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Okpara C, Ioannidis G, Thabane L, Adachi JD, Rabinovich A, Hewston P, Lee J, McArthur C, Kennedy C, Woo T, Boulos P, Bobba R, Wang M, Thrall S, Mangin D, Marr S, Armstrong D, Patterson C, Bray S, de Wit K, Maharaj S, Misiaszek B, Sookhoo JB, Thompson K, Papaioannou A. The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial. Pilot Feasibility Stud 2023; 9:124. [PMID: 37461117 PMCID: PMC10351184 DOI: 10.1186/s40814-023-01346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic. METHODS Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component. RESULTS The program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant's adherence levels included virtual exercise sessions 81% (95% CI: 75-88%), home-based exercise 50% (95% CI: 38-62%), protein supplements consumption 68% (95% CI: 55-80%), and medication optimization 38% (95% CI: 21-59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms. CONCLUSION The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant's intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change. TRIAL REGISTRATION ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366.
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Affiliation(s)
- Chinenye Okpara
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - George Ioannidis
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- The Research Institute of St Joseph’s Healthcare, Hamilton, ON Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | | | | | - Patricia Hewston
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Justin Lee
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Caitlin McArthur
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS Canada
| | - Courtney Kennedy
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Tricia Woo
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Pauline Boulos
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Raja Bobba
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Mimi Wang
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Samuel Thrall
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Derelie Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Sharon Marr
- Department of Medicine, University of Toronto, Hamilton, ON Canada
| | - David Armstrong
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Steven Bray
- Department of Kinesiology, McMaster University, Hamilton, ON Canada
| | - Kerstin de Wit
- Department of Emergency Medicine, Queen’s University, Kingston, ON Canada
| | - Shyam Maharaj
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Brian Misiaszek
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Karen Thompson
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
| | - Alexandra Papaioannou
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Geras Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
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Niemöller U, Arnold A, Stein T, Juenemann M, Erkapic D, Rosenbauer J, Kostev K, Meyer M, Tanislav C. Comprehensive Geriatric Care in Older Adults: Walking Ability after an Acute Fracture. Med Sci (Basel) 2023; 11:40. [PMID: 37367739 DOI: 10.3390/medsci11020040] [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: 03/31/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES Comprehensive Geriatric Care (CGC) is a specific multimodal treatment for older patients. In the current study, we aimed to investigate walking performance after CGC in medically ill patients versus those with fractures. METHODS The timed up and go test (TuG), a 5-grade scale assessment (1 = no walking impairment to 5 = no walking ability at all) for evaluating individual walking ability was performed in all patients who underwent CGC prior to and after treatment. Factors associated with improvement in walking ability were analyzed in the subgroup of patients with fractures. RESULTS Out of 1263 hospitalized patients, 1099 underwent CGC (median age: 83.1 years (IQR 79.0-87.8 years); 64.1% were female). Patients with fractures (n = 300) were older than those without (n = 799), (median 85.6 versus 82.4 years, p = 0.001). Improvement in TuG after CGC was found in 54.2% of the fracture patients compared to just 45.9% of those without fractures. In fracture group patients, TuG improved from median 5 on admission to median 3 on discharge (p = 0.001). In fracture patients, improvement in walking ability was associated with higher Barthel index values on admission (median 45 (IQR: 35-55) versus 35 (IQR: 20-50): p = 0.001) and Tinetti assessment scores (median 9 (IQR: 4-14.25) versus 5 (IQR: 0-13); p = 0.001) and was negatively associated with the diagnosis of dementia (21.4% versus 31.5%; p = 0.058). CONCLUSION CGC improved walking ability in more than half of all patients examined. Older patients in particular might benefit from undergoing the procedure after an acute fracture. A better initial functional status favors a positive result following the treatment.
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Affiliation(s)
- Ulrich Niemöller
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Andreas Arnold
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Thomas Stein
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Martin Juenemann
- Department of Neurology, Justus Liebig University, 35392 Giessen, Germany
| | - Damir Erkapic
- Department of Cardiology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Josef Rosenbauer
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Karel Kostev
- Department of Epidemiology, Philipps University Marburg, 35043 Marburg, Germany
| | - Marco Meyer
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
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Hosoi T, Yamana H, Tamiya H, Matsui H, Fushimi K, Akishita M, Yasunaga H, Ogawa S. Association between comprehensive geriatric assessment and polypharmacy at discharge in patients with ischaemic stroke: A nationwide, retrospective, cohort study. EClinicalMedicine 2022; 50:101528. [PMID: 35784439 PMCID: PMC9241103 DOI: 10.1016/j.eclinm.2022.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Polypharmacy and its adverse drug events are a major healthcare challenge related to falls, hospitalisations and mortality. Comprehensive geriatric assessment (CGA) may contribute to polypharmacy improvement, however, there is no clear evidence so far. METHODS Using a national inpatient database in Japan from April 1, 2014 to March 31, 2018, we investigated the association between CGA and polypharmacy. We identified patients aged ≥65 years admitted for ischaemic stroke who could receive oral medications. Propensity score matching was conducted for patients with and without CGA during hospitalisation. The outcomes were polypharmacy (defined as use of five or more types of oral medications) at discharge, the number of medication types prescribed at discharge, and the difference between the numbers of medication types prescribed on admission and at discharge. FINDINGS A total of 162,443 patients were analysed, of whom 39,356 (24·2%) received CGA, and propensity score matching identified 39,349 pairs. Compared with non-CGA group, the CGA group had a significantly lower proportion of polypharmacy at discharge (34·3% vs. 32·9%, p < 0·001) and a smaller number of medication types prescribed at discharge (3·84 vs. 3·76, p < 0·001). INTERPRETATION This study shows the clear evidence that there is a positive relationship between CGA and a reduction in the number of medications in older inpatients with ischaemic stroke. FUNDING The Ministry of Health, Labour and Welfare, Japan and the Ministry of Education, Culture, Sports, Science and Technology, Japan.
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Affiliation(s)
- Tatsuya Hosoi
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Tamiya
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Corresponding author at: Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Backman C, Harley A, Papp S, Webber C, Poitras S, Berdusco R, Beaulé PE, French-Merkley V. Feasibility, acceptability, and preliminary effects of PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP): a protocol for a mixed method study. Pilot Feasibility Stud 2022; 8:124. [PMID: 35690813 PMCID: PMC9188093 DOI: 10.1186/s40814-022-01079-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip fractures in older adults are significant contributors to severe functional decline and disability as well as hospitalization and increased health care costs. Research shows that timely referral to geriatric rehabilitation leads to better patient outcomes. Currently, a wide variability in the timing, the frequency, and the choice of appropriate setting for rehabilitation of hip fracture patients exists. AIM Evaluate the feasibility, acceptability, and preliminary effectiveness of PATH4HIP, a pathway intervention for timely transfer of post-operative geriatric hip fracture patients from hospital to rehabilitation to home. METHODS This is a single-arm, pragmatic feasibility study to measure reach, effectiveness, adoption, implementation, and maintenance of PATH4HIP, a pathway for post-operative hip fracture patients from a large academic health science center to a geriatric rehabilitation service in Ottawa, Canada. During a 6-month period, all hip fracture patients, 65 years of age or older who have undergone surgery and have met the eligibility criteria (n = 96), will be transferred to the geriatric rehabilitation service no later than post-operative day 6. Patients (n = 10-12) and clinicians who are working on the orthopedic team (n = 10-12) and on the geriatric rehabilitation service (n = 10-12) will be invited to participate in an interview to share their feedback on the intervention's feasibility and acceptability and to provide suggestions to improve PATH4HIP. Descriptive statistics will be used to summarize results of the quantitative data and content analysis will be used to analyze the qualitative data. The study will be open for recruitment from January to July 2022. DISCUSSION If feasible, PATH4HIP will result in the reduction of the post-operative acute care length of stay to less than or equal to 6 days, while having no detrimental effect on rehabilitation outcomes such as functional gains, or discharge destination.
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Affiliation(s)
- Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa; Affiliate Investigator, Ottawa Hospital Research Institute, Affiliate Investigator, Bruyère Research Institute, 451, Smyth Road, RGN 3239, Ottawa, ON, K1H 8M5, Canada.
| | - Anne Harley
- Bruyere Continuing Care; Assistant Professor Faculty of Medicine, University of Ottawa, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Steve Papp
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451, Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Randa Berdusco
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery at The Ottawa Hospital, Faculty of Medicine, University of Ottawa, General Campus, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
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5
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Health outcomes and implementation barriers and facilitators of comprehensive geriatric assessment in community settings: a systematic integrative review [PROSPERO registration no.: CRD42021229953]. BMC Geriatr 2022; 22:379. [PMID: 35488198 PMCID: PMC9052611 DOI: 10.1186/s12877-022-03024-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background Comprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence on quantitative health outcomes and implementation barriers and facilitators would inform practice and policy on CGA for community-dwelling older adults. Methods We systematically searched four medical and social sciences electronic databases for quantitative, qualitative, and mixed methods studies published from 1 January 2000 to 31 October 2020. Due to heterogeneity of articles, we narratively reviewed the synthesis of evidence on health outcomes and implementation barriers and facilitators. Results We screened 14,151 titles and abstracts and 203 full text articles, and included 43 selected articles. Study designs included controlled intervention studies (n = 31), pre-post studies without controls (n = 4), case-control (n = 1), qualitative methods (n = 3), and mixed methods (n = 4). A majority of articles studied populations aged ≥75 years (n = 18, 42%). CGAs were most frequently conducted in the home (n = 25, 58%) and primary care settings (n = 8, 19%). CGAs were conducted by nurses in most studies (n = 22, 51%). There was evidence of improved functional status (5 of 19 RCTs, 2 of 3 pre-post), frailty and fall outcomes (3 of 6 RCTs, 1 of 1 pre-post), mental health outcomes (3 of 6 RCTs, 2 of 2 pre-post), self-rated health (1 of 6 RCTs, 1 of 1 pre-post), and quality of life (4 of 17 RCTs, 3 of 3 pre-post). Barriers to implementation of CGAs involved a lack of partnership alignment and feedback, poor acceptance of preventive work, and challenges faced by providers in operationalising and optimising CGAs. The perceived benefits of CGA that served to facilitate its implementation included the use of highly skilled staff to provide holistic assessments and patient education, and the resultant improvements in care coordination and convenience to the patients, particularly where home-based assessments and management were performed. Conclusion There is mixed evidence on the quantitative health outcomes of CGA on community-dwelling older adults. While there is perceived positive value from CGA when carried out by highly skilled staff, barriers such as bringing providers into a partnership, greater acceptance of preventive care, and operational issues could impede its implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03024-4.
