features derived from sensor data. The parameters of this model are determined on the basis of a study among health experts (n = 38). The use of the full model is illustrated with three cases.
Results: We identified 25 predictors and their attributes. For 12 of them that can be measured with passive infrared motion sensors we determined their parameters: the attribute thresholds and the urgency thresholds.
Conclusions: With the parametrized predictors in the model, domestic sensors can be deployed to assess functional health in a standardized way. Three case examples showed how the model can be used as a screening instrument for functional decline.
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Measurement of function in older adults transitioning from hospital to home: an integrative review. Geriatr Nurs 2017; 39:336-343. [PMID: 29249631 DOI: 10.1016/j.gerinurse.2017.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Abstract
Older adults often experience decline in functional status during the transition from hospital to home. In order to determine the effectiveness of interventions to prevent functional decline, researchers must have instruments that are reliable and valid for use with older adults. The purpose of this integrative review is to: (1) summarize the research uses and methods of administering functional status instruments when investigating older adults transitioning from hospital to home, (2) examine the development and existing psychometric testing of the instruments, and (3) discuss gaps and implications for future research. The authors conducted an integrative review of forty research studies that assessed functional status in older adults transitioning from hospital to home. This review reveals important gaps in the functional status instruments' psychometric testing, including limited testing to support their validity and reliability when administered by self-report and limited evidence supporting their ability to detect change over time.
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Torisson G, Stavenow L, Minthon L, Londos E. Importance and added value of functional impairment to predict mortality: a cohort study in Swedish medical inpatients. BMJ Open 2017; 7:e014464. [PMID: 28566362 PMCID: PMC5730010 DOI: 10.1136/bmjopen-2016-014464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Accurate estimation of prognosis in multimorbid hospital patients could improve quality of care. This study aims to determine the relative importance and added value of a performance-based activities of daily living (ADL) measure with regard to mortality prediction. METHODS 200 inpatients, aged over 60 years, were recruited at the Department of General Internal Medicine at a tertiary university hospital. Two nested survival models were built, one with established risk factors (age, sex, Charlson comorbidity index, haemoglobin, albumin, body mass index and glomerular filtration rate), and one using the same covariates with the Gottfries-Bråne-Steen (GBS)-ADL measure added. The relative importance of GBS-ADL was evaluated in the full model. The added value of GBS-ADL was determined by comparing the nested models using four approaches: difference in overall χ2, discrimination, continuous net reclassification index (NRI >0) and integrated discrimination improvement (IDI). RESULTS In the full model, GBS-ADL was the single most important predictor of mortality (χ2-df=30, p<0.001). The likelihood ratio χ2 test showed significant added value of ADL (p<0.001). The C-statistic was 0.78 with ADL and 0.72 without (difference 0.058, 95% CI 0.022 to 0.094). The NRI >0 was 0.42 (95% CI 0.20 to 0.58) and IDI 0.15 (95% CI 0.07 to 0.22). CONCLUSIONS Compared with a set of available clinical risk factors, impairment in ADL was a stronger predictor of all-cause mortality, showing substantial added value. Implementing quantitative ADL measurements could enable more appropriate and individual care for the elderly.
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Affiliation(s)
- Gustav Torisson
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Lars Stavenow
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
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De Brauwer I, Cornette P, Boland B, Verschuren F, D'Hoore W. Can we predict functional decline in hospitalized older people admitted through the emergency department? Reanalysis of a predictive tool ten years after its conception. BMC Geriatr 2017; 17:105. [PMID: 28499358 PMCID: PMC5429553 DOI: 10.1186/s12877-017-0498-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 05/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background In the Emergency Department (ED), early and rapid identification of older people at risk of adverse outcomes, who could best benefit from complex geriatric intervention, would avoid wasting time, especially in terms of prevention of adverse outcomes, and ensure optimal orientation of vulnerable patients. We wanted to test the predictive ability of a screening tool assessing risk of functional decline (FD), named SHERPA, 10 years after its conception, and to assess the added value of other clinical or biological factors associated with FD. Methods A prospective cohort study of older patients (n = 305, ≥ 75 years) admitted through the emergency department, for at least 48 h in non-geriatric wards (mean age 82.5 ± 4.9, 55% women). SHERPA variables (i.e. age, pre-admission instrumental Activity of Daily Living (ADL) status, falls within a year, self-rated health and 21-point MMSE) were collected within 48 h of admission, along with socio-demographic, medical and biological data. Functional status was followed at 3 months by phone. FD was defined as a decrease at 3 months of at least one point in the pre-admission basic ADL score. Predictive ability of SHERPA was assessed using c-statistic, predictive values and likelihood ratios. Measures of discrimination improvement were Net Reclassification Improvement and Integrated Discrimination Improvement. Results One hundred and five patients (34%) developed 3-month FD. Predictive ability of SHERPA decreased dramatically over 10 years (c = 0.73 vs. 0.64). Only two of its constitutive variables, i.e. falls and instrumental ADL, were significant in logistic regression analysis for functional decline, while 21-point MMSE was kept in the model for clinical relevance. Demographic, comorbidity or laboratory data available upon admission did not improve the SHERPA predictive yield. Conclusions Prediction of FD with SHERPA is difficult, but predictive factors, i.e. falls, pre-existing functional limitation and cognitive impairment, stay consistent across time and with literature. As accuracy of SHERPA and others existing screening tools for FD is moderate, using these predictors as flags instead of using composite scales can be a way to screen for high-risk patients. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0498-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabelle De Brauwer
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium. .,Department of Geriatric Medicine, Cliniques universitaires Saint Luc, Brussels, Belgium.
