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Hanson D, Samendinger S, McCulley E. Multidisciplinary understanding of modifiable physical disability risk factors for health professionals: A scoping review protocol. PLoS One 2024; 19:e0306438. [PMID: 38990918 PMCID: PMC11238968 DOI: 10.1371/journal.pone.0306438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/18/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Physical disability represents a major burden to health and lifespan, particularly as the proportion of older adults within the United States is expected to grow. Prevention efforts for physical disability targets methods and strategies to decrease modifiable risk factors. Potential challenges for health professionals may exist in synthesizing and interpreting this broad spectrum of literature due to the discipline-specific nuance of language used, practice type or specialty, and lack of interdisciplinary resources. This scoping review will map and synthesize the literature across healthcare disciplines to identify modifiable risk factors and the evidence related to their ability to predict physical disability. We will also draw attention to the possibility of modifiable risk factors for physical disability being operationalized as pre-disability in order to strengthen primary and secondary prevention efforts. METHODS A planned search strategy using physical disability terminology will be searched in English across MEDLINE, CINAHL, Health Source, PEDro, and REHABDATA by two reviewers in line with our review objectives and inclusion criteria. Eligibility for inclusion include peer-reviewed primary research published in the English language and have established a relationship between a person-level measurable characteristic that is modifiable by changes in lifestyle behaviors and any of the commonly accepted terms used to categorize or describe physical disability. EXPECTED RESULTS Presentation of results will be using the PRISMA flowchart, with additional mapping and synthesis of evidence for modifiable risk factors for physical disability to clarify divergent terms used in classifying and measuring these factors and their potential for prediction of physical disability. EXPECTED CONCLUSION It is anticipated that this scoping review will identify and highlight a variety of modifiable risk factors for physical disability that may aid primary and secondary prevention efforts for health professionals.
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Affiliation(s)
- Derek Hanson
- Nutrition Science & Wellness Department, State University of New York (SUNY)-Farmingdale, Farmingdale, NY, United States of America
| | - Stephen Samendinger
- Health Sciences Department, Drexel University, Philadelphia, PA, United States of America
| | - Edwin McCulley
- Urban Health Collaborative, Philadelphia, PA, United States of America
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
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Wong CK, Rosati J, Forbes K, Feng S, Donohue A, Beckley A. A scoping review of postoperative early rehabilitation programs after dysvascular-related amputations. Prosthet Orthot Int 2024:00006479-990000000-00247. [PMID: 38771800 DOI: 10.1097/pxr.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/29/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND After amputation, people face challenges including wound healing and decreased functional mobility. Early mobilization in acute hospital care has proved safe, improved function, and sped discharge. Still, loss of a leg complicates standing and early mobilization after amputation. Approaches to early mobilization and rehabilitation after amputation surgery have not been widely studied. OBJECTIVES To map the evidence regarding early postoperative mobilization after dysvascular amputation. Specific aims included identifying research designs and populations, describing rehabilitation approaches, and identifying gaps within the literature. STUDY DESIGN Scoping review following PRISMA-Sc guidelines. METHODS The a priori scoping review methodology conducted in June 2022 with English language and 20-year limits used the OVID Medline, OVID Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane databases, and Journal of Prosthetics and Orthotics archive. Reviewer pairs used Covidence software to screen for inclusion (subjects with major lower limb dysvascular amputations, seen immediately postoperatively for hospital-based rehabilitation) with decisions by concurrence. Data for best practice scoping reviews were synthesized for analysis. RESULTS Two hundred ninety-six citations were screened, 13 full texts reviewed, and 8 articles included: 2 cohort studies, 3 case-control studies, 2 single-group interventional studies, and 1 case study. There were no randomized control trials or prospective comparison group trials. CONCLUSIONS Few studies were identified regarding acute rehabilitation after major lower extremity amputation. The limited evidence in this review suggested that early mobilization in the days after amputation was safe with or without use of temporary prostheses, although further research is certainly warranted.