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6
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Impact of cardiometabolic risk factors on the quality of life of soldiers of Kinshasa. TURKISH JOURNAL OF KINESIOLOGY 2022. [DOI: 10.31459/turkjkin.1062785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Backman C, Harley A, Papp S, French-Merkley V, Beaulé PE, Poitras S, Dobransky J, Squires JE. Barriers and Enablers to Early Identification, Referral and Access to Geriatric Rehabilitation Post-Hip Fracture: A Theory-Based Descriptive Qualitative Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593211047666. [PMID: 35340622 PMCID: PMC8943317 DOI: 10.1177/21514593211047666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 07/28/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background Geriatric hip fracture patients often experience gaps in care including
variability in the timing and the choice of an appropriate setting for
rehabilitation following hip fracture surgery. Many guidelines recommend
standardized processes, including timely access of no later than day 6 to
rehabilitation services. A pathway for early identification, referral and
access to geriatric rehabilitation post-hip fracture was created to
facilitate the implementation. The study aimed to describe the barriers and
enablers prior to the implementation of this pathway. Methods We conducted a qualitative descriptive study consisting of semi-structured
interviews with geriatric hip fracture patients (n = 8), caregivers (n = 1),
administrators (n = 12) and clinicians (n = 17) in 2 orthopaedics units and
a geriatric rehabilitation service. Responses were analysed using a
systematic approach, and overarching themes describing the barriers and
enablers were identified. Results The clinicians’ and administrators’ top barriers to implementation of the
pathway were competing demands (n = 24); lack of bed availability, community
resources and funding (n = 19); and the need for extended hours and
increased staff (n = 16). The top 3 enablers were clear communication with
patients (n = 27), awareness of the benefits of geriatric rehabilitation (n
= 24) and the need for education and resources to properly use the pathway
(n = 15). Common barriers among patients and caregivers included lack of
care coordination, overcoming some of their own specific challenges during
their transition, gaps in the information they received before discharge,
not knowing what questions to ask and lack of resources. Despite these
barriers, patients were generally pleased with their transition from the
hospital to geriatric rehabilitation. Conclusion We identified and described key barriers and enablers to early
identification, referral and access to geriatric rehabilitation post-hip
fracture. These influencing factors provide a basis for the development of a
standardized pathway aimed at improving access to rehabilitative care for
geriatric hip fracture patients.
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Affiliation(s)
- Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute.,Bruyère Research Institute
| | - Anne Harley
- Attending Physician in Geriatric Rehabilitation at Bruyere Continuing Care, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Steve Papp
- Clinical Director and Trauma Surgeon at The Ottawa Hospital, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Veronique French-Merkley
- Department Chief in Care of the Elderly at Bruyere Continuing Care, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- Head of the Division of Orthopaedic Surgery at The Ottawa Hospital; Professor Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa
| | - Johanna Dobransky
- Clinical Research Program Manager, Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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8
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Thonga T, Stasi S, Papathanasiou G. The Effect of Intensive Close-Kinetic-Chain Exercises on Functionality and Balance Confidence After Total Knee Arthroplasty. Cureus 2021; 13:e18965. [PMID: 34815906 PMCID: PMC8606040 DOI: 10.7759/cureus.18965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives The aim of this study was to evaluate the effects of an additional close-kinetic-chain exercise program (CKC-PT), in conjunction with the standard physiotherapy intervention (TKA-PT), on the general health status, functionality, balance confidence, and postoperative falls of knee osteoarthritic patients who had undergone total knee arthroplasty (TKA). Patients and methods Thirty community-dwellers, aged >65 years, were randomized into equal groups. The Greek versions of the SF-36 version1.0 (SF-36v1.0-Gr), WOMAC® (WOMAC®-Gr), Activities-specific Balance Confidence scale (ABC-Greek), Timed Up and Go (TUG) test, and Berg Balance Scale were assessed preoperatively and twice postoperatively (7th week and 12th month). Non-parametric (Mann-Whitney test) and parametric (two-way analysis of variance (ANOVA) model and student t-test) analyses were used to compare the percentage changes in all variables. Results The CKC-PT group reported better (%) functional improvement (WOMAC®-Gr Physical Function subscale) and higher (%) balance confidence (ABS-Greek) at the seventh week and twelfth month as compared to TKA-PT (p<0.05). No other statistically significant differences were observed. Conclusions The implementation of a close-kinetic-chain exercise program, in addition to standard physiotherapy, may significantly increase both the functionality and balance confidence of patients who have undergone TKA. Further studies are needed to verify these findings.
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Affiliation(s)
- Theano Thonga
- Physiotherapy and Paramedical Department, General Hospital of Attica "KAT", Athens, GRC
| | - Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion - LANECASM, Physiotherapy Department, University of West Attica, Athens, GRC
| | - George Papathanasiou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion - LANECASM, Physiotherapy Department, University of West Attica, Athens, GRC
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9
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Cowley A, Goldberg SE, Gordon AL, Logan PA. Rehabilitation potential in older people living with frailty: a systematic mapping review. BMC Geriatr 2021; 21:533. [PMID: 34620112 PMCID: PMC8496021 DOI: 10.1186/s12877-021-02498-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Following periods of acute ill-health and injury, older people are frequently assessed and provided with rehabilitation services. Healthcare practitioners are required to make nuanced decisions about which patients are likely to benefit from and respond to rehabilitation. The clinical currency in which these decisions are transacted is through the term “rehabilitation potential”. The aim of this study was to explore information about rehabilitation potential in older people to inform the development of an evidence-based assessment tool. Methods A systematic mapping review was completed to describe the extent of research and the concepts underpinning rehabilitation potential. We searched Medline, CINHAL, EMBASE, AMED, PsycINFO, PEDro, Cochrane Library, Web of Science, ProQuest, Trip and EThOS from inception to December 2020. We included studies which focused on rehabilitation potential and/or assessing for rehabilitation interventions for older people with comorbidities in the hospital and community setting. Reviewer pairs independently screened articles and extracted data against the inclusion criteria. A descriptive narrative approach to analysis was taken. Results 13,484 papers were identified and 49 included in the review. Rehabilitation potential was found to encompass two different but interrelated concepts of prognostication and outcome measurement. 1. Rehabilitation potential for prognostication involved the prediction of what could be achieved in programmes of rehabilitation. 2. Rehabilitation potential as an outcome measure retrospectively considered what had been achieved as a result of rehabilitation interventions. Assessments of rehabilitation potential included key domains which were largely assessed by members of the multi-disciplinary team at single time points. Limited evidence was identified which specifically considered rehabilitation potential amongst older people living with frailty. Conclusions Current approaches to rehabilitation potential provide a snapshot of an individual’s abilities and conditions which fail to capture the dynamic nature and fluctuations associated with frailty and rehabilitation. New approaches to measures and abilities over time are required which allow for the prognostication of outcomes and potential benefits of rehabilitation interventions for older people living with frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02498-y.
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Affiliation(s)
- Alison Cowley
- Institute of Care Excellence, Derwent House, City Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK. .,School of Medicine, University of Nottingham, Nottingham, UK.
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK.,University Hospitals of Derby and Burton NHS Foundation Trust, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Pip A Logan
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK.,Nottingham CityCare Partnership CIC, Nottingham, UK
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Grund S, Kilb M, Breitinger E, Hundsdörfer W, Schäfer HG, Schols JMGA, Gordon AL, Bauer JM, Alpers GW. Evaluation of a new screening instrument for psychological distress in postacute rehabilitation in older person. Eur Geriatr Med 2021; 13:243-251. [PMID: 34510385 DOI: 10.1007/s41999-021-00554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/11/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE Although psychological distress has a negative impact on functional recovery, institutionalisation and mortality rates, there is typically no established procedure to screen for psychological distress in geriatric rehabilitation. The aim of the study was to evaluate a brief single-item Verbal Numerical Rating Scale (VNRS-PD) as a screening tool for psychological distress in multimorbid geriatric rehabilitation patients. METHODS In this cross-sectional study, N = 132 geriatric rehabilitation in-patients (M = 82 years old; 70.5% female) completed a verbal numerical rating scale (VNRS-PD) on satisfaction with their mood as well as the Hospital Anxiety and Depression Scale (HADS) and the short-form of the Geriatric Depression Scale (GDS). Based on the questionnaire data, the rehabilitation patients were classified as high or low in psychopathology. Using receiver-operating characteristic (ROC) curve analysis, optimal cutoff scores of the VNRS-PD were calculated for each questionnaire to detect significant psychological distress. RESULTS Between 28.8% (HADS ≥ 18) and 43.9% (GDS ≥ 6) of the sample had above-cutoff questionnaire scores. The area under the curve (AUC) of the VNRS-PD varied from 0.785 (95%-CI 0.709-0.861) (GDS ≥ 6) and 0.790 (95%-CI 0.716-0.864) (HADS ≥ 18) to 0.807 (95%-CI 0.734-0.880) (GDS ≥ 7). A score of ≤ 5 in the VNRS-PD proved to be the cutoff with an optimal trade-off between sensitivity (0.776-0.867) and specificity (0.638-0.703). CONCLUSION The VNRS-PD may be a suitable screening instrument to detect patients with psychological distress in inpatient geriatric rehabilitation for and to initiate further diagnostics within a graduated psychodiagnostic scheme. This first step may help to identify older patients with psychological distress and mental disorders, to initiate targeted interventions. Further research is needed to replicate these findings in a larger sample.