| | - Pascale Cornette
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.,Department of Geriatric Medicine, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Benoît Boland
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.,Department of Geriatric Medicine, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Franck Verschuren
- Department of Acute Medicine, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - William D'Hoore
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Wales K, Lannin NA, Clemson L, Cameron ID. Measuring functional ability in hospitalized older adults: a validation study. Disabil Rehabil 2017; 40:1972-1978. [PMID: 28482704 DOI: 10.1080/09638288.2017.1323021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the internal consistency, construct validity and responsiveness of functional assessments tools when used with hospitalized older adults. MATERIALS AND METHODS The functional ability of 66 patients was assessed using a semi-structured interview scale (n = 16 tools). The assessment of motor and process skills was administered during hospital admission and again at three months post-discharge. RESULTS Tools showed poor-to-excellent internal consistency (α = 0.27-0.92). Of the tools that were internally consistent, only two demonstrated change: the Groningen activity restriction scale (GARS) (smallest detectable change [SDC] 11.68, effect size -1.59) and the modified reintegration to normal living scale (SDC 7.04, effect size -1.20). Validity was supported by strong correlations between the functional independence measure™ (FIM™) and the GARS, FIM™ and Sunnaas activity daily living (ADL) index. CONCLUSIONS Findings suggest that the GARS and the modified reintegration to normal living index (mRNLI) are internally consistent, valid and responsive to change over time when applied to a sample of hospitalized older adults. Further investigation of these tools in terms of inter and intra rater reliability in clinical practice is warranted. Implications for Rehabilitation Therapists and researchers need to choose standardized functional assessments carefully when working with hospitalized older adults, as not all assessments are reliable and valid in this population. The GARS and mRNLI are valid and responsive functional assessments for hospitalized older adults. Activity and participation have been viewed traditionally as only one component of function. Therapists and researchers can use standardized assessments of function that are activity or participation-based.
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Affiliation(s)
- Kylie Wales
- a Ageing Work and Health Research Unit , University of Sydney , Lidcombe , Australia
| | - Natasha A Lannin
- b Department of Occupational Therapy, Alfred Health , School of Allied Health, La Trobe University , Melbourne , Australia
| | - Lindy Clemson
- a Ageing Work and Health Research Unit , University of Sydney , Lidcombe , Australia
| | - Ian D Cameron
- c John Walsh Centre for Rehabilitation Research , University of Sydney , Sydney , Australia
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Functional decline in older patients with cancer receiving chemotherapy: A multicenter prospective study. J Geriatr Oncol 2017; 8:196-205. [DOI: 10.1016/j.jgo.2017.02.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 01/02/2017] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
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van Abbema D, van Vuuren A, van den Berkmortel F, van den Akker M, Deckx L, Buntinx F, van Kampen R, Lambooij E, de Boer M, de Vos-Geelen J, Tjan-Heijnen VC. Functional status decline in older patients with breast and colorectal cancer after cancer treatment: A prospective cohort study. J Geriatr Oncol 2017; 8:176-184. [PMID: 28159513 DOI: 10.1016/j.jgo.2017.01.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/17/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of the present study was to disentangle the impact of age and that of cancer diagnosis and treatment on functional status (FS) decline in older patients with cancer. MATERIALS AND METHODS Patients with breast and colorectal cancer aged 50-69years and aged ≥70years who had undergone surgery, and older patients without cancer aged ≥70years were included. FS was assessed at baseline and after 12months follow-up, using the Katz index for activities of daily living (ADL) and the Lawton scale for instrumental activities of daily living (IADL). FS decline was defined as ≥1 point decrease on the ADL or IADL scale from baseline to 12months follow-up. RESULTS In total, 179 older patients with cancer (≥ 70years), 341 younger patients with cancer (50-69years) and 317 older patients without cancer (≥ 70years) were included. FS decline was found in 43.6%, 24.6% and 28.1% of the groups, respectively. FS decline was significantly worse in older compared to younger patients with cancer receiving no chemotherapy (44.5% versus 17.6%, p<0.001), but not for those who did receive chemotherapy (39.4% versus 30.8%, p=0.33). Among the patients with cancer, FS decline was significantly associated with older age (OR 2.63), female sex (OR 3.72), colorectal cancer (OR 2.81), polypharmacy (OR 2.10) and, inversely, with baseline ADL dependency (OR 0.44). CONCLUSION Cancer treatment, and older age are important predictors of FS decline. The relation of baseline ADL dependency and chemotherapy with FS decline suggest that the fittest of the older patients with cancer were selected for chemotherapy.