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Affiliation(s)
| | | | | | - Shanshan Feng
- Programs in Physical Therapy, Columbia University, New York, NY
| | - Aine Donohue
- Programs in Physical Therapy, Columbia University, New York, NY
| | - Akinpelumi Beckley
- Department of Rehabilitation Medicine, Columbia University Irving Medical Center, New York, NY
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Tawiah P, Mensah PB, Gyabaah S, Adebanji AO, Konadu E, Amoah I. Gait speed and its associated factors among older black adults in Sub-Saharan Africa: Evidence from the WHO study on Global AGEing in older adults (SAGE). PLoS One 2024; 19:e0295520. [PMID: 38635683 PMCID: PMC11025960 DOI: 10.1371/journal.pone.0295520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/22/2023] [Indexed: 04/20/2024] Open
Abstract
Gait speed is an essential predictor of functional and cognitive decline in older adults. The study aimed to investigate the gait speed of older adults in Ghana and South Africa and to determine its associated factors, as the Sub-Saharan representatives in the World Health Organization's Study on Global AGEing in Older Adults (SAGE). A secondary analysis of data from the SAGE study which consists of nationally representative data involving participants aged ≥50+ years with smaller samples of younger adults aged 18-49 years in Ghana and South Africa was conducted. SAGE study employed a multistage, stratified clustered sample design and involved the use of a standardised questionnaire to obtain participants' (n = 5808) demographic, anthropometric and gait speed information. The standard 4 metre-gait speed was used. Median gait speed for the study group, which comprised African/Black participants aged ≥50+ years was 0.769(Q1 = 0.571, Q3 = 0.952)m/s for males and 0.667 (Q1 = 0.500,Q3 = 0.833)m/s for females. For every unit increase in age, the odds of being in a higher-ranked gait speed category was 0.96(95%CI 0·96, 0·97, p<0.001) times that of the previous age. Females had odds of 0.55 (95%CI 0.50, 0.61, p<0.001) of recording higher gait speed, as compared to males. Rural dwellers had odds of 1.43 (95%CI 1.29, 1.58, p < 0.001) of being in a higher-ranked category of gait speed compared to urban dwellers. Underweight (OR = 0.85, 95%C1 = 0.73-1.00, p<0.05) and obesity (OR = 0.53, 95%CI = 0.46-0.61, p<0.001) were associated with slower gait speed. Amongst functional indices, the World Health Organization Disability Assessment Schedule (WHODAS) score was the biggest determinant of gait speed. Having a "Severe/Extreme" WHODAS score had the strongest association with gait speed (OR = 0.18, 95%CI = 0.14-0.23, p<0.001). These gait speed results provide an essential reference for older adults' care in Ghana and South Africa.
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Affiliation(s)
- Phyllis Tawiah
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Atinuke Olusola Adebanji
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Konadu
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Amoah
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Carter SJ, Singh H, Long EB, Martins C, McCarthy JP, Bickel CS, Bryan DR, Hunter GR. Walking net V ˙ O 2 rises with advancing age in older women: where to go from here? Eur J Appl Physiol 2024:10.1007/s00421-024-05465-8. [PMID: 38578446 DOI: 10.1007/s00421-024-05465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Walking net V ˙ O2 tends to increase with advancing age; however, factors contributing to this relationship have not been widely described. The implications of such findings could inform targeted strategies to promote independent mobility in older adults. Herein, we evaluated the relationship between net V ˙ O2 and age at two submaximal workloads while exploring potential moderators of this relationship. METHODS Secondary analyses were performed on 35 older (65 ± 3 years) women who completed a battery of physical assessments including fixed-speed, non-graded and graded (+ 2.5%) treadmill walking with indirect calorimetry to determine net V ˙ O2. Maximal oxygen uptake ( V ˙ O2max), knee extensor maximal isometric voluntary contraction (MVC), peak rate of torque development (RTD), and plantar flexor range-of-motion (PFROM) were also measured. RESULTS Bivariate correlations showed non-graded (r = 0.403, p = 0.017) and graded (r = 0.413, p = 0.014) net V ˙ O2 were positively related to age. Notably, these relationships strengthened after adjusting for V ˙ O2max. Regression modeling showed age, RTD:MVC ratio (composite of muscle performance), and PFROM together explained 49% and 34% of the variance in non-graded and graded net V ˙ O2, respectively. Further analyses suggested knee extensor MVC moderates the relationship between non-graded net V ˙ O2 and age, accounting for 9% of the variance [ΔR2 = 0.090, F (1,31) = 4.13, p = 0.05]. CONCLUSION These data support the premise that, in older women, walking net V ˙ O2 rises with advancing age, and additionally, the RTD:MVC ratio and PFROM are independent correlates of non-graded net V ˙ O2. Exercise interventions with a high degree of training specificity including explosive, velocity-based elements may promote independent mobility in older women.
