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Molina S, Martinez-Urrea A, Malik K, Libori G, Monzon H, Martínez-Camblor P, Almagro P. Medium and long-term prognosis in hospitalised older adults with multimorbidity. A prospective cohort study. PLoS One 2023; 18:e0285923. [PMID: 37267235 DOI: 10.1371/journal.pone.0285923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/04/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Data about long-term prognosis after hospitalisation of elderly multimorbid patients remains scarce. OBJECTIVES Evaluate medium and long-term prognosis in hospitalised patients older than 75 years of age with multimorbidity. Explore the impact of gender, age, frailty, physical dependence, and chronic diseases on mortality over a seven-year period. METHODS We included prospectively all patients hospitalised for medical reasons over 75 years of age with two or more chronic illnesses in a specialised ward. Data on chronic diseases were collected using the Charlson comorbidity index and a questionnaire for disorders not included in this index. Demographic characteristics, Clinical Frailty Scale, Barthel index, and complications during hospitalisation were collected. RESULTS 514 patients (46% males) with a mean age of 85 (± 5) years were included. The median follow-up was 755 days (interquartile range 25-75%: 76-1,342). Mortality ranged from 44% to 68%, 82% and 91% at one, three, five, and seven years. At inclusion, men were slightly younger and with lower levels of physical impairment. Nevertheless, in the multivariate analysis, men had higher mortality (p<0.001; H.R.:1.43; 95% C.I.95%:1.16-1.75). Age, Clinical Frailty Scale, Barthel, and Charlson indexes were significant predictors in the univariate and multivariate analysis (all p<0.001). Dementia and neoplastic diseases were statistically significant in the unadjusted but not the adjusted model. In a cluster analysis, three patterns of patients were identified, with increasing significant mortality differences between them (p<0.001; H.R.:1.67; 95% CI: 1.49-1.88). CONCLUSIONS In our cohort, individual diseases had a limited predictive prognostic capacity, while the combination of chronic illness, frailty, and physical dependence were independent predictors of survival.
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Affiliation(s)
- Siena Molina
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Ana Martinez-Urrea
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Komal Malik
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Ginebra Libori
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Helena Monzon
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Pablo Martínez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States of America
- Faculty of Health Sciences, Universidad Autonoma de Chile, Providencia, Chile
| | - Pere Almagro
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
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Langer D, Melchior H, Mazor-Karsenty T. Grip strength in healthy Israeli adults: Comparison to internationally reported normative data. Work 2022; 71:787-794. [DOI: 10.3233/wor-205330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Grip strength is frequently used in research and clinical work and is commonly compared to normative data in clinical settings. To enable accurate interpretation of grip strength values, normative reference values should be close to the demographic, occupational, cultural and geographic characteristics of the individual tested. OBJECTIVE: Investigate the effects of gender, age, work-group and hand dominance on grip strength for the Israeli population, and to compare the grip strength to two normative studies from the United States. METHODS: A cross sectional study. The grip strength of 637 healthy adults was measured using a Jamar dynamometer. The effects for age, gender, hand dominance, and work strain were investigated. Israeli sample results were compared to US norms. RESULTS: Within the Israeli sample, a significant age effect was found for both men and women. This effect was most apparent among the 70+ age groups, in which grip strength was weaker than all the other groups. Males were significantly stronger than females, in both hands, and the dominant hand was significantly stronger, regardless of gender. Results also demonstrated a medium to large effect for type of work on grip strength portraying high manual strain workers to have stronger grip strength. Overall, the grip strength in the Israeli sample was weaker than both US samples. CONCLUSION: Clinicians should be cautious when comparing grip strength to published norms from a different culture/geographical region. The amount of manual strain invested in various occupational roles should be considered in the assessment and intervention process.
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Affiliation(s)
- Danit Langer
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Hanna Melchior
- Department of Occupational Therapy, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tal Mazor-Karsenty
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Peiris CL, Shields N, Lowe A, Tan G, Taylor NF. Functional status of community-dwelling older adults after inpatient rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0084] [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
Background/aims: Factors that influence functional ability in older adults after rehabilitation are not well understood. The aim of this study was to investigate how older people function in their community after being discharged from inpatient rehabilitation. Methods A cross-sectional study was undertaken of community-dwelling older adults (n=86, 75 ± 6 years) discharged from rehabilitation in the previous 12 months. Basic functional independence was assessed using the Functional Independence Measure and complex functional independence was assessed using the Frenchay Activities Index. Multiple regression analyses were conducted to assess any association between predetermined factors and function. Results Functional Independence Measure scores and physical activity levels after being discharged accounted for 50% of the variance in basic function (R2=0.50, F=40.75, P<0.001). Frenchay Activities Index scores, physical activity, age, sex and migrant status accounted for 68% of variance in complex function (R2=0.68, F=29.75, P<0.001). Conclusions Clinicians are encouraged to implement strategies to improve function at discharge from rehabilitation and to promote physical activity among older people at risk of poor function following rehabilitation.