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Affiliation(s)
- Stefan Grund
- Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany.
| | - Michael Kilb
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Eva Breitinger
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Wilfried Hundsdörfer
- Diakonissen Hospital Mannheim Department of Geriatric Rehabilitation, Mannheim, Germany
| | - Hans G Schäfer
- Diakonissen Hospital Mannheim Department of Geriatric Rehabilitation, Mannheim, Germany
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,School of Health Sciences, City University of London, London, UK
| | - Jürgen M Bauer
- Department of Geriatrics and Geriatric Rehabilitation, Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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11
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Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G, Stolakis K, Georgiopoulos I, Benetos A. The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians. J Clin Med 2021; 10:3018. [PMID: 34300184 PMCID: PMC8304813 DOI: 10.3390/jcm10143018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Geriatric Medicine (GM) holds a crucial role in promoting health and managing the complex medical, cognitive, social, and psychological issues of older people. However, basic principles of GM, essential for optimizing the care of older people, are commonly unknown or undermined, especially in countries where GM is still under development. This narrative review aims at providing insights into the role of GM to non-geriatrician readers and summarizing the main aspects of the added value of a geriatric approach across the spectrum of healthcare. Health practitioners of all specialties are frequently encountered with clinical conditions, common in older patients (such as cancer, hypertension, delirium, major neurocognitive and mental health disorders, malnutrition, and peri-operative complications), which could be more appropriately managed under the light of the approach of GM. The role of allied health professionals with specialized knowledge and skills in dealing with older people's issues is essential, and a multidisciplinary team is required for the delivery of optimal care in response to the needs and aspirations of older people. Thus, countries should assure the educational background of all health care providers and the specialized health and social care services required to meet the demands of a rapidly aging society.
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Affiliation(s)
- Marina Kotsani
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Evrydiki Kravvariti
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- 1st Department of Propaedeutic Internal Medicine, Laiko General Hospital, 11527 Athens, Greece
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christina Avgerinou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Symeon Panagiotakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Internal Medicine, Heraklion University Hospital, 71003 Heraklion, Greece
| | - Katerina Bograkou Tzanetakou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Psychology Unit, School of Medicine, European University Cyprus, 1516 Nicosia, Cyprus
| | - Eleftheria Antoniadou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Rehabilitation Unit, Patras University Hospital, 26504 Rio, Greece
| | - Georgios Karamanof
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Clinic, Vrinnevi Hospital, 60379 Norrköping, Sweden
| | - Athanasios Karampeazis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Oncology Unit, NIMTS Veterans Hospital, 11521 Athens, Greece
| | - Anastasia Koutsouri
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
| | - Kyriaki Panagiotopoulou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Ward, Hôpital “Sainte Thérèse”, VIVALIA-IFAC, 6600 Bastogne, Belgium
| | - George Soulis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - Konstantinos Stolakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- School of Medicine, Patras University, 26504 Rio, Greece
| | - Ioannis Georgiopoulos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Athanase Benetos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
- INSERM DCAC, 54505 Vandœuvre-lès-Nancy, France
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12
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Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, Maitra I, Farrell IS, Pearce L, Moug SJ. Frailty in Older Patients Undergoing Emergency Laparotomy: Results From the UK Observational Emergency Laparotomy and Frailty (ELF) Study. Ann Surg 2021; 273:709-718. [PMID: 31188201 DOI: 10.1097/sla.0000000000003402] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to document the prevalence of frailty in older adults undergoing emergency laparotomy and to explore relationships between frailty and postoperative morbidity and mortality. SUMMARY BACKGROUND DATA The majority of adults undergoing emergency laparotomy are older adults (≥65 y) that carry the highest mortality. Improved understanding is urgently needed to allow development of targeted interventions. METHODS An observational multicenter (n=49) UK study was performed (March-June 2017). All older adults undergoing emergency laparotomy were included. Preoperative frailty score was calculated using the progressive Clinical Frailty Score (CFS): 1 (very fit) to 7 (severely frail). Primary outcome measures were the prevalence of frailty (CFS 5-7) and its association to mortality at 90 days postoperative. Secondary outcomes included 30-day mortality and morbidity, length of critical care, and overall hospital stay. RESULTS A total of 937 older adults underwent emergency laparotomy: frailty was present in 20%. Ninety-day mortality was 19.5%. After age and sex adjustment, the risk of 90-day mortality was directly associated with frailty: CFS 5 adjusted odds ratio (aOR) 3.18 [95% confidence interval (CI), 1.24-8.14] and CFS 6/7 aOR 6·10 (95% CI, 2.26-16.45) compared with CFS 1. Similar associations were found for 30-day mortality. Increasing frailty was also associated with increased risk of complications, length of Intensive Care Unit, and overall hospital stay. CONCLUSIONS A fifth of older adults undergoing emergency laparotomy are frail. The presence of frailty is associated with greater risks of postoperative mortality and morbidity and is independent of age. Frailty scoring should be integrated into acute surgical assessment practice to aid decision-making and development of novel postoperative strategies.
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Affiliation(s)
- Kat L Parmar
- Manchester Cancer Research Centre, Manchester, UK
| | | | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | - Ishaan Maitra
- North West Deanery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Lyndsay Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Susan J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, Scotland, UK
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13
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Farragher JF, Zhang J, Harrison TG, Ravani P, Elliott MJ, Hemmelgarn B. The Association Between Estimated Glomerular Filtration Rate and Hospitalization for Fatigue: A Population-Based Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211001224. [PMID: 33796323 PMCID: PMC7970172 DOI: 10.1177/20543581211001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Fatigue is a pervasive symptom among patients with chronic kidney disease
(CKD) that is associated with several adverse outcomes, but the incidence of
hospitalization for fatigue is unknown. Objective: To explore the association between estimated glomerular filtration rate
(eGFR) and incidence of hospitalization for fatigue. Design: Population-based retrospective cohort study using a provincial administrative
dataset. Setting: Alberta, Canada. Patients: People above age 18 who had at least 1 outpatient serum creatinine
measurement taken in Alberta between January 1, 2009, and December 31,
2016. Measurements: The first outpatient serum creatinine was used to estimate GFR.
Hospitalization for fatigue was identified using International
Classification of Diseases, Tenth Revision (ICD-10) code R53.x. Methods: Patients were stratified by CKD category based on their index eGFR. We used
negative binomial regression to determine if there was an increased
incidence of hospitalization for fatigue by declining kidney function
(reference eGFR ≥ 60 mL/min/1.73m2). Estimates were stratified by
age, and adjusted for age, sex, socioeconomic status, and comorbidity. Results: The study cohort consisted of 2 823 270 adults, with a mean age of 46.1 years
and median follow-up duration of 6.0 years; 5 422 hospitalizations for
fatigue occurred over 14 703 914 person-years of follow-up. Adjusted rates
of hospitalization for fatigue increased with decreasing kidney function,
across all age strata. The highest rates were seen in adults on dialysis
(adjusted incident rate ratios 24.47, 6.66, and 3.13 for those aged 18 to
64, 65 to 74, and 75+, respectively, compared with eGFR ≥ 60
mL/min/1.73m2). Limitations: Fatigue hospitalization codes have not been validated; reference group
limited to adults with at least 1 outpatient serum creatinine measurement;
remaining potential for residual confounding. Conclusions: Declining kidney function was associated with increased incidence of
hospitalization for fatigue. Further research into ways to address fatigue
in the CKD population is warranted. Trial Registration: Not applicable (not a clinical trial).
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Affiliation(s)
- Janine F Farragher
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Jianguo Zhang
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Tyrone G Harrison
- Department of Community Health Sciences, University of Calgary, AB, Canada.,Department of Medicine, University of Calgary, AB, Canada
| | - Pietro Ravani
- Department of Community Health Sciences, University of Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Meghan J Elliott
- Department of Community Health Sciences, University of Calgary, AB, Canada.,Department of Medicine, University of Calgary, AB, Canada
| | - Brenda Hemmelgarn
- Department of Community Health Sciences, University of Calgary, AB, Canada.,Department of Medicine, University of Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, AB, Canada.,Faculty of Medicine & Dentistry, University of Alberta, AB, Canada
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14
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Wu CY, Rodakowski JL, Terhorst L, Karp JF, Fields B, Skidmore ER. A Scoping Review of Nonpharmacological Interventions to Reduce Disability in Older Adults. THE GERONTOLOGIST 2020; 60:e52-e65. [PMID: 31002312 DOI: 10.1093/geront/gnz026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Minimizing disability is critical to reduce the costly health care associated with disability and maintain quality of life into old age. We examined the effect sizes of nonpharmacological intervention studies in reducing disability and explored the active ingredients of interventions. RESEARCH DESIGN AND METHODS A scoping review was conducted via PubMed, PsycINFO, and CINAHL databases. Thirty-one randomized controlled trials were included. Eight active ingredients were identified by three experts (exercise, problem-solving, cognitive behavioral therapy, environmental modification, education, goal setting, comprehensive geriatric assessment, and cognitive training). RESULTS The range of Cohen's d was -0.85 to 1.76 across 31 studies (included 33 interventions); 67% studies (n = 22) obtained small-to-negative effect sizes (d = -0.85 to 0.18), accounting for 83% participants across studies. Interventions that incorporated exercise, problem-solving, cognitive behavior therapy, and environmental modification were associated with stronger effect sizes. Interventions that incorporated comprehensive geriatric assessment obtained small effect sizes. DISCUSSION AND IMPLICATIONS Majority of intervention studies found little or no effect in reducing disability for older adults. To optimize the effects of nonpharmacological interventions, we recommend researchers to (i) develop a screening tool for "risk of disability" to inform those who are early on the disability progression, yet not experience any difficulties in activities of daily living and instrumental activities of daily living; (ii) specify the active ingredients embedded in complex interventions to facilitate change in disability; and (iii) select sensitive tools to capture the progression of disability in late life.