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Affiliation(s)
- Stephen J Carter
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, 1025 E 7th Street Suite 044, Bloomington, IN, 47405, USA.
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, 46202, USA.
| | - Harshvardhan Singh
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Emily B Long
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, 1025 E 7th Street Suite 044, Bloomington, IN, 47405, USA
| | - Catia Martins
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - John P McCarthy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - C Scott Bickel
- Department of Physical Therapy, Samford University, Birmingham, AL, 35229, USA
| | - David R Bryan
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Gary R Hunter
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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Bovonsunthonchai S, Witthiwej T, Vachalathiti R, Hengsomboon P, Thong-On S, Sathornsumetee S, Ngamsombat C, Chawalparit O, Muangpaisan W, Richards J. Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus. Sci Rep 2024; 14:2053. [PMID: 38267518 PMCID: PMC10808249 DOI: 10.1038/s41598-024-52516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a spinal tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-h post-tap tests which were compared using Paired t-tests, Cohen's d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables.
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Affiliation(s)
| | - Theerapol Witthiwej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | - Sith Sathornsumetee
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine Siriraj Hospital, NANOTEC-Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Mahidol University, Bangkok, Thailand
| | - Chanon Ngamsombat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orasa Chawalparit
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
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de Moura TG, da Rocha IF, Guedes LS, Alves AT, Garcia PA. Is prehospital physical performance a predictor of functional capacity decline at discharge in hospitalized Brazilian older adults? Braz J Phys Ther 2024; 28:100576. [PMID: 38217948 PMCID: PMC10825594 DOI: 10.1016/j.bjpt.2023.100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Hospitalization contributes to functional decline in older adults. OBJECTIVE To assess the relationship between physical performance on admission and functional capacity and functional capacity decline at discharge, and to investigate tools capable of predicting this decline. METHODS Prospective longitudinal study with 75 older adults admitted to a public hospital between July 2021 and February 2022. The independent variable was physical performance evaluated on admission by handgrip strength (HGS) and the Short Physical Performance Battery (SPPB). The dependent variables were functional capacity for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) and their decline between admission and discharge. Statistical analyses were performed using linear and logistic regression and ROC curves. RESULTS The median time between admission and participant assessment was 1 day (IQR=1-2 days). Median hospitalization time was 18 days (IQR= 7.5-30 days). Functional capacity for BADLs and IADLs declined in 39% and 79% of the participants, respectively. Performance in HGS and the SPPB at baseline, in adjusted models, explained 29.3 to 35.3% of functional capacity at discharge. One additional point in the SPPB decreased the risk of functional capacity decline for BADLs by 20.9% (OR=0.79, 95% CI: 0.68, 0.91). The AUC values for the SPPB (AUC=0.67) and HGS (AUC=0.65) were significant in identifying functional decline for BADLs, but not IADLs. CONCLUSION In Brazilian older adults, physical performance on admission was related to functional capacity and its decline at discharge. Physical performance on admission is predictive of functional decline at discharge.
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Affiliation(s)
- Tayla Gomes de Moura
- Postgraduate Program in Rehabilitation Sciences, Faculty of Ceilândia, Universidade de Brasilia, Centro Metropolitano, Brasília, DF, Brazil.
| | | | | | - Aline Teixeira Alves
- Postgraduate Program in Rehabilitation Sciences, Faculty of Ceilândia, Universidade de Brasilia, Centro Metropolitano, Brasília, DF, Brazil
| | - Patrícia Azevedo Garcia
- Postgraduate Program in Rehabilitation Sciences, Faculty of Ceilândia, Universidade de Brasilia, Centro Metropolitano, Brasília, DF, Brazil
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Nabavi H, Mehdizadeh S, Shum LC, Flint AJ, Mansfield A, Taati B, Iaboni A. A pilot observational study of gait changes over time before and after an unplanned hospital visit in long-term care residents with dementia. BMC Geriatr 2023; 23:723. [PMID: 37940854 PMCID: PMC10634101 DOI: 10.1186/s12877-023-04385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Older adults with dementia living in long-term care (LTC) have high rates of hospitalization. Two common causes of unplanned hospital visits for LTC residents are deterioration in health status and falls. Early detection of health deterioration or increasing falls risk may present an opportunity to intervene and prevent hospitalization. There is some evidence that impairments in older adults' gait, such as reduced gait speed, increased variability, and poor balance may be associated with hospitalization. However, it is not clear whether changes in gait are observable and measurable before an unplanned hospital visit and whether these changes persist after the acute medical issue has been resolved. The objective of this study was to examine gait changes before and after an unplanned acute care hospital visit in people with dementia. METHODS We performed a secondary analysis of quantitative gait measures extracted from videos of natural gait captured over time on a dementia care unit and collected information about unplanned hospitalization from health records. RESULTS Gait changes in study participants before hospital visits were characterized by decreasing stability and step length, and increasing step variability, although these changes were also observed in participants without hospital visits. In an age and sex-adjusted mixed effects model, gait speed and step length declined more quickly in those with a hospital visit compared to those without. CONCLUSIONS These results provide preliminary evidence that clinically meaningful longitudinal gait changes may be captured by repeated non-invasive gait monitoring, although a larger study is needed to identify changes specific to future medical events.