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Affiliation(s)
- Doris van Abbema
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Arnée van Vuuren
- Department of Internal Medicine, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen-Geleen, The Netherlands
| | - Franchette van den Berkmortel
- Department of Internal Medicine, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen-Geleen, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Maastricht University, Peter Debyelaan 1, 6229 HX, Maastricht, The Netherlands; Department of General Practice, KU Leuven, Kapucijnenvoer 33, PB 7001 3000 Leuven, Belgium
| | - Laura Deckx
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, PB 7001 3000 Leuven, Belgium.
| | - Frank Buntinx
- Department of Family Medicine, Maastricht University, Peter Debyelaan 1, 6229 HX, Maastricht, The Netherlands; Department of General Practice, KU Leuven, Kapucijnenvoer 33, PB 7001 3000 Leuven, Belgium
| | - Roel van Kampen
- Department of Internal Medicine, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen-Geleen, The Netherlands
| | - Els Lambooij
- Department of Internal Medicine, Máxima Medical Center, De Run 4600, 5504, DB, Veldhoven, The Netherlands
| | - Maaike de Boer
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Judith de Vos-Geelen
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Vivianne C Tjan-Heijnen
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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Henchoz Y, Büla C, Guessous I, Rodondi N, Goy R, Demont M, Santos-Eggimann B. Chronic symptoms in a representative sample of community-dwelling older people: a cross-sectional study in Switzerland. BMJ Open 2017; 7:e014485. [PMID: 28096256 PMCID: PMC5253546 DOI: 10.1136/bmjopen-2016-014485] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The burden of multiple diagnoses is well documented in older people, but less is known about chronic symptoms, many of which are even not brought to medical attention. This study aimed to determine the prevalence of chronic symptoms, their relationships with disability in basic activities of daily living (BADL) and quality of life (QoL), and their public health impact. DESIGN A large cross-sectional population-based study. SETTING Community in 2 regions of French-speaking Switzerland. PARTICIPANTS Community-dwelling older adults aged 68 years and older in 2011 (N=5300). OUTCOMES Disability in BADL defined as difficulty or help needed with any of dressing, bathing, eating, getting in/out of bed or an arm chair, and using the toilet. Overall QoL dichotomised as favourable (ie, excellent or very good) or unfavourable (ie, good, fair or poor). Disturbance by any of the following 14 chronic symptoms for at least 6 months: joint pain, back pain, chest pain, dyspnoea, persistent cough, swollen legs, memory gaps, difficulty concentrating, difficulty making decisions, dizziness/vertigo, skin problems, stomach/intestine problems, urinary incontinence and impaired sexual life. RESULTS Only 17.1% of participants did not report being disturbed by any of these chronic symptoms. Weighted prevalence ranged from 3.1% (chest pain) to 47.7% (joint pain). Most chronic symptoms were significantly associated with disability in BADL or unfavourable QoL, with substantial gender differences. The number of chronic symptoms was significantly associated with disability in BADL and unfavourable QoL, with gradients suggesting dose-response relationships. Joint pain and back pain had the highest population attributable fractions. CONCLUSIONS Chronic symptoms are highly prevalent in older people, and are associated with disability in BADL and unfavourable QoL, particularly when multiple chronic symptoms co-occur. Owing to their high public health impact, musculoskeletal chronic symptoms represent good targets for preventive interventions.