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Affiliation(s)
- Chao-Yi Wu
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania
| | - Juleen L Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania.,Department of Health and Community Systems, School of Nursing, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, School of Medicine, Pennsylvania.,Department of Anesthesiology, School of Medicine, Pennsylvania
| | - Beth Fields
- Center for Caregiving Research, Education and Policy, Pennsylvania.,Center for Health Equity and Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania.,Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pennsylvania
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15
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Thompson ME, Machanda ZP, Fox SA, Sabbi KH, Otali E, Thompson González N, Muller MN, Wrangham RW. Evaluating the impact of physical frailty during ageing in wild chimpanzees ( Pan troglodytes schweinfurthii). Philos Trans R Soc Lond B Biol Sci 2020; 375:20190607. [PMID: 32951544 DOI: 10.1098/rstb.2019.0607] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
While declining physical performance is an expected consequence of ageing, human clinical research has placed increasing emphasis on physical frailty as a predictor of death and disability in the elderly. We examined non-invasive measures approximating frailty in a richly sampled longitudinal dataset on wild chimpanzees. Using urinary creatinine to assess lean body mass, we found moderate but significant declines in physical condition with age in both sexes. While older chimpanzees spent less of their day in the trees and feeding, they did not alter activity budgets with respect to travel or resting. There was little evidence that declining lean body mass had negative consequences independent of age. Old chimpanzees with poor lean body mass rested more often but did not otherwise differ in activity. Males, but not females, in poor condition were more likely to exhibit respiratory illness. Poor muscle mass was associated acutely with death in males, but it did not predict future mortality in either sex. While there may be some reasons to suspect biological differences in the susceptibility to frailty in chimpanzees versus humans, our data are consistent with recent reports from humans that lean, physically active individuals can successfully combat frailty. This article is part of the theme issue 'Evolution of the primate ageing process'.
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Affiliation(s)
- Melissa Emery Thompson
- Department of Anthropology, University of New Mexico, 500 University Boulevard NE, Albuquerque, NM 87131, USA.,Kibale Chimpanzee Project, Makerere University Biological Field Station, PO Box 409, Fort Portal, Uganda
| | - Zarin P Machanda
- Department of Anthropology, Tufts University, 302 Eaton Hall, 5 The Green, Medford, MA 02155, USA
| | - Stephanie A Fox
- Department of Anthropology, University of New Mexico, 500 University Boulevard NE, Albuquerque, NM 87131, USA
| | - Kris H Sabbi
- Department of Anthropology, University of New Mexico, 500 University Boulevard NE, Albuquerque, NM 87131, USA
| | - Emily Otali
- Kibale Chimpanzee Project, Makerere University Biological Field Station, PO Box 409, Fort Portal, Uganda
| | - Nicole Thompson González
- Department of Anthropology, University of New Mexico, 500 University Boulevard NE, Albuquerque, NM 87131, USA
| | - Martin N Muller
- Department of Anthropology, University of New Mexico, 500 University Boulevard NE, Albuquerque, NM 87131, USA.,Kibale Chimpanzee Project, Makerere University Biological Field Station, PO Box 409, Fort Portal, Uganda
| | - Richard W Wrangham
- Kibale Chimpanzee Project, Makerere University Biological Field Station, PO Box 409, Fort Portal, Uganda.,Department of Human Evolutionary Biology, Harvard University, 11 Divinity Avenue, Cambridge, MA 02138, USA
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16
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Huang HH, Chang JCY, Tseng CC, Yang YJ, Fan JS, Chen YC, Peng LN, Yen DHT. Comprehensive geriatric assessment in the emergency department for the prediction of readmission among older patients: A 3-month follow-up study. Arch Gerontol Geriatr 2020; 92:104255. [PMID: 32966944 DOI: 10.1016/j.archger.2020.104255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older people present to the emergency department (ED) with distinct patterns and emergency care needs. This study aimed to use comprehensive geriatric assessment (CGA) surveying the patterns of ED visits among older patients and determine frailty associated with the risk of revisits/readmission. METHODS This prospective study screened 2270 patients aged ≥75 years in the ED from August 2018 to February 2019. All patients underwent CGA. A 3-months follow-up was conducted to observe the hospital courses of admission and revisit/readmission. RESULTS A total of 270 older patients were enrolled. The independent predictors of admission at initial ED visit were the risk of nutritional deficit and instrumental activities of daily living (IADL). In the admission group, the independent predictors of revisit/readmission were a fall in the past year and mobility difficulties. In the discharge group, the independent predictors of revisit/readmission were frailty and insomnia. Regardless if older patients were either admitted or discharged at the initial ED visit, the independent predictor of revisit/readmission for older patients was frailty. CONCLUSION Our study showed that frailty was the only independent predictor for revisit/readmission after ED discharge during the 3-month follow up. For ED physicians, malnutrition and IADL were independent predictors in recognizing whether the older patient should be admitted to the hospital. For discharged older ED patients, frailty was the independent predictor for the integration of community services for older patients to decrease the rate of revisit/readmission in 3 months.
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Affiliation(s)
- Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Julia Chia-Yu Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chien-Chien Tseng
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Jie Yang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Sing Fan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yen-Chia Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Hung-Tsang Yen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Emergency Medicine, National Defense Medical Center, Taipei, Taiwan.
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17
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Hosoi T, Yamana H, Tamiya H, Matsui H, Fushimi K, Akishita M, Yasunaga H, Ogawa S. Association between comprehensive geriatric assessment and short-term outcomes among older adult patients with stroke: A nationwide retrospective cohort study using propensity score and instrumental variable methods. EClinicalMedicine 2020; 23:100411. [PMID: 32566923 PMCID: PMC7298723 DOI: 10.1016/j.eclinm.2020.100411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary method to identify geriatric conditions among older patients. The aim of the present study was to examine the associations between CGA and short-term outcomes among older adult inpatients with stroke. METHODS The study was a nationwide, retrospective cohort study. We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify older adult stroke patients from 2014 to 2017. The associations between CGA and in-hospital mortality, length of hospital stay, readmission rate, rehabilitation intervention, and introduction of home health care were evaluated using propensity score matching and instrumental variable analysis. FINDINGS We identified 338,720 patients, 21·3% of whom received CGA. A propensity score-matched analysis of 53,861 pairs showed that in-hospital mortality was significantly lower in the CGA group than in the non-CGA group (3·6% vs. 4·1%, p < 0·001). The rate of long-term hospitalization (> 60 days) was significantly lower in the CGA group than in the non-CGA group (8·7% vs. 10·1%, p < 0·001), and the rates of rehabilitation intervention (30·3% vs. 24·9%, p < 0·001) and home health care (8·3% vs. 7·6%, p = 0·001) were both higher in the CGA group than in the non-CGA group. Instrumental variable analysis showed similar results. INTERPRETATION CGA was significantly associated with the examined short-term outcomes. These findings from Japan, one of the most aged countries worldwide, highlight the possible benefits of CGA for short-term outcomes and can be of use for health policy in other international contexts. FUNDING This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
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Affiliation(s)
- Tatsuya Hosoi
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Tamiya
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Corresponding author.
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Mitchell R, Draper B, Brodaty H, Close J, Ting HP, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporos Int 2020; 31:465-474. [PMID: 31897545 DOI: 10.1007/s00198-019-05260-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
UNLABELLED This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. INTRODUCTION To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. METHODS A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. RESULTS Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. CONCLUSION Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. HIGHLIGHTS • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - B Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - H Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - H P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - R Lystad
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - I Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - C Sherrington
- School of Public Health, University of Sydney, Sydney, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Carter B, Law J, Hewitt J, Parmar KL, Boyle JM, Casey P, Maitra I, Pearce L, Moug SJ, Ross B, Oleksiewicz J, Fearnhead N, Jump C, Boyle J, Shaw A, Barker J, Hughes J, Randall J, Tonga I, Kynaston J, Boal M, Eardley N, Kane E, Reader H, Mahapatra SR, Garner-Jones M, Tan JJ, Mohamed S, George R, Whiteman E, Malik K, Smart CJ, Bogdan M, Chaudhury MP, Sharma V, Subar D, Patel P, Chok SM, Lim E, Adhiyaman V, Davies G, Ross E, Maitra R, Steele CW, Roxburgh C, Griffiths S, Blencowe NS, Kirkham EN, Abraham JS, Griffiths K, Abdulaal Y, Iqbal MR, Tarazi M, Hill J, Khan A, Farrell I, Conn G, Patel J, Reddy H, Sarveswaran J, Arunachalam L, Malik A, Ponchietti L, Pawelec K, Goh YM, Vitish-Sharma P, Saad A, Smyth E, Crees A, Merker L, Bashir N, Williams G, Hayes J, Walters K, Harries R, Singh R, Henderson NA, Polignano FM, Knight B, Alder L, Kenchington A, Goh YL, Dicurzio I, Griffiths E, Alani A, Knight K, MacGoey P, Ng GS, Mackenzie N, Maitra I, Moug S, Ong K, McGrath D, Gammeri E, Lafaurie G, Faulkner G, Di Benedetto G, McGovern J, Subramanian B, Narang SK, Nowers J, Smart NJ, Daniels IR, Varcada M, Gala T, Cornish J, Barber Z, O'Neill S, McGregor R, Robertson AG, Paterson-Brown S, Raymond T, Thaha MA, English WJ, Forde CT, Paine H, Morawala A, Date R, Casey P, Bolton T, Gleaves X, Fasuyi J, Durakovic S, Dunstan M, Allen S, Riga A, Epstein J, Pearce L, Gaines E, Howe A, Choonara H, Dewi F, Bennett J, King E, McCarthy K, Taylor G, Harris D, Nageswaran H, Stimpson A, Siddiqui K, Lim LI, Ray C, Smith L, McColl G, Rahman M, Kler A, Sharma A, Parmar K, Patel N, Crofts P, Baldari C, Thomas R, Stechman M, Aldridge R, O'Kelly J, Wilson G, Gallegos N, Kalaiselvan R, Rajaganeshan R, Mackenzie A, Naik P, Singh K, Gandraspulli H, Wilson J, Hancorn K, Khawaja A, Nicholas F, Marks T, Abbott C, Chandler S. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Br J Surg 2020; 107:218-226. [DOI: 10.1002/bjs.11392] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/20/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.