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Affiliation(s)
- Hoda Nabavi
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Sina Mehdizadeh
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Leia C Shum
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Avril Mansfield
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Babak Taati
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Andrea Iaboni
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Buele J, Palacios-Navarro G. Cognitive-motor interventions based on virtual reality and instrumental activities of daily living (iADL): an overview. Front Aging Neurosci 2023; 15:1191729. [PMID: 37396651 PMCID: PMC10311491 DOI: 10.3389/fnagi.2023.1191729] [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: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Non-invasive, non-pharmacological interventions utilizing virtual reality (VR) represent a promising approach to enhancing cognitive function in patients with degenerative cognitive disorders. Traditional "pen and paper" therapies often lack the practical engagement in everyday activities that older individuals encounter in their environment. These activities pose both cognitive and motor challenges, underscoring the necessity of understanding the outcomes of such combined interventions. This review aimed to assess the advantages of VR applications that integrate cognitive-motor tasks, simulating instrumental activities of daily living (iADLs). We systematically searched five databases-Scopus, Web of Science, Springer Link, IEEE Xplore, and PubMed, from their inception until January 31, 2023. Our review revealed that motor movements, coupled with VR-based cognitive-motor interventions, activate specific brain areas and foster improvements in general cognition, executive function, attention, and memory. VR applications that meld cognitive-motor tasks and simulate iADLs can offer significant benefits to older adults. Enhanced cognitive and motor performance can promote increased independence in daily activities, thereby contributing to improved quality of life.
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Affiliation(s)
- Jorge Buele
- SISAu Research Group, Facultad de Ingeniería, Industria y Producción, Universidad Indoamérica, Ambato, Ecuador
- Department of Electronic Engineering and Communications, University of Zaragoza, Teruel, Spain
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Loyd C, Zhang Y, Weisberg T, Boyett J, Huckaby ER, Grundhoefer J, Otero S, Roberts L, Giordano‐Mooga S, Capo‐Lugo C, Smith CH, Kennedy RE, King BJ, Brown CJ. A systematic review and meta-analysis: Assessment of hospital walking programs among older patients. Nurs Open 2023; 10:1942-1953. [PMID: 36441641 PMCID: PMC10006621 DOI: 10.1002/nop2.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/27/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
AIM The aim of this study is to assess effect of hospital walking programs on outcomes for older inpatients and to characterize hospital walking dose reported across studies. DESIGN A systematic review and meta-analysis examining impact of hospital walking and/or reported walking dose among medical-surgical inpatients. For inclusion, studies were observational or experimental, published in English, enrolled inpatients aged ≥ 65 yrs hospitalized for medical or surgical reasons. METHODS Searches of PubMed, CINAHL, Embase, Scopus, NICHSR, OneSearch, ClinicalTrials.gov, and PsycINFO were completed in December 2020. Two reviewers screened sources, extracted data, and performed quality bias appraisal. RESULTS Hospital walking dose was reported in 6 studies and commonly as steps/24 hr. Length of stay (LOS) was a common outcome reported. Difference in combined mean LOS between walking and control groups was -5.89 days. Heterogeneity across studies was considerable (I2 = 96%) suggesting poor precision of estimates. Additional, high-quality trials examining hospital walking and patient outcomes of older patients is needed.