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Affiliation(s)
- Yves Henchoz
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - René Goy
- Pro Senectute Vaud, Lausanne, Switzerland
| | | | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
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47
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Nielsen LM, Kirkegaard H, Østergaard LG, Bovbjerg K, Breinholt K, Maribo T. Comparison of self-reported and performance-based measures of functional ability in elderly patients in an emergency department: implications for selection of clinical outcome measures. BMC Geriatr 2016; 16:199. [PMID: 27899065 PMCID: PMC5129645 DOI: 10.1186/s12877-016-0376-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Assessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED). Methods Participants were 61 patients aged 65 years and above admitted to an ED. The self-reported measure used was the Barthel-20; the performance-based measures were Timed Up and Go (TUG); 30s-Chair Stand Test (30s-CST) and Assessment of Motor and Process Skills (AMPS) with the two scales; motor and process. Correlation analyses were conducted to examine the relationships between the self-reported and performance-based measures of functional ability. Results The correlation between the Barthel-20 and the TUG was moderate (r = −0.64). The correlation between the Barthel-20 and the AMPS motor was also moderate (r = 0.53). The correlation between the Barthel-20 and the 30s-CST was fair (r = 0.45). The correlation between Barthel-20 and the AMPS process was non-significant. The results were affected by high ceiling effect (Barthel-20). Conclusion Self-reported and performance-based measures seem to assess different aspects of functional ability. Thus, the two methods provide different information, and this highlight the importance of supplementing self-reported measures with performance-based measures when assessing functional ability in elderly patients. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0376-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise M Nielsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark. .,School of Occupational Therapy at VIA University College, Aarhus N, Denmark.
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Lisa G Østergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark
| | - Karina Bovbjerg
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark
| | - Kasper Breinholt
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark
| | - Thomas Maribo
- MarselisborgCentret, DEFACTUM, Central Denmark Region, Department of Public Health, Aarhus University, Aarhus C, Denmark
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Geriatric preinjury activities of daily living function is associated with glasgow coma score and discharge disposition: a retrospective, consecutive cohort study. J Trauma Nurs 2016; 22:6-13. [PMID: 25584447 DOI: 10.1097/jtn.0000000000000095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary objective was to evaluate the associations of the Injury Severity Score (ISS), age, Glasgow Coma Score (GCS), preexisting medical conditions (PEMC), and preinjury activities of daily living (ADL) Katz score with discharge disposition in surviving geriatric trauma patients.Data were obtained from the trauma registry. The preinjury Katz ADL score was prospectively ascertained.Of 184 consecutive surviving geriatric trauma patients with an ISS of 4 to 30, age was 80 ± 8 years and 75% fell. A PEMC was present in 93%. Preinjury ADL limitation occurred in 33%. The Katz score had inverse associations with the number of PEMCs (P< .01) and dementia (P < .01). Preinjury residence was home in 93% and nursing home in 7%. Katz scores by discharge disposition were as follows: home (36%) 5.5 ± 1; nursing home (15%) 3.6 ± 2; rehabilitation (44%) 5.6 ± 1; long-term acute care (5%) 4.0 ± 3 (P < .01). Nursing home/long-term acute care discharge was independently associated (P< .01) withlower Katz score, higher age, and lower discharge GCS; dementia and the number of PEMCs had P > .05. The discharge GCS was associated with the Katz score (P < .01), head injury score (P < .01), dementia (P < .01), and admission GCS (P < .01). The discharge GCS was independently associated (P < .01) with the Katz score and admission GCS. The admission GCS was associated with the Katz score (P = .02), ISS (P < .01), head injury score (P < .01), and dementia (P < .01). The admission GCS was independently associated (P < .05) with the Katz score and ISS.The majority of geriatric trauma survivors with an ISS of 4 to 30 are not discharged home. Lower preinjury ADL function is associated with the lower admission and discharge GCS and greater care needs at discharge. Dementia and the number of PEMCs are not independent predictors of discharge disposition.
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Thornton A, Binstock G, Young-DeMarco L, Mitchell C, Yount KM, Xie Y. Evaluating the measurement reliabilities and dimensionality of developmental idealism measures. CHINESE JOURNAL OF SOCIOLOGY 2016; 2:609-635. [PMID: 29560276 PMCID: PMC5857385 DOI: 10.1177/2057150x16672813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper investigates the measurement of developmental idealism. Developmental idealism is a set of beliefs and values stating that modern societies and families are better than traditional ones, that modern families facilitate modern societies, and that modern societies foster modern families. Prior research has shown that developmental idealism is widespread globally but has provided little evidence about whether beliefs concerning developmental idealism can be measured reliably at the individual level. It also has provided little information about the dimensionality and psychometric properties of measures of developmental idealism. Using cross-sectional survey data from Argentina, China, and Egypt, we explore and test the factor structure underlying observed measures for aspects of developmental idealism and estimate the reliability of different models. Theory and data suggest that developmental idealism consists of multiple dimensions, and when family-related items are measuring similar underlying constructs, the measurement reliabilities are high. These results provide evidence that the dimensions of developmental idealism can be measured with a high degree of reliability.
