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Bueno Yáñez O, Calvo Aguirre JJ, Uranga Zaldua J, Alustiza Navarro J, Ugartemendia Yerobi M. [Alusti test as a premonitory variable of adverse health events in a nursing home. Two-years follow-up]. Rev Esp Geriatr Gerontol 2024; 59:101476. [PMID: 38417197 DOI: 10.1016/j.regg.2024.101476] [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: 07/31/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Functional capacity is a good indicator of health, quality of life, and a good predictor of morbimortality. It is a priority to functionally assess the geriatric population through objective, precise, and simple instruments. The Alusti Test in its two versions, complete (TA) and abbreviated (TAA), is a scale that meets these criteria. OBJECTIVE To determine the usefulness of the Alusti Test as a predictor of adverse health events: falls, hospitalizations, cognitive deterioration, and mortality in the elderly institutionalized population, with a two-year follow-up. MATERIAL AND METHODS This observational study's sample included 176 persons admitted to a nursing home for 32months, with a mean age of 85.5years. The TA was performed on 138 and the TAA on 38. RESULTS The ratio of falls is much higher in residents with mild dependence than in those with total dependence (P<.001). Hospitalizations increase as the results of the Alusti Test are more favorable. The risk of hospitalization in dependent patients is 50% lower (P<.001) than in those with preserved mobility. Cognitive impairment is similar in all the populations with some mild-moderate level of functional dependence and decreases in the population with preserved mobility. Categorization as total and mild/severe dependence is related to a 3-4times higher mortality at six months follow-up. CONCLUSIONS A higher mild-moderate level of dependence on the AT correlates with a lower risk of falls, a lower rate of hospitalization, and a higher risk of mortality at six months.
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Affiliation(s)
- Olga Bueno Yáñez
- Osakidetza, Centro de Salud Beraun, Errenteria, Guipúzcoa, España
| | | | | | | | - Maider Ugartemendia Yerobi
- Departamento de Enfermería, Facultad de Medicina y Enfermería, Universidad del País Vasco UPV/EHU, San Sebastián, España.
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Rodriguez-Lopez C, Mayordomo-Cava J, Zarralanga-Lasobras T, Romero-Estarlich V, Vidan MT, Ortiz-Alonso J, Valenzuela PL, Rodriguez-Romo G, Lucia A, Serra-Rexach JA. Exercise Intervention and Hospital-Associated Disability: A Nonrandomized Controlled Clinical Trial. JAMA Netw Open 2024; 7:e2355103. [PMID: 38329757 PMCID: PMC10853827 DOI: 10.1001/jamanetworkopen.2023.55103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024] Open
Abstract
Importance Inpatient exercise interventions may prevent, at least partly, hospital-associated disability (HAD) in older adults, but whether they also confer clinical benefits in the months following discharge is unclear. Objective To examine the association of exercise and health education with HAD incidence in hospitalized older adults receiving acute hospital care at discharge and 3 months later. Design, Setting, and Participants This single-center open-label, nonrandomized controlled clinical trial included patients aged 75 years or older seen at an acute care for elders unit at a tertiary public hospital in Madrid, Spain, from May 1, 2018, to June 30, 2022. Interventions Patients were allocated to an intervention or control group. Both groups received usual care, but the intervention group also performed a supervised multicomponent exercise program (daily strength, balance, and walking exercises along with inspiratory muscle training) during hospitalization and received health education on how to exercise at home and telephone counseling during follow-up. Main Outcomes and Measures The primary outcome was HAD incidence (determined by the Katz Index of Independence in Activities of Daily Living [hereafter, Katz Index]) at discharge and after 3 months compared with baseline (ie, 2 weeks before admission). Secondary outcomes included HAD incidence determined by the Barthel Index for Activities of Daily Living, ambulatory capacity decline at discharge and follow-up, changes in physical performance at discharge, and incidence of falls, readmissions, and mortality during the follow-up period. Results The study included 260 patients (134 women [51.5%]; mean [SD] age, 87.4 [4.9] years [range, 75-105 years]; median hospital length of stay, 7 days [IQR, 5-10 days]), of whom 130 received the intervention and 130 were in the control group. Differences in HAD incidence did not reach statistical significance at discharge (odds ratio [OR], 0.62; 95% CI, 0.37-1.05; P = .08) or follow-up (OR, 0.65; 95% CI, 0.36-1.17; P = .15) when using the Katz Index. A lower HAD incidence was observed in the intervention group at discharge (OR, 0.47; 95% CI, 0.27-0.81; P = .01) and at follow-up (OR, 0.36; 95% CI, 0.20-0.66; P = .001) when using the Barthel Index for Activities of Daily Living. The intervention was also associated with a lesser decline in ambulatory capacity (OR, 0.55; 95% CI, 0.32-0.96; P = .03) and improved physical performance at discharge (Cohen d, 0.39; 95% CI, 0.12-0.65; P = .004). No significant associations were observed for readmissions, falls, or mortality. Conclusions and Relevance In this nonrandomized controlled clinical trial, an exercise and health education intervention was not significantly associated with reduced HAD incidence when measured by the Katz Index. However, the benefits found for several secondary outcomes might support the implementation of in-hospital exercise programs for older patients. Trial Registration ClinicalTrials.gov Identifier: NCT03604640.
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Affiliation(s)
- Carlos Rodriguez-Lopez
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Teresa Zarralanga-Lasobras
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Vicente Romero-Estarlich
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Maria Teresa Vidan
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Ortiz-Alonso
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Pedro L. Valenzuela
- Physical Activity and Health Research Group, Research Institute of Hospital ‘12 de Octubre,’ Madrid, Spain
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - Gabriel Rodriguez-Romo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alejandro Lucia
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Physical Activity and Health Research Group, Research Institute of Hospital ‘12 de Octubre,’ Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
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