Methods
The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.
Results
A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.
Conclusion
Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.
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Affiliation(s)
- B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Law
- Department of Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - K L Parmar
- Manchester Cancer Research Centre, Manchester, NorthWest Deanery, UK
| | - J M Boyle
- Royal College of Surgeons of England, London, UK
| | - P Casey
- Health Education North West, Manchester, NorthWest Deanery, UK
| | - I Maitra
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - L Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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Mitchell R, Fajardo Pulido D, Ryder T, Norton G, Brodaty H, Draper B, Close J, Rapport F, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals' views. Disabil Rehabil 2019; 43:834-845. [PMID: 31335212 DOI: 10.1080/09638288.2019.1643418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. METHODS Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. RESULTS Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to individual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. CONCLUSIONS The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.IMPLICATIONS FOR REHABILITATIONNeed to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation.Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision.Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability.
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Affiliation(s)
- Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Grace Norton
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - Brian Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Reidar Lystad
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Lara Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | | | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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21
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Fritz H, Seidarabi S, Barbour R, Vonbehren A. Occupational Therapy Intervention to Improve Outcomes Among Frail Older Adults: A Scoping Review. Am J Occup Ther 2019; 73:7303205130p1-7303205130p12. [PMID: 31120843 DOI: 10.5014/ajot.2019.030585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Frailty is common in later life and increases older adults' risk for early disability, institutionalization, and mortality. OBJECTIVE To explore the research literature on occupational therapy interventions to improve outcomes among frail, community-dwelling older adults. DESIGN Scoping review of the peer-reviewed literature about occupational therapy interventions and frailty published between January 1996 and January 2017. RESULTS Ten studies met the inclusion criteria. The majority of the studies focused on adults age 65 yr or older, operationalized frailty as activities of daily living disability, and did not use validated frailty measures to identify frail older adults. Interventions were delivered both as a stand-alone intervention and as part of a multidisciplinary approach. Treatments focused on recommendations and training in use of adaptive devices or assistive technologies, performance of self-care, and recommendations for home modifications. CONCLUSION Additional research is warranted to build the evidence base and better inform the design and selection of occupational therapy interventions to improve outcomes among frail older adults.
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Affiliation(s)
- Heather Fritz
- Heather Fritz, PhD, OTR/L, is Assistant Professor of Occupational Therapy and Gerontology, Eugene Applebaum College of Pharmacy and Health Sciences and Institute of Gerontology, Wayne State University, Detroit, MI;
| | - Sara Seidarabi
- Sara Seidarabi, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Ryan Barbour
- Ryan Barbour, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Alexandra Vonbehren
- Alexandra Vonbehren, MOT, is Occupational Therapy Student, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
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Bean JF, Orkaby AR, Driver JA. Geriatric Rehabilitation Should Not Be an Oxymoron: A Path Forward. Arch Phys Med Rehabil 2019; 100:995-1000. [PMID: 30735624 DOI: 10.1016/j.apmr.2018.12.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/31/2018] [Indexed: 12/18/2022]
Abstract
Older adults are the fastest growing segment of our population and contribute greatly to the high costs of health care. The primary concern among older adults seeking health care is maintaining or improving functional independence. This concern is the focus of both rehabilitative care and geriatric medicine; however, collaboration between these fields can be hampered by a lack of mutual understanding of the fundamental principles of the other field. We describe 3 steps that can be implemented at an organizational or individual level to bridge the fields of geriatric medicine and rehabilitation, allowing them to better serve older patients. These include (1) recognizing the interwoven concepts of multimorbidity, function, and frailty; (2) communicating with a common language; and (3) synthesizing our knowledge from both fields.
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Affiliation(s)
- Jonathan F Bean
- New England Geriatric Research, Education and Clinical Center, Boston VA Healthcare System, Boston, Massachusetts, United States; Department of PM&R, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States; Harvard Medical School, Boston, Massachusetts, United States.
| | - Ariela R Orkaby
- New England Geriatric Research, Education and Clinical Center, Boston VA Healthcare System, Boston, Massachusetts, United States; Harvard Medical School, Boston, Massachusetts, United States; Division of Aging, Brigham & Women's Hospital, Boston, Massachusetts, United States
| | - Jane A Driver
- New England Geriatric Research, Education and Clinical Center, Boston VA Healthcare System, Boston, Massachusetts, United States; Harvard Medical School, Boston, Massachusetts, United States; Division of Aging, Brigham & Women's Hospital, Boston, Massachusetts, United States
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23
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McMurray J, McNeil H, Gordon A, Elliott J, Stolee P. Building a Rehabilitative Care Measurement Instrument to Improve the Patient Experience. Arch Phys Med Rehabil 2019; 100:39-44. [DOI: 10.1016/j.apmr.2018.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/14/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
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van Seben R, Smorenburg SM, Buurman BM. A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives. Clin Rehabil 2018; 33:128-140. [PMID: 30103621 PMCID: PMC6311617 DOI: 10.1177/0269215518791663] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To characterize how rehabilitation goals of older patients change over time and to explore professionals' attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals. DESIGN: Qualitative interview study. SETTING: Three geriatric rehabilitation centers. SUBJECTS: Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited. METHODS: Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed. RESULTS: During inpatient rehabilitation, participants' main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge. CONCLUSION: During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge.
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Affiliation(s)
- Rosanne van Seben
- 1 Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bianca M Buurman
- 1 Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.,3 ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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25
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Abstract
PURPOSE OF THE REVIEW In clinical practice, older patients are often undertreated due to underrepresentation in clinical trials and fear of toxicity. Our objective was therefore to review toxicities that are specific to older cancer patients, to review risk factors in order to help physicians guide their decisions, and to review interventions that can be implemented in routine clinical practice to prevent toxicity induced by cancer therapies. RECENT FINDINGS On the whole, reviews report similar number and frequency as well as similar grade 3 or 4 adverse events between subjects older and younger than 65 years. Yet patients included in clinical trials are often not representative of real-life patients and are often fit older cancer patients. Moreover, tolerance to the additive impact of multiple adverse effects is different between older and younger patients. And specific symptoms such as stomatitis may cause a series of consequences such as dehydration, denutrition, renal insufficiency, and adverse events of renally excreted drugs. Older patients are at high risk of toxicity due to many factors but mainly due to the prevalence of frailty in this population that has been estimated to be around 40% increasing the risk of chemotherapy intolerance. As a consequence, interventions must be implemented according to altered domains of comprehensive geriatric assessment in order to improve anticancer tolerance. These interventions are reviewed here.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | - Claire Falandry
- Geriatric Oncology Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,CarMen biomedical research laboratory (Cardiovascular diseases, Metabolism, diabetology and Nutrition) INSERM UMR 1060, Université de Lyon, Oullins, France
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26
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Pikkarainen A, Vähäsantanen K, Paloniemi S, Eteläpelto A. Rehabilitation agency of older adults in group-based intervention. Scand J Occup Ther 2018; 26:411-422. [PMID: 29313394 DOI: 10.1080/11038128.2018.1424237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS This study investigated the individual rehabilitation agency of older adults in a one-year group-based gerontological rehabilitation context. Here, rehabilitation agency is understood as being manifested when older adults make choices and decisions regarding their everyday lives, including notions of themselves. METHODS The data were obtained via non-participant observation of the final individual goal evaluation sessions of 38 older adults with their personal counselor. In these sessions, older adults discussed their rehabilitation outcomes, actions, choices and decisions during the rehabilitation year, along with their future in home settings. The data were analyzed using qualitative content analysis and an agency-centred approach. FINDINGS The findings revealed that older adults made choices and decisions differently concerning their life in and beyond the rehabilitation context. Four forms of rehabilitation agency of older adults were identified: (i) renewable, (ii) widened, (iii) selective and (iv) fractured. These forms of agency were differently connected to older adults' life courses and to their peer relations in the rehabilitation context. CONCLUSIONS An agency-centred approach could produce new theoretical ideas and practical implications for developing older adults' rehabilitation to better meet their needs as well as the goals of group-based rehabilitation interventions.