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Affiliation(s)
- Arland Thornton
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Georgina Binstock
- CONICET and Centro de Estudios de Población (CENEP). Av. Corrientes 2817 Piso 7 "B". Ciudad Autónoma de Buenos Aires (1193AAA), Argentina
| | | | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Kathryn M Yount
- Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, GA 30322
| | - Yu Xie
- Center for Social Research, Peking University, Beijing, China 186 Wallace Hall, Princeton University, Princeton, NJ 08544, USA
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50
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Ferretti-Rebustini REDL, Balbinotti MAA, Jacob-Filho W, Rebustini F, Suemoto CK, Pasqualucci CAG, Farfel JM, Leite REP, Grinberg LT, Nitrini R. Validity of the Katz Index to assess activities of daily living by informants in neuropathological studies. Rev Esc Enferm USP 2016; 49:946-52. [PMID: 27419678 DOI: 10.1590/s0080-623420150000600010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/15/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the evidences of construct validity of the Katz Index for the retrospective assessment of activities of daily living (ADL) by informants, to assist neuropathological studies in the elderly. METHOD A cross-sectional study analyzed the functional ability of ADL measure by the Katz Index, of 650 cases randomly selected from the Brazilian Brain Bank of the Ageing Brain Study Group (BBBABSG) database. Sample was divided in two subsamples for the analysis (N=325, each) and then stratified according to cognitive decline assessed by the Clinical Dementia Rating Scale (CDR). Factor analyses with calculations of internal consistency and invariance were performed. RESULTS Factor analysis evidenced a unidimensional instrument with optimal internal consistency, in all subgroups. Goodness of fit indices were obtained after two treatments of covariance, indicating adequacy of the scale for assessing ADL by informants. The scale is invariant to cognitive decline meaning that it can be used for subjects with or without cognitive impairment. CONCLUSION Katz Index is valid for the retrospective assessment of basic ADL by informants, with optimal reliability.
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Affiliation(s)
- Renata Eloah de Lucena Ferretti-Rebustini
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgia, São Paulo, SP, Brazil.,University of Quebec in Trois-Rivières, Department of Psychology, Laboratory of Psychometric and Experimental Methods, Trois-Rivière, QC, Canada
| | - Marcos Alencar Abaide Balbinotti
- University of Quebec in Trois-Rivières, Department of Psychology, Laboratory of Psychometric and Experimental Methods, Trois-Rivière, QC, Canada
| | - Wilson Jacob-Filho
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiopatologia no Envelhecimento, São Paulo, SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Disciplina de Geriatria, São Paulo, SP, Brazil
| | - Flávio Rebustini
- University of Quebec in Trois-Rivières, Department of Psychology, Laboratory of Psychometric and Experimental Methods, Trois-Rivière, QC, Canada.,Universidade Estadual Paulista Júlio de Mesquita Filho, Instituto de Biociências, Laboratório de Estudos e Pesquisas em Psicologia do Esporte, Rio Claro, SP, Brazil
| | - Claudia Kimie Suemoto
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiopatologia no Envelhecimento, São Paulo, SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Disciplina de Geriatria, São Paulo, SP, Brazil
| | - Carlos Augusto Gonçalves Pasqualucci
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiopatologia no Envelhecimento, São Paulo, SP, Brazil.,Serviço de Verificação de Óbitos da Capital, São Paulo, SP, Brazil
| | - José Marcelo Farfel
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiopatologia no Envelhecimento, São Paulo, SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Disciplina de Geriatria, São Paulo, SP, Brazil
| | - Renata Elaine Paraizo Leite
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiopatologia no Envelhecimento, São Paulo, SP, Brazil
| | - Lea Tenenholz Grinberg
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiopatologia no Envelhecimento, São Paulo, SP, Brazil.,University of California, Department of Neurology, Memory and Aging Center, San Francisco, California, USA
| | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Fisiopatologia no Envelhecimento, São Paulo, SP, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo, SP, Brazil
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