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Affiliation(s)
- Casey L Peiris
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
| | - Nora Shields
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
| | - Anna Lowe
- National Centre for Sport & Exercise Medicine, Sheffield-Hallam University, Sheffield, UK
| | - Germaine Tan
- Northern Health, Northern Centre for Health Education and Research, Epping, Australia
| | - Nicholas F Taylor
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
- Eastern Health, Allied Health Clinical Research Office, Melbourne, Australia
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The association between geriatric treatment and 30-day readmission risk among medical inpatients aged ≥75 years with multimorbidity. PLoS One 2022; 17:e0262340. [PMID: 34995327 PMCID: PMC8741041 DOI: 10.1371/journal.pone.0262340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions. Methods Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records. Results We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91–0.99) per year), female gender (2.17 (1.15–4.00)) and higher MMSE score (1.03 (1.00–1.06) per point) were significant risk factors for readmission. Conclusions Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.
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Sandvik MK, Watne LO, Brugård A, Wang-Hansen MS, Kersten H. Association between psychotropic drug use and handgrip strength in older hospitalized patients. Eur Geriatr Med 2021; 12:1213-1220. [PMID: 34033072 PMCID: PMC8626357 DOI: 10.1007/s41999-021-00511-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Handgrip strength is an indicator of frailty and longevity in older adults. The association between psychotropic drug use and handgrip strength in older hospitalized patients was investigated in this study. METHODS A total of 488 patients were included in this retrospective cross-sectional study, 333 women and 155 men, from two different cohorts of older (mean age 84 years) hospitalized in-patients. We used multiple linear regression models to explore the association between psychotropic drug use and handgrip strength. We adjusted for factors known to affect handgrip strength: Age, gender, body mass index (BMI) and comorbidity (Charlson comorbidity index). RESULTS Both unadjusted and adjusted analyses showed that psychotropic drug use was associated with handgrip strength (β = - 0.183, p < 0.0001). The relationship was of a linear character, with no clear threshold value, but with the greatest reduction in handgrip strength between zero and two psychotropic drugs. CONCLUSION An increasing number of psychotropic drugs were significantly associated with reduced handgrip strength in a linearly pattern. Hence, it is timely to question the guided threshold value of avoidance of three or more psychotropic drugs in older people. Psychotropic drug use should be kept as low as possible in treatment of older patients.
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Affiliation(s)
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anniken Brugård
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - Marte Sofie Wang-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
| | - Hege Kersten
- Department of Research, Telemark Hospital Trust, Skien, Norway.,Department of Pharmaceutical Bioscience, School of Pharmacy, University of Oslo, Oslo, Norway
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Villani ER, Vetrano DL, Franza L, Carfì A, Brandi V, Volpato S, Corsonello A, Lattanzio F, Ruggiero C, Onder G, Palmer K. Physical performance measures and hospital outcomes among Italian older adults: results from the CRIME project. Aging Clin Exp Res 2021; 33:319-327. [PMID: 32929695 DOI: 10.1007/s40520-020-01691-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/19/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Older adults are a complex population, at risk of adverse events during and after hospital stay. AIM To investigate the association of walking speed (WS) and grip strength (GS) with adverse outcomes, during and after hospitalization, among older individuals admitted to acute care wards. METHODS Multicentre observational study including 1123 adults aged ≥ 65 years admitted to acute wards in Italy. WS and GS were measured at admission and discharge. Outcomes were length-of-stay, in-hospital mortality, 1-year mortality and rehospitalisation. Length-of-stay was defined as a number of days from admission to discharge/death. RESULTS Mean age was 81 ± 7 years, 56% were women. Compared to patients with WS ≥ 0.8 m/sec, those unable to perform or with WS < 0.8 m/sec had a higher likelihood of longer length-of-stay (OR 2.57; 95% CI 1.63-4.03 and 2.42; 95% CI 1.55-3.79) and 1-year mortality and rehospitalization (OR 1.47, 95% CI 1.07-2.01; OR 1.57, 95% CI 1.04-2.37); those unable to perform WS had a higher likelihood of in-hospital mortality (OR 9.59; 95% CI 1.23-14.57) and 1-year mortality (OR 2.60; 95% CI 1.37-4.93). Compared to good GS performers, those unable to perform had a higher likelihood of in-hospital mortality (OR 17.43; 95% CI 3.87-28.46), 1-year mortality ( OR 3.14; 95% CI 1.37-4.93) and combination of 1-year mortality and rehospitalisation (OR 1.46; 95% CI 1.01-2.12); poor GS performers had a higher likelihood of 1-year mortality (OR 1.39; 95% CI 1.03-2.35); participants unable to perform GS had a lower likelihood of rehospitalisation (OR 0.59; 95% CI 0.39-0.89). CONCLUSION Walking speed (WS) and grip strength (GS) are easy-to-assess predictors of length-of-stay, in-hospital and post-discharge death and should be incorporated in the standard assessment of hospitalized patients.