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Affiliation(s)
- Aila Pikkarainen
- a School of Health and Social Studies , Jyväskylä University of Applied Sciences , Jyväskylä , Finland
| | - Katja Vähäsantanen
- b Adult Education, Faculty of Education and Psychology , University of Jyväskylä , Jyväskylä , Finland
| | - Susanna Paloniemi
- b Adult Education, Faculty of Education and Psychology , University of Jyväskylä , Jyväskylä , Finland
| | - Anneli Eteläpelto
- b Adult Education, Faculty of Education and Psychology , University of Jyväskylä , Jyväskylä , Finland
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The Rest of the Story: A Qualitative Study of Complementing Standardized Assessment Data with Informal Interviews with Older Patients and Families. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:215-224. [PMID: 27596366 DOI: 10.1007/s40271-016-0193-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND While standardized health assessments capture valuable information on patients' demographic and diagnostic characteristics, health conditions, and physical and mental functioning, they may not capture information of most relevance to individual patients and their families. Given that patients and their informal caregivers are the experts on that patient's unique context, it is important to ensure they are able to convey all relevant personal information to formal healthcare providers so that high-quality, patient-centered care may be delivered. This study aims to identify information that older patients and families consider important but that might not be included in standardized assessments. METHODS Transcripts were analyzed from 29 interviews relating to eight patients with hip fractures from three sites (large urban, smaller urban, rural) in two provinces in Canada. These interviews were conducted as part of a larger ethnographic study. Each transcript was analyzed by two researchers using content analysis. Results were reviewed in two focus group interviews with older adults and family caregivers. Identified themes were compared with items from two standardized assessments used in healthcare settings. RESULTS Three broad themes emerged from the qualitative analysis that were not covered in the standardized assessments: informal caregiver and family considerations, insider healthcare knowledge, and patients' healthcare attitudes and experiences. The importance of these themes was confirmed through focus group interviews. Focus group participants also emphasized the importance of conducting assessments in a patient-centered way and the importance of open-ended questions. CONCLUSIONS A less structured interview approach may yield information that would otherwise be missed in standardized assessments. Combining both sources could yield better-informed healthcare planning and quality-improvement efforts.
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Bornet MA, Rubli Truchard E, Rochat E, Pasquier J, Monod S. Factors associated with quality of life in elderly hospitalised patients undergoing post-acute rehabilitation: a cross-sectional analytical study in Switzerland. BMJ Open 2017; 7:e018600. [PMID: 29061633 PMCID: PMC5665247 DOI: 10.1136/bmjopen-2017-018600] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We investigated whether biopsychosocial and spiritual factors and satisfaction with care were associated with patients' perceived quality of life. DESIGN This was a cross-sectional analytical study. SETTING Data were collected from inpatients at a postacute geriatric rehabilitation centre in a university hospital in Switzerland. PARTICIPANTS Participants aged 65 years and over were consecutively recruited from October 2014 to January 2016. Exclusion criteria included significant cognitive disorder and terminal illness. Of 227 eligible participants, complete data were collected from 167. MAIN OUTCOME MEASURES Perceived quality of life was measured using WHO Quality of Life Questionnaire-version for older people. Predictive factors were age, sex, functional status at admission, comorbidities, cognitive status, depressive symptoms, living conditions and satisfaction with care. A secondary focus was the association between spiritual needs and quality of life. RESULTS Patients undergoing geriatric rehabilitation experienced a good quality of life. Greater quality of life was significantly associated with higher functional status (rs=0.204, p=0.011), better cognitive status (rs=0.175, p=0.029) and greater satisfaction with care (rs=0.264, p=0.003). Poorer quality of life was significantly associated with comorbidities (rs=-.226, p=0.033), greater depressive symptoms (rs=-.379, p<0.001) and unmet spiritual needs (rs=-.211, p=0.049). Multivariate linear regression indicated that depressive symptoms (β=-0.961; 95% CIs -1.449 to 0.472; p<0.001) significantly predicted quality of life. CONCLUSIONS Patient perceptions of quality of life were significantly associated with depression. More research is needed to assess whether considering quality of life could improve care plan creation.
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Affiliation(s)
- Marc-Antoine Bornet
- Platform Medicine, Spirituality, Care and Society, Lausanne University Hospital Center, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital Center, Lausanne, Switzerland
| | - Etienne Rochat
- Platform Medicine, Spirituality, Care and Society, Lausanne University Hospital Center, Lausanne, Switzerland
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine, Lausanne University Hospital Center, Lausanne, Switzerland
| | - Stéfanie Monod
- Department of Public Health, Canton of Vaud, Lausanne, Switzerland
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Glenny C, Kuspinar A, Naglie G, Stolee P. A qualitative study of healthcare provider perspectives on measuring functional outcomes in geriatric rehabilitation. Clin Rehabil 2017; 32:546-556. [PMID: 28958168 DOI: 10.1177/0269215517733114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore, from the perspective of healthcare providers, the barriers to and facilitators of using standardized outcome measures of physical function in geriatric rehabilitation settings. METHODS In-depth semi-structured interviews with medical doctors, nurses, physiotherapists and occupational therapists were conducted from three geriatric rehabilitation hospitals in Ontario. Qualitative content analysis through an inductive approach was used to identify barriers to and facilitators of outcome measurement in geriatric rehabilitation settings. RESULTS A total of 20 healthcare providers from different disciplines were interviewed. Barriers are standardized outcome measures that (1) cannot be used in isolation to inform clinical decision-making for older patients, (2) are difficult to complete and interpret in older complex patients, (3) may not be useful for all members of the clinical team and (4) are used for reasons unrelated to patient care. Facilitators are to (1) divide the standardized outcome measure into components that are useful for each team member's practice, (2) encourage standardized outcome measures as tools for improving daily communication and (3) provide adequate education and support for their daily use. CONCLUSION This study revealed important barriers to using standardized outcome measures in geriatric rehabilitation from the perspective of healthcare providers. However, it also identified multiple factors that may help facilitate their use.
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Affiliation(s)
- Christine Glenny
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,2 Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ayse Kuspinar
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,3 School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Gary Naglie
- 4 Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.,5 Research Department, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,6 Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Paul Stolee
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Heyman N, Tsirulnicov T, Ben Natan M. Prediction of geriatric rehabilitation outcomes: Comparison between three cognitive screening tools. Geriatr Gerontol Int 2017; 17:2507-2513. [PMID: 28707303 DOI: 10.1111/ggi.13117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023]
Abstract
AIM Comparison between the predictions of functional rehabilitation outcomes at a department of geriatric rehabilitation using three cognitive screening tools - Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). METHODS This study is a prospective study. The study participants were 212 patients aged 65 and older admitted to rehabilitation departments at a geriatric facility in central Israel, from April 2016 to October 2016. The cognitive functioning of each patient was assessed using the MMSE, MoCA, and IQCODE. Upon discharge, rehabilitation outcomes were examined using the Functional Independence Measure (FIM), cognitive FIM, delta FIM (Δ FIM), and ADL. RESULTS Cognitive impairment was found to interfere with the rehabilitation process. The MMSE was the best predictor of functional rehabilitation outcomes at discharge, compared to the IQCODE, while the MoCA did not predict these measures. In addition, when distinguishing between patients by ethnicity (Jewish versus Arab), the MMSE and the IQCODE predicted FIM upon discharge among Jewish patients, while only the IQCODE predicted FIM upon discharge among Arab patients. CONCLUSIONS The research findings show that cognitive assessment upon admission for rehabilitation - MMSE among Jewish patients and IQCODE among Arab patients - can help predict functional rehabilitation outcomes and make the appropriate adaptations in the rehabilitation program. Geriatr Gerontol Int 2017; 17: 2507-2513.
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Affiliation(s)
- Noemi Heyman
- Department of Geriatrics, Shoham Medical Center, Pardes Hana, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Pardes Hana, Israel
| | - Tatyana Tsirulnicov
- Department of Geriatrics, Shoham Medical Center, Pardes Hana, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Pardes Hana, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Israel
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Perna S, Francis MD, Bologna C, Moncaglieri F, Riva A, Morazzoni P, Allegrini P, Isu A, Vigo B, Guerriero F, Rondanelli M. Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools. BMC Geriatr 2017; 17:2. [PMID: 28049443 PMCID: PMC5209899 DOI: 10.1186/s12877-016-0382-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 11/25/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the performance of Edmonton Frail Scale (EFS) on frailty assessment in association with multi-dimensional conditions assessed with specific screening tools and to explore the prevalence of frailty by gender. METHODS We enrolled 366 hospitalised patients (women\men: 251\115), mean age 81.5 years. The EFS was given to the patients to evaluate their frailty. Then we collected data concerning cognitive status through Mini-Mental State Examination (MMSE), health status (evaluated with the number of diseases), functional independence (Barthel Index and Activities Daily Living; BI, ADL, IADL), use of drugs (counting of drugs taken every day), Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS), Skeletal Muscle Index of sarcopenia (SMI), osteoporosis and functionality (Handgrip strength). RESULTS According with the EFS, the 19.7% of subjects were classified as non frail, 66.4% as apparently vulnerable and 13.9% with severe frailty. The EFS scores were associated with cognition (MMSE: β = 0.980; p < 0.01), functional independence (ADL: β = -0.512; p < 0.00); (IADL: β = -0.338; p < 0.01); use of medications (β = 0.110; p < 0.01); nutrition (MNA: β = -0.413; p < 0.01); mood (GDS: β = -0.324; p < 0.01); functional performance (Handgrip: β = -0.114, p < 0.01) (BI: β = -0.037; p < 0.01), but not with number of comorbidities (β = 0.108; p = 0.052). In osteoporotic patients versus not-osteoporotic patients the mean EFS score did not differ between groups (women: p = 0.365; men: p = 0.088), whereas in Sarcopenic versus not-Sarcopenic patients, there was a significant differences in women: p < 0.05. CONCLUSIONS This study suggests that measuring frailty with EFS is helpful and performance tool for stratifying the state of fragility in a group of institutionalized elderly. As matter of facts the EFS has been shown to be associated with several geriatric conditions such independence, drugs assumption, mood, mental, functional and nutritional status.
