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Hunold KM, Schwaderer AL, Exline M, Hebert C, Lampert BC, Southerland LT, Stephens JA, Boyer EW, Gure TR, Mion LC, Hill M, Chu CMB, Lee G, Caterino JM. Functional decline in older adults with suspected pneumonia at emergency department presentation. J Am Geriatr Soc 2024; 72:1532-1535. [PMID: 38366347 PMCID: PMC11090742 DOI: 10.1111/jgs.18798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/18/2024]
Affiliation(s)
| | | | - Matthew Exline
- Department of Internal Medicine, The Ohio State University, Columbus OH
| | - Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus OH
- Division of Infectious Disease, The Ohio State University, Columbus OH
| | - Brent C. Lampert
- Division of Cardiovascular Medicine, The Ohio State University, Columbus OH
| | | | - Julie A. Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus OH
| | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Tanya R. Gure
- Division of General Internal Medicine & Geriatrics, The Ohio State University, Columbus, OH
| | | | - Michael Hill
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Ching-Min B. Chu
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Gabriel Lee
- Department of Emergency Medicine, The Ohio State University, Columbus OH
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Functional Decline After Nonhospitalized Injuries in Older Patients: Results From the Canadian Emergency Team Initiative Cohort in Elders. Ann Emerg Med 2022; 80:154-164. [DOI: 10.1016/j.annemergmed.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/23/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022]
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Attitudes and acceptability of organ and tissue donation registration in the emergency department: a national survey of emergency physicians. CAN J EMERG MED 2022; 24:293-299. [PMID: 35124786 PMCID: PMC8818093 DOI: 10.1007/s43678-022-00262-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/06/2022] [Indexed: 11/02/2022]
Abstract
Purpose Methods Results Conclusion Supplementary Information
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Mooijaart SP, Du Puy RS, Stott DJ, Kearney PM, Rodondi N, Westendorp RGJ, den Elzen WPJ, Postmus I, Poortvliet RKE, van Heemst D, van Munster BC, Peeters RP, Ford I, Kean S, Messow CM, Blum MR, Collet TH, Watt T, Dekkers OM, Jukema JW, Smit JWA, Langhorne P, Gussekloo J. Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older With Subclinical Hypothyroidism. JAMA 2019; 322:1977-1986. [PMID: 31664429 PMCID: PMC6822162 DOI: 10.1001/jama.2019.17274] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022]
Abstract
IMPORTANCE It is unclear whether levothyroxine treatment provides clinically important benefits in adults aged 80 years and older with subclinical hypothyroidism. OBJECTIVE To determine the association of levothyroxine treatment for subclinical hypothyroidism with thyroid-related quality of life in adults aged 80 years and older. DESIGN, SETTING, AND PARTICIPANTS Prospectively planned combined analysis of data involving community-dwelling adults aged 80 years and older with subclinical hypothyroidism. Data from a randomized clinical trial were combined with a subgroup of participants aged 80 years and older from a second clinical trial. The trials were conducted between April 2013 and May 2018. Final follow-up was May 4, 2018. EXPOSURES Participants were randomly assigned to receive levothyroxine (n = 112; 52 participants from the first trial and 60 from the second trial) or placebo (n = 139; 53 participants from the first trial and 86 from the second trial). MAIN OUTCOMES AND MEASURES Co-primary outcomes were Thyroid-Related Quality of Life Patient-Reported Outcome (ThyPRO) questionnaire scores for the domains of hypothyroid symptoms and tiredness at 1 year (range, 0-100; higher scores indicate worse quality of life; minimal clinically important difference, 9). RESULTS Of 251 participants (mean age, 85 years; 118 [47%] women), 105 were included from the first clinical trial and 146 were included from the second clinical trial. A total of 212 participants (84%) completed the study. The hypothyroid symptoms score decreased from 21.7 at baseline to 19.3 at 12 months in the levothyroxine group vs from 19.8 at baseline to 17.4 at 12 months in the placebo group (adjusted between-group difference, 1.3 [95% CI, -2.7 to 5.2]; P = .53). The tiredness score increased from 25.5 at baseline to 28.2 at 12 months in the levothyroxine group vs from 25.1 at baseline to 28.7 at 12 months in the placebo group (adjusted between-group difference, -0.1 [95% CI, -4.5 to 4.3]; P = .96). At least 1 adverse event occurred in 33 participants (29.5%) in the levothyroxine group (the most common adverse event was cerebrovascular accident, which occurred in 3 participants [2.2%]) and 40 participants (28.8%) in the placebo group (the most common adverse event was pneumonia, which occurred in 4 [3.6%] participants). CONCLUSIONS AND RELEVANCE In this prospectively planned analysis of data from 2 clinical trials involving adults aged 80 years and older with subclinical hypothyroidism, treatment with levothyroxine, compared with placebo, was not significantly associated with improvement in hypothyroid symptoms or fatigue. These findings do not support routine use of levothyroxine for treatment of subclinical hypothyroidism in adults aged 80 years and older. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01660126; Netherlands Trial Register: NTR3851.