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Affiliation(s)
- Emanuele Rocco Villani
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Università Cattolica Sacro Cuore, Largo Francesco Vito no. 8, 00168, Rome, Italy.
| | - Davide Liborio Vetrano
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Franza
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Angelo Carfì
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Brandi
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Volpato
- Department of Medical Science, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre On Aging (INRCA), Cosenza, Italy
| | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy
| | - Carmelinda Ruggiero
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
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Abstract
Multimorbidity is a global health challenge. Here, we define multimorbidity, describe ways multimorbidity is measured, discuss the prevalence of multimorbidity and how it differs across different populations, examine mechanisms of disease and disability, and discuss the effects of multimorbidity on outcomes such as survival and function.
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Affiliation(s)
- Sindhuja Kadambi
- Department of Hematology/Oncology, University of Rochester, 601 Elmwood Drive, Rochester, NY 14642, USA.
| | - Maya Abdallah
- Department of Medicine, Baystate Health, Springfield, MA 01199, USA
| | - Kah Poh Loh
- Department of Hematology/Oncology, University of Rochester, 601 Elmwood Drive, Rochester, NY 14642, USA
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Clynes MA, Bevilacqua G, Jameson KA, Cooper C, Dennison EM. Does self-report of multimorbidity in later life predict impaired physical functioning, and might this be useful in clinical practice? Aging Clin Exp Res 2020; 32:1443-1450. [PMID: 32056154 PMCID: PMC7452933 DOI: 10.1007/s40520-020-01500-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/28/2020] [Indexed: 12/24/2022]
Abstract
Background Multimorbidity has been shown in several studies to relate to impaired physical function in later life. Aims To examine if self-report of multimorbidity predicts impaired physical functioning, as assessed by formal physical function testing, in community-dwelling older adults. Methods Non-communicable diseases (NCDs) were self-reported by 443 older community-dwelling UK adults via questionnaire, asking the question: ‘Have you been told by a doctor that you have any of the following conditions?’ Assessments of walking speed, chair stands and balance allowed us to create a composite score (0–12) on which impaired physical functioning was defined as ≤ 9. Results The mean age of participants was 75.5 ± 2.5 years for men and 75.8 ± 2.6 for women. The proportion of individuals with impaired physical functioning was 71.2% in women and 56.9% in men. Having four or more NCDs was associated with an increased risk of poor physical function in men and women (p < 0.05). The number of medications and medicated systems was associated with gait speed (p < 0.03 and < 0.02, respectively) and timed up-and-go tests (p < 0.03 and < 0.02, respectively) in women but not men. Discussion and conclusion Self-report of 4 or more NCDs was associated with an increased risk of poor physical function, an outcome which has previously been associated with adverse clinical sequelae. This observation may inform development of a simple screening tool to look for poor physical function in older adults. Electronic supplementary material The online version of this article (10.1007/s40520-020-01500-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael A Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Karen A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LE, UK.