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Affiliation(s)
- Simone Perna
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, University of Pavia, Azienda di Servizi alla Persona di Pavia, Via Emilia 12, Pavia, Italy
| | - Matthew D’Arcy Francis
- Deprtment of Internal Medicine and Medical Therapy, Section of Geriatrics University of Pavia, Azienda di Servizi alla Persona, Pavia, Italy
| | - Chiara Bologna
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, University of Pavia, Azienda di Servizi alla Persona di Pavia, Via Emilia 12, Pavia, Italy
| | - Francesca Moncaglieri
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, University of Pavia, Azienda di Servizi alla Persona di Pavia, Via Emilia 12, Pavia, Italy
| | | | | | | | - Antonio Isu
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, University of Pavia, Azienda di Servizi alla Persona di Pavia, Via Emilia 12, Pavia, Italy
| | - Beatrice Vigo
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, University of Pavia, Azienda di Servizi alla Persona di Pavia, Via Emilia 12, Pavia, Italy
| | - Fabio Guerriero
- Deprtment of Internal Medicine and Medical Therapy, Section of Geriatrics University of Pavia, Azienda di Servizi alla Persona, Pavia, Italy
| | - Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, University of Pavia, Azienda di Servizi alla Persona di Pavia, Via Emilia 12, Pavia, Italy
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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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Douglas A, Liu L, Warren S, Hopper T. Cognitive Assessments for Older Adults: Which Ones are Used by Canadian Therapists and Why. The Canadian Journal of Occupational Therapy 2016; 74:370-81. [DOI: 10.2182/cjot.07.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background. Occupational therapists routinely evaluate cognition in older adults, yet little is known about which assessments they use and for what purposes. Purpose. To examine the standardised and non-standardised assessments used by occupational therapists to evaluate cognition. Method. Arandom sample of 1042 Canadian occupational therapists completed the questionnaire by e-mail, post, or Internet website (n=247, response rate: 24.5%). Results. Respondents reported using 75 standardised and non-standardised measures. The assessments were grouped according to theoretical approach: bottom-up (assessment of cognitive components), top-down (assessment of function) and combined (either of above, plus interview). Theoretical approaches were used similarly across regions, despite differences in reporting of particular assessments. Therapists used more bottom-up assessments that were standardised, identified deficits, and easy to administer. They used more top-down assessments that were non-standardised, predicted function, and fit with their theoretical approach. Conclusion. It is recommended that standardised top-down assessments be developed to support evidence-based occupational therapy.
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Marosi C, Köller M. Challenge of cancer in the elderly. ESMO Open 2016; 1:e000020. [PMID: 27843603 PMCID: PMC5070391 DOI: 10.1136/esmoopen-2015-000020] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/21/2022] Open
Abstract
Despite the sustained trend of decreasing overall cancer incidence, the number of elderly patients with cancer will considerably increase in the coming years, as the incidence of cancer is elevated 11-fold after the age of 65 years compared to adults up to 65 years. This soon-to-erupt tsunami of elderly patients with cancer requires adequate treatment, for which guidelines and evidence-based data are still scarce, given the longlasting under-representation of elderly patients with cancer in cancer trials. Older adults present not only with the physiological decreases of organ functions related to age, but also with an individual burden of comorbidities, other impairments and social factors that might impact on their potential for undergoing cancer care. Close collaboration with gerontologists and other health professionals to assess the personal resources and limitations of each person enables providing adequate therapy to elderly patients with cancer. There are promising achievements in each of the requirements listed, but a huge, holistic effort has still to be made.
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Affiliation(s)
- Christine Marosi
- Clinical Division of Medical Oncology, Department of Internal Medicine I , Medical University of Vienna , Vienna , Austria
| | - Marcus Köller
- Sophienspital der Gemeinde Wien & Department of Internal Medicine III , Medical University of Vienna , Vienna , Austria
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Resnick B, Beaupre L, McGilton KS, Galik E, Liu W, Neuman MD, Gruber-Baldini AL, Orwig D, Magaziner J. Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review. J Am Med Dir Assoc 2016; 17:200-5. [PMID: 26612482 PMCID: PMC4769900 DOI: 10.1016/j.jamda.2015.10.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Currently, most rehabilitation services for individuals who sustain a hip fracture are not designed to meet the complex needs of those who also have cognitive impairment. The goal of this review was to identify current best practices for rehabilitation in long-term care settings and approaches to optimize outcomes among individuals with dementia and other cognitive impairments post-hip fracture. PROCEDURES The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was used to guide the review. Five electronic databases, including PubMed, EMBASE, CINAHL (EBSCO), Medline (EBSCO), and PsycINFO (EBSCO), were searched for intervention studies published in English language journals. Studies were eligible if they focused on rehabilitation interventions post-hip fracture among older individuals (≥ 65 years) with cognitive impairment who were living in or transferred to long-term care or postacute/rehabilitation settings post-hip fracture. Studies were excluded if they did not enroll individuals with cognitive impairment, the study was descriptive without any intervention content, or the intervention components were only medication, surgical approach or medical treatment. MAIN FINDINGS A total of 4478 records were identified, 1915 of which were duplicative, 2563 were relevant based on title, and after careful review 7 studies were included. Two included studies were randomized controlled trials, one was a single group pre- and post-test, one a descriptive comparison between those with and without cognitive impairment, one a case controlled matched trial, one a nonequivalent groups trial, and one a case report. The interventions varied between manipulating the type and amount of exercise or testing multifactorial issues including environmental interventions and the use of an interdisciplinary team to address psychosocial factors, medication management, use of assistive devices, and specific preferences or concerns of the individuals. CONCLUSIONS The evidence summarized in this review suggests that it is feasible to implement rehabilitation programs focused on individuals with cognitive impairment in postacute care settings. Moreover, there was evidence to suggest that intensive rehabilitation and exercise activities are beneficial, although innovative approaches may be needed to engage individuals with cognitive impairment.
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Affiliation(s)
- Barbara Resnick
- University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, Maryland 21201, Phone: 410 706 5178
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada, T6G 2G4
| | - Katherine S McGilton
- Toronto Rehabilitation Institute – UHN, Associate Professor, Lawrence S Bloomberg Faculty of Nursing, Toronto, Ontario, Canada M6K 2R7
| | - Elizabeth Galik
- University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, Maryland 21201
| | | | - Mark D. Neuman
- Perelman School of Medicine at the University of Pennsylvania
| | - Ann L. Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Denise Orwig
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201
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McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring Patients' Experience of Rehabilitation Services Across the Care Continuum. Part II: Key Dimensions. Arch Phys Med Rehabil 2016; 97:121-30. [DOI: 10.1016/j.apmr.2015.08.408] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/11/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022]
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de Vos AJBM, Asmus-Szepesi KJE, Bakker TJEM, de Vreede PL, van Wijngaarden JDH, Steyerberg EW, Mackenbach JP, Nieboer AP. [INTEGRATED APPROACH TO PREVENT FUNCTIONAL DECLINE IN HOSPITALIZED ELDERLY]. Tijdschr Gerontol Geriatr 2015; 46:12-27. [PMID: 25403322 DOI: 10.1007/s12439-014-0100-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. METHODS/DESIGN To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented the Prevention and Reactivation Care Programme (PReCaP), an innovative program aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. DISCUSSION This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the prevention and Reactivation Centre; (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of forthcoming papers. This article is an edited translation of the previously published article 'Integrated approach to prevent functional decline in hospitalized elderly: the Prevention and Reactivation Care Program (PReCaP), BMC Geriatrics 2012;12:7, AJBM de Vos, KJE Asmus-Szepesi, TJEM Bakker, PL de Vreede, JDH van Wijngaarden, EW Steyerberg, JP Mackenbach, AP Nieboer.
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Affiliation(s)
- A J B M de Vos
- Instituut Beleid & Management Gezondheidszorg, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands,
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Cheng L, Zhu M, Poss JW, Hirdes JP, Glenny C, Stolee P. Opinion versus practice regarding the use of rehabilitation services in home care: an investigation using machine learning algorithms. BMC Med Inform Decis Mak 2015; 15:80. [PMID: 26453354 PMCID: PMC4600209 DOI: 10.1186/s12911-015-0203-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Resources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment. METHODS We applied two algorithms from machine learning and data mining - the LASSO and the random forest - to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada. RESULTS Analyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not. CONCLUSIONS Inconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice.
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Affiliation(s)
- Lu Cheng
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Mathematics Building No. 3, Waterloo, ON N2L 3G1 Canada
| | - Mu Zhu
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Mathematics Building No. 3, Waterloo, ON N2L 3G1 Canada
| | - Jeffrey W. Poss
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Christine Glenny
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
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Jamour M, Marburger C, Runge M, Sieber CC, Tümena T, Swoboda W. [Effectiveness of geriatric rehabilitation in the oldest old: evaluation of South German observational data]. Z Gerontol Geriatr 2015; 47:389-96. [PMID: 25012107 DOI: 10.1007/s00391-014-0662-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Geriatric rehabilitation might be the only way for the very old to maintain their participation in social life, since in many cases self care, everyday skills and basic activities of daily living can only be recovered by an integrative treatment approach using a multiprofessional team setting. At the same time limited financial resources in health care have to be considered to make appropriate allocation decisions in geriatric rehabilitation. PURPOSE The goal of this work was to determine whether chronological age is a limiting factor for functional outcome in geriatric rehabilitation. MATERIALS AND METHODS Data from the state of Baden-Württemberg (KODAS data set) from the years 2005-2011 for nonagenarians and data for centenarians from the Geriatrics in Bavaria database (GiB-DAT) project from the years 2003-2011 were compared to the data of the younger seniors undergoing geriatric rehabilitation. For the KODAS data collection, 31 geriatric rehabilitation clinics in Baden-Württemberg were involved. The GiB-DAT project included 59 geriatric rehabilitation clinics in Bavaria. Both databases compare the results of the geriatric assessment at the beginning and at the end of geriatric rehabilitation. RESULTS The analyzed data are presented with regard to the functional outcome in the very elderly and are discussed with respect to policy implications.