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Affiliation(s)
- Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- Institute for Evidence-Based Medicine in Old Age, Leiden, the Netherlands
| | - Robert S. Du Puy
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - David J. Stott
- Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rudi G. J. Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Wendy P. J. den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Iris Postmus
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- Institute for Evidence-Based Medicine in Old Age, Leiden, the Netherlands
| | | | - Diana van Heemst
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Robin P. Peeters
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Sharon Kean
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | | | - Manuel R. Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Torquil Watt
- Department of Internal Medicine, Copenhagen University Hospital Herlev, Gentofte, Denmark
| | - Olaf M. Dekkers
- Department of Endocrinology and Metabolic Disorders, Leiden University Medical Center, Leiden, the Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Abstract
BACKGROUND We apply recently recommended Parkinson's disease mild cognitive impairment (PD-MCI) classification criteria from the movement disorders society (MDS) to PD patients and controls and compare diagnoses to that of short global cognitive scales at baseline and over time. We also examine baseline prevalence of neuropsychiatric symptoms across different definitions of MCI. METHODS 51 PD patients and 50 controls were classified as cognitively normal, MCI, or demented using MDS criteria (1.5 or 2.0 SD below normative values), Clinical Dementia Rating Scale (CDR), and the Dementia Rating Scale (DRS). All subject had parallel assessment with the Neuropsychiatric inventory (NPI). RESULTS We confirmed that PD-MCI (a) is frequent, (b) increases the risk of PDD, and (c) affects multiple cognitive domains. We highlight the predictive variability of different criteria, suggesting the need for further refinement and standardization. When a common dementia outcome was used, the Level II MDS optimal testing battery with impairment defined as two SD below norms in 2+ tests performs the best. Neuropsychiatric symptoms were more common in PD across all baseline and longitudinal cognitive classifications. CONCLUSIONS Our results advance previous findings on the utility of MDS PD-MCI criteria for PD patients and controls at baseline and over time. Additionally, we emphasize the possible utility of other cognitive scales and neuropsychiatric symptoms.