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Victoria University of Wellington, Wellington, New Zealand
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Wang DX, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle 2020; 11:3-25. [PMID: 31788969 PMCID: PMC7015244 DOI: 10.1002/jcsm.12502] [Citation(s) in RCA: 285] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are essential for independent living and are predictors of morbidity and mortality in older populations. Older adults who are dependent in ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities. The aim of this systematic review and meta-analysis was to determine if muscle measures are predictive of ADL and IADL in older populations. Methods A systematic search was conducted using four databases (MEDLINE, EMBASE, Cochrane, and CINAHL) from date of inception to 7 June 2018. Longitudinal cohorts were included that reported baseline muscle measures defined by muscle mass, muscle strength, and physical performance in conjunction with prospective ADL or IADL in participants aged 65 years and older at follow-up. Meta-analyses were conducted using a random effect model. Results Of the 7760 articles screened, 83 articles were included for the systematic review and involved a total of 108 428 (54.8% female) participants with a follow-up duration ranging from 11 days to 25 years. Low muscle mass was positively associated with ADL dependency in 5/9 articles and 5/5 for IADL dependency. Low muscle strength was associated with ADL dependency in 22/34 articles and IADL dependency in 8/9 articles. Low physical performance was associated with ADL dependency in 37/49 articles and with IADL dependency in 9/11 articles. Forty-five articles were pooled into the meta-analyses, 36 reported ADL, 11 reported IADL, and 2 reported ADL and IADL as a composite outcome. Low muscle mass was associated with worsening ADL (pooled odds ratio (95% confidence interval) 3.19 (1.29-7.92)) and worsening IADL (1.28 (1.02-1.61)). Low handgrip strength was associated with both worsening ADL and IADL (1.51 (1.34-1.70); 1.59 (1.04-2.31) respectively). Low scores on the short physical performance battery and gait speed were associated with worsening ADL (3.49 (2.47-4.92); 2.33 (1.58-3.44) respectively) and IADL (3.09 (1.06-8.98); 1.93 (1.69-2.21) respectively). Low one leg balance (2.74 (1.31-5.72)), timed up and go (3.41 (1.86-6.28)), and chair stand test time (1.90 (1.63-2.21)) were associated with worsening ADL. Conclusions Muscle measures at baseline are predictors of future ADL and IADL dependence in the older adult population.
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Affiliation(s)
- Daniel X.M. Wang
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Jessica Yao
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Yasar Zirek
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Esmee M. Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Andrea B. Maier
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
- Department of Human Movement Sciences, @AgeAmsterdamVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
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Juul-Larsen HG, Andersen O, Bandholm T, Bodilsen AC, Kallemose T, Jørgensen LM, Klausen HH, Gilkes H, Petersen J. Differences in function and recovery profiles between patterns of multimorbidity among older medical patients the first year after an acute admission-An exploratory latent class analysis. Arch Gerontol Geriatr 2019; 86:103956. [PMID: 31586786 DOI: 10.1016/j.archger.2019.103956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Multimorbidity is common among older people and may contribute to adverse health effects, such as functional limitations. It may help stratify rehabilitation of older medical patients, if we can identify differences in function under and after an acute medical admission, among patient with different patterns of multimorbidity. AIM To investigate differences in function and recovery profiles among older medical patients with different patterns of multimorbidity the first year after an acute admission. METHODS Longitudinal prospective cohort study of 369 medical patients (77.9 years, 62% women) acutely admitted to the Emergency Department. During the first 24 h after admission, one month and one year after discharge we assessed mobility level using the de Morton Mobility Index. At baseline and one-year we assessed handgrip strength, gait speed, Barthel20, and the New Mobility Score. Information about chronic conditions was collected by national registers. We used Latent Class Analysis to determine differences among patterns of multimorbidity based on 22 chronic conditions. RESULTS Four distinct patterns of multimorbidity were identified (Minimal chronic disease; Degenerative, lifestyle, and mental disorders; Neurological, functional and sensory disorders; and Metabolic, pulmonary and cardiovascular disorders). The "Neurological, functional and sensory disorders"-pattern showed significant lower function than the "Minimal chronic disease"-pattern in all outcome measures. There were no differences in recovery profile between patients in the four patterns. CONCLUSION The results support that patients with different patterns of multimorbidity among acutely hospitalized older medical patients differ in function, which suggests a differentiated approach towards treatment and rehabilitation warrants further studies.