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Affiliation(s)
- M Jamour
- Geriatrische Rehabilitationsklinik Ehingen, Alb-Donau-Klinikum, Spitalstr. 29, 89584, Ehingen, Deutschland,
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Uchmanowicz I, Lisiak M, Wontor R, Łoboz-Grudzień K. Frailty in patients with acute coronary syndrome: comparison between tools for comprehensive geriatric assessment and the Tilburg Frailty Indicator. Clin Interv Aging 2015; 10:521-9. [PMID: 25767379 PMCID: PMC4354429 DOI: 10.2147/cia.s78365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE It is a known fact that age is a strong predictor of adverse events in acute coronary syndrome (ACS). In this context, the main risk factor in elderly patients, ie, frailty syndrome, gains special importance. The availability of tools to identify frail people is relevant for both research and clinical purposes. The purpose of this study was to investigate the correlation of a scale for assessing frailty - the Tilburg Frailty Indicator (TFI) and its domains (mental and physical) - with other research tools commonly used for comprehensive geriatric assessment in patients with ACS. PATIENTS AND METHODS The study covered 135 people and was carried out in the cardiology ward at T Marciniak Lower Silesian Specialist Hospital in Wroclaw, Poland. The patients were admitted with ACS. ST segment elevation myocardial infarction and non-ST segment elevation myocardial infarction were defined by the presence of certain conditions in reference to the literature. The Polish adaptation of the TFI was used for the frailty syndrome assessment, which was compared to other single measures used in geriatric assessment: the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), and Katz Index of Independence in Activities of Daily Living (ADLs). RESULTS The mean TFI value in the studied group amounted to 7.13±2.81 (median: 7, interquartile range: 5-9, range [0, 14]). Significant correlations were demonstrated between the values of the TFI and other scales: positive for HADS (r=0.602, P<0.001) and the reverse for MMSE (r=-0.603, P<0.001) and IADL (r=-0.462, P<0.001). Patients with a TFI score ≥5 revealed considerably higher values on HADS (P<0.001) and considerably lower values on the MMSE (P<0.001) and IADL scales (P=0.001). CONCLUSION The results for the TFI comply with the results of other scales (MMSE, HADS, ADL, IADL), which confirm the credibility of the Polish adaptation of the tool. Stronger correlations were observed for mental components and the mental scales turned out to be independently related to the TFI in a multidimensional analysis.
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Affiliation(s)
| | - Magdalena Lisiak
- Department of Clinical Nursing, Wrocław Medical University, Wrocław, Poland
| | - Radosław Wontor
- Department of Cardiology, T Marciniak Memorial Hospital, Wrocław, Poland
| | - Krystyna Łoboz-Grudzień
- Department of Clinical Nursing, Wrocław Medical University, Wrocław, Poland ; Department of Cardiology, T Marciniak Memorial Hospital, Wrocław, Poland
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van Dam van Isselt EF, Spruit M, Groenewegen-Sipkema KH, Chavannes NH, Achterberg WP. Geriatric rehabilitation for patients with advanced chronic obstructive pulmonary disease: a naturalistic prospective cohort study on feasibility and course of health status. Chron Respir Dis 2015; 11:111-9. [PMID: 24728657 DOI: 10.1177/1479972314529674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In view of the worldwide aging population, disease-specific geriatric rehabilitation (GR) programs are needed. Therefore, we developed and implemented a postacute GR program for patients with advanced chronic obstructive pulmonary disease (COPD) (the GR-COPD program). The aim of this study is to investigate the feasibility of the GR-COPD program and to present clinical data on patient characteristics and course of functional capacity and health status. This is a naturalistic prospective cohort study of patients with advanced COPD. A total of 61 patients entered the GR-COPD program and were eligible to participate in this study. All patients suffered from advanced COPD, and comorbidities were frequent. On admission, functional capacity and health status were severely limited but showed significant and clinically relevant improvement during the GR-COPD program. Patients with advanced COPD admitted to hospital for an acute exacerbation suffer from severely impaired functional capacity and poor health status. Development and implementation of a postacute GR program for these patients are feasible and likely to offer substantial improvements. Further research is essential and should focus on designing a controlled intervention trial to investigate the efficacy of the program.
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Abstract
Changing global demography is resulting in older people presenting to emergency departments (EDs) in greater numbers than ever before. They present with greater urgency and are more likely to be admitted to hospital or re-attend and utilize greater resources. They experience longer waits for care and are less likely to be satisfied with their experiences. Not only that, but older people suffer poorer health outcomes after ED attendance, with higher mortality rates and greater dependence in activities of daily living or rates of admission to nursing homes. Older people's assessment and management in the ED can be complex, time consuming, and require specialist skills. The interplay of multiple comorbidities and functional decline result in the complex state of frailty that can predispose to poor health outcomes and greater care needs. Older people with frailty may present to services in an atypical fashion requiring detailed, multidimensional, and increasingly multidisciplinary care to provide the correct diagnosis and management as well as appropriate placement for ongoing care or admission avoidance. Specific challenges such as delirium, functional decline, or carer strain need to be screened for and managed appropriately. Identifying patients with specific frailty syndromes can be critical to identifying those at highest risk of poor outcomes and most likely to benefit from further specialist interventions. Models of care are evolving that aim to deliver multidimensional assessment and management by multidisciplinary specialist care teams (comprehensive geriatric assessment). Increasingly, these models are demonstrating improved outcomes, including admission avoidance or reduced death and dependence. Delivering this in the ED is an evolving area of practice that adapts the principles of geriatric medicine for the urgent-care environment.
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Affiliation(s)
- Graham Ellis
- Medicine for the Elderly, Monklands Hospital, Airdrie, Scotland, UK
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Fox B, Hodgkinson B, Parker D. The effects of physical exercise on functional performance, quality of life, cognitive impairment and physical activity levels for older adults aged 65 years and older with a diagnosis of dementia: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Holland AE, Wadell K, Spruit MA. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD. Eur Respir Rev 2014; 38:25-9. [PMID: 24293474 DOI: 10.1071/ah13067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 09/18/2013] [Indexed: 12/20/2022] Open
Abstract
Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD) and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD.
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Affiliation(s)
- Anne E Holland
- Dept of Physiotherapy, La Trobe University, Melbourne, 2 Dept of Physiotherapy, Alfred Health, Melbourne, and 3 Institute for Breathing and Sleep, Melbourne, Australia. 4 Dept of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden. 5 Program Development Center, Center of Expertise for Chronic Organ Failure, CIRO+, Horn, The Netherlands
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Provencher V, Mortenson WB, Tanguay-Garneau L, Bélanger K, Dagenais M. Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: A systematic review. Arch Gerontol Geriatr 2014; 59:18-24. [DOI: 10.1016/j.archger.2014.03.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 03/17/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
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Health status measured by the Clinical COPD Questionnaire (CCQ) improves following post-acute pulmonary rehabilitation in patients with advanced COPD: a prospective observational study. NPJ Prim Care Respir Med 2014; 24:14007. [PMID: 24842278 PMCID: PMC4373298 DOI: 10.1038/npjpcrm.2014.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/27/2014] [Accepted: 02/09/2014] [Indexed: 12/21/2022] Open
Abstract
Aims: To evaluate outcomes of the Clinical Chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ) in patients with advanced COPD admitted for a post-acute pulmonary rehabilitation (PR) programme and to relate (change in) health status to lung function, degree of dyspnoea and (change in) functional capacity. Methods: This is a prospective observational study in patients with advanced COPD admitted for a post-acute PR programme in a skilled nursing facility. Health status (CCQ) and functional capacity were measured before and after rehabilitation. Results: Health status measured by the CCQ was severely impaired and showed significant and clinically relevant improvement during the post-acute PR programme. Moderate to strong correlations were found between CCQ scores and functional capacity on admission and at discharge. Moderate correlations were found between improvement in CCQ scores and improvement in functional capacity. No correlation was found between CCQ scores and lung function (forced expiratory volume in 1 s % predicted). Conclusions: Health status measured by the CCQ improves following a post-acute PR programme in patients with advanced COPD and correlates with improvement in functional capacity. These results suggest that the CCQ is sensitive to change in response to PR in this specific group of patients.
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Nielsen LM, Maribo T, Nielsen HG, Jensen J, Petersen K. Assessing functional ability in older patients. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.5.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: This study aimed to develop an understanding of how primary and secondary care health professionals perceive current practice and challenges in assessing older patients' functional abilities. A secondary aim was to gain insight into how these professionals perceive the need for generic tools for assessing functional ability among older patients. Method: A qualitative design was used to explore health professionals' perspectives on the assessment of older patients' functional ability. Two groups of health professionals participated in focus group interviews, with one group for each of the two different settings: the local hospital and the municipality. Results: Focus group interviews showed that health professionals in the hospital and the municipality expressed the need for an observation-based tool to predict and guide decisions about the rehabilitation needs of older patients. Participants from the hospital expressed a need for a fast and simple screening tool to identify those in need of further rehabilitation and care after discharge. Participants from the municipality expressed a need for a more detailed assessment tool to capture information about patients' ability to perform daily activities, any need for food delivery, and information about social relationships and home environment. Conclusion: The health professionals at the hospital and in the municipality had different expectations when it comes to assessment tools. All participants would like a simple tool that is quick to administer, to assess the quality of functional ability and predict the need for rehabilitation. The different context (hospital or primary care) seems to influence the way health professionals perceive the need for assessment of functional ability in older patients.
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Affiliation(s)
- Louise Møeldrup Nielsen
- PhD student at the Aarhus University Hospital and Center for Health Improvement, Rehabilitation and Health Technology at VIA University College, Aarhus
| | - Thomas Maribo
- Lecturer at Aarhus University, Aarhus, and Marselisborg Centret, Danish Rehabilitation Research Center, Aarhus
| | - Hanne Grethe Nielsen
- Lecturer at the Center for Health Improvement, Rehabilitation and Health Technology at VIA University College, Aarhus
| | - Jonna Jensen
- Lecturer at Metropolitan University College, Institut of Rehabilitation and Nutrition, Copenhagen and the Center for Health Improvement, Rehabilitation and Health Technology at VIA University College, Aarhus
| | - Kirsten Petersen
- Lecturer at Aarhus University, Aarhus, Denmark and MarselisborgCentret, Danish Rehabilitation Research Center, Aarhus, Denmark
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