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Eagles D, Perry JJ, Sirois MJ, Lang E, Daoust R, Lee J, Griffith L, Wilding L, Neveu X, Emond M. Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma†. Age Ageing 2017; 46:214-218. [PMID: 28399218 PMCID: PMC5385920 DOI: 10.1093/ageing/afw184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background there is no standardised test for assessing mobility in the Emergency Department (ED). Objective we wished to evaluate the relationship between the Timed Up and Go (TUG) and frailty, functional decline and falls in community dwelling elders that present to the ED following minor trauma. Methods this was a secondary analysis of a prospective cohort study conducted at eight Canadian hospitals. Evaluations included: TUG; Study of Osteoporotic Fractures Frailty Index; Older American Resources and Service Functional Scale; and self-reported falls. Of note, 3- and 6-month follow-up was conducted. Generalised linear model with log-binomial distribution was utilised. Relative risks (RR) and 95% CI were calculated. Results TUG scores were available for 911/2918 patients, mean age 76.2 (SD 7.8) and 57.9% female. There was an association between TUG scores and frailty (P < 0.05) and functional decline at 3 (P < 0.05) and 6 (P < 0.05) months but not self-reported falls. For TUG scores 10-19 seconds, 20-29 seconds and ≥30 seconds, respectively: (i) frailty RR (95% CI): 1.8 (1.3-2.4), 3.0 (2.2-4.2) and 3.7 (2.6-5.1); (ii) functional decline RR (95% CI): 2.7 (1.1-6.4), 5.5 (2.1-14.3) and 8.9 (3.0-25.8); (iii) falls RR (95% CI): 0.9 (0.5-1.5), 1.3 (0.6-2.5) and 1.1 (0.4-3.5). Conclusion in community dwelling elders presenting to the ED following minor trauma, TUG scores were associated with frailty and strongly associated with functional decline at 3 and 6 months post injury. TUG scores were not associated with self-reported falls. Use of the TUG in the ED will help identify frail patients at risk of functional decline.
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Affiliation(s)
- Debra Eagles
- Université Laval, Québec City, Québec, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Eddy Lang
- Alberta Health Science Center, Calgary, Alberta, Canada
| | - Raoul Daoust
- Hôpital du Sacre-Coeur de Montreal, Montreal, Québec, Canada
| | - Jacques Lee
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Laura Wilding
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Xavier Neveu
- Research Center, CHU de Québec, Québec City, Québec, Canada
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Comparison of functional outcomes in elderly who have sustained a minor trauma with or without head injury: a prospective multicenter cohort study. CAN J EMERG MED 2016; 19:329-337. [PMID: 27609246 DOI: 10.1017/cem.2016.368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a head injury on the functional outcomes six months post-injury in older adults who sustained a minor trauma. METHODS This multicenter prospective cohort study in eight sites included patients who were aged 65 years or older, previously independent, presenting to the emergency department (ED) for a minor trauma, and discharged within 48 hours. To assess the functional decline, we used a validated test: the Older Americans' Resources and Services Scale. The cognitive function of study patients was also evaluated. Finally, we explored the influence of a concomitant injury on the functional decline in the MT-HI group. RESULTS All 926 eligible patients were included in the analyses: 344 MT-HI patients and 582 minor trauma without head injury. After six months, the functional decline was similar in both groups: 10.8% and 11.9%, respectively (RR=0.79 [95% CI: 0.55-1.14]). The proportion of patients with mild cognitive disabilities was also similar: 21.7% and 22.8%, respectively (RR=0.91 [95% CI: 0.71-1.18]). Furthermore, for the group of patients with a MT-HI, the functional outcome was not statistically different with or without the presence of a co-injury (RR=1.35 [95% CI: 0.71-2.59]). CONCLUSION This study did not demonstrate that the occurrence of a MT-HI is associated with a worse functional or cognitive prognosis than other minor injuries without a head injury in an elderly population, six months after injury.
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Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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Assessing the Functional Status of Older Cancer Patients in an Ambulatory Care Visit. Healthcare (Basel) 2015; 3:846-59. [PMID: 27417801 PMCID: PMC4939579 DOI: 10.3390/healthcare3030846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/26/2015] [Accepted: 09/10/2015] [Indexed: 01/22/2023] Open
Abstract
Functional status assessment is a useful and essential component of the complete history and physical exam of the older patient diagnosed with cancer. Functional status is the ability to conduct activities that are necessary for independence and more executive activities, such as money management, cooking, and transportation. Assessment of functional status creates a portal into interpreting the health of in older persons. Understanding limitations and physical abilities can help in developing cancer treatment strategies, patient/family teaching needs, and in-home services that enhance patient/family care. This article will review the benefits of functional assessment, instruments that can be used during an ambulatory care visit, and interventions that can address potential limitations.
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