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Affiliation(s)
- Helle Gybel Juul-Larsen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Ove Andersen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Emergency Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ann Christine Bodilsen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Exercise and Health, Roskilde Municipality, Roskilde, Denmark
| | - Thomas Kallemose
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lillian Mørch Jørgensen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Emergency Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hedegaard Klausen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Gilkes
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
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11
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Aarden JJ, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, Twisk JWR, Buurman BM, Engelbert RHH. Muscle strength is longitudinally associated with mobility among older adults after acute hospitalization: The Hospital-ADL study. PLoS One 2019; 14:e0219041. [PMID: 31276471 PMCID: PMC6611658 DOI: 10.1371/journal.pone.0219041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background 30 to 60% of the acute hospitalized older adults experience functional decline after hospitalization. The first signs of functional decline after discharge can often be observed in the inability to perform mobility tasks, such as raising from a chair or walking. Information how mobility develops over time is scarce. Insight in the course of mobility is needed to prevent and decrease mobility limitations. Objectives The objectives of this study were to determine (i) the course of mobility of acute hospitalized older adults and (ii) the association between muscle strength and the course of mobility over time controlled for influencing factors. Methods In a multicenter, prospective, observational cohort study, measurements were taken at admission, discharge, one- and three months post-discharge. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. The longitudinal association between muscle strength and mobility was analysed with a Linear Mixed Model and controlled for potential confounders. Results 391 older adults were included in the analytic sample with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from admission up to three months post-discharge but did not reach normative levels. Muscle strength was associated with the course of mobility (beta = 0.64; p<0.01), even after controlling for factors as age, cognitive impairment, fear of falling and depressive symptoms (beta = 0.35; p<0.01). Conclusion Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted, in acute hospitalized older adults.
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Affiliation(s)
- Jesse J. Aarden
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Marike van der Schaaf
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, Netherlands
| | - Lucienne A. Reichardt
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Rosanne van Seben
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Jos A. Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jos W. R. Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands
| | - Bianca M. Buurman
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Su Zan Tan E, Mackenzie L, Travasssaros K, Yeo M. A pilot study to investigate the feasibility of the modified Blaylock Tool for Occupational Therapy Referral (MBTOTR) for use by nurses in acute care. Disabil Rehabil 2019; 43:414-422. [PMID: 31204519 DOI: 10.1080/09638288.2019.1624840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Patients in acute care settings may have limitations in their functional capacity associated with multiple morbidities. Occupational therapy can address factors affecting functional decline, and early and accurate identification of patients requiring occupational therapy referral can facilitate safe discharge. This study aimed to investigate the feasibility of the Modified Blaylock Tool for Occupational Therapy Referral to identify the characteristics of patients who would potentially require occupational therapy referral, for use by acute care nurses. METHODS A cross-sectional study was conducted using mixed methods. The Modified Blaylock Tool for Occupational Therapy Referral was completed for 305 patients by six acute care nurses across three clinical areas in an acute hospital setting. Data were analyzed using descriptive and non-parametric statistics. Semi-structured interviews were then conducted with these six nurses to understand their perspectives of their use of the Modified Blaylock Tool for Occupational Therapy Referral. RESULTS Nearly half (45%) of the assessed patients had Modified Blaylock Tool for Occupational Therapy Referral scores recommending occupational therapy referral. Items associated with risk of functional decline were mobility, memory and recent hospital admissions. Barriers to referral included resource limitations, lack of visibility, poor understanding of occupational therapy and lack of holistic assessment of patients. CONCLUSION The Modified Blaylock Tool for Occupational Therapy Referral could be used by nurses to identify acute care patients at risk of functional decline. Future research should include larger and longitudinal studies to validate the Modified Blaylock Tool for Occupational Therapy Referral further. Implications for rehabilitation The Modified Blaylock Tool for Occupational Therapy Referral could be used by nurses to identify acute care patients at risk of functional decline. This allows the early and accurate identification of patients requiring occupational therapy referral to facilitate safe discharge from acute care.
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Affiliation(s)
- Emma Su Zan Tan
- Occupational Therapy, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | | | - Megan Yeo
- Occupational Therapy, Royal North Shore Hospital, St. Leonards, NSW, Australia
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Whitney SL, Ellis J, Otis L, Marchetti G. A Multidimensional Exercise Program in the Home for Older Adults Designed to Improve Function. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822318820531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to determine whether there was difference in the OASIS (Outcome and Assessment Information Set) activities of daily living (ADL) items scores between the Safe Strides program and Safe Strides plus Zōntago program. Eight home care offices were selected for this prospective randomized quality improvement study where Safe Strides versus Safe Strides plus Zōntago were compared. Rehabilitation outcome OASIS ADL change scores were analyzed for 112 total patient care episodes. The Safe Strides + Zōntago mean total ADL score change and ADL change per visit were higher than the Safe Strides group. Differences in ADL outcomes in older adults undergoing home care provided by physical therapists and physical therapist assistants in the Safe Strides exercise program versus the Safe Strides plus Zōntago program were noted. The Safe Strides + Zōntago compared with Safe Strides alone improved patient functional outcomes as measured by the OASIS.
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