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Affiliation(s)
- Christine Loyd
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
| | - Tara Weisberg
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - James Boyett
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Elizabeth R. Huckaby
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Jeri Grundhoefer
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Steve Otero
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Lisa Roberts
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
| | - Samantha Giordano‐Mooga
- Department of Clinical and Diagnostic Sciences, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Carmen Capo‐Lugo
- Department of Physical Therapy, UAB School of Health ProfessionsUniversity of AlabamaAlabamaBirminghamUSA
| | - Catherine H. Smith
- Lister Hill Library of the Health SciencesUniversity of Alabama at BirminghamAlabamaBirminghamUSA
| | - Richard E. Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
| | | | - Cynthia J. Brown
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, UAB School of MedicineUniversity of AlabamaAlabamaBirminghamUSA
- Department of MedicineLouisiana State University Health Sciences CenterLouisianaNew OrleansUSA
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Dysphagia is an independent predictor of hospital-acquired disability in older patients with heart failure: a propensity score-matched analysis : Predictors of HAD in older HF patients. Heart Vessels 2023; 38:66-76. [PMID: 35831636 DOI: 10.1007/s00380-022-02133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/29/2022] [Indexed: 01/06/2023]
Abstract
This study aims to identify the relationship between dysphagia and developing hospital-acquired disability (HAD) in older patients with heart failure (HF). This single-center retrospective cohort study included 360 patients (median age, 84 years: 58.1% female, 41.9% male) who had undergone rehabilitation and were aged 65 years and older. Patients were divided into dysphagia and non-dysphagia groups and compared based on the Functional Oral Intake Scale score. HAD was defined as a decline in the Barthel Index score (indication of daily activity levels) at discharge relative to that before admission. The relationship between dysphagia and HAD was analyzed using bivariate analysis after adjusting for age, sex, body mass index, medical history, clinical and laboratory data, short physical performance battery (SPPB), and cognitive function at the start of rehabilitation, using propensity score matching. HAD was observed in 38.1% of the patients. Patients with dysphagia were significantly older, and had lower body mass index and physical and cognitive function than those without. After propensity score matching, the prevalence of HAD was significantly higher in the dysphagia group than in the non-dysphagia group (61.9% vs. 42.9%, P = 0.032). Dysphagia at the start of rehabilitation was an independent predictor of HAD. The results of this study may contribute to risk stratification of HAD.
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Blondal BS, Geirsdottir OG, Halldorsson TI, Beck AM, Jonsson PV, Ramel A. HOMEFOOD Randomised Trial - Six-Month Nutrition Therapy in Discharged Older Adults Reduces Hospital Readmissions and Length of Stay at Hospital Up to 18 Months of Follow-Up. J Nutr Health Aging 2023; 27:632-640. [PMID: 37702336 DOI: 10.1007/s12603-023-1962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Malnutrition is frequently observed in older adults and is associated with hospital readmissions, length of stay (LOS), and mortality in discharged patients. OBJECTIVE The aim of this study was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence 1-, 6-, 12- and 18-months post-discharge in older Icelandic adults. DESIGN Secondary analysis of a randomized controlled trial. PARTICIPANTS Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. INTERVENTION The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. MEASUREMENTS The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. RESULTS The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions per participant (1 month: 0.02 vs 0.19, P=0.015; 6 month: 0.33 vs 0.77, P=0.014; 0.62 vs 1.12, P=0.044) and a shorter LOS (1 month: 0.02 vs 0.92, P=0.013; 6 months: 2.44 vs 13.21; P=0.006; 12 months: 5.83 vs 19.40, P=0.034; 18 months: 10.42 vs 26.00, P=0.033) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. CONCLUSION A six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge. However, it did neither affect mortality, ER, nor need of long-term care residence in this group.
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Affiliation(s)
- B S Blondal
- Berglind Soffia Blondal, Faculty of Food Science and Nutrition, University of Iceland, Aragata 14, 101 Reykjavik, Iceland, Telephone: +354 842 0242,
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Kim M, Kim N, Jeon Y, Kim SJ. Estimation of Functional Reserve in Patients with Hospital-Associated Deconditioning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14140. [PMID: 36361014 PMCID: PMC9654475 DOI: 10.3390/ijerph192114140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to analyze the applicability of sit-to-stand (STS) muscle power tests for evaluating functional reserve in patients with hospital-associated deconditioning (HAD). METHODS This study is a single group preliminary observational study. STS tests were performed in the early stages of comprehensive rehabilitation treatment, and the interval changes in the clinical indicators were assessed after four weeks of clinical observation. A STS capacity ratio was estimated by the time duration of five STS repetitions (5r-STS) and the maximum number of STS repetitions over 30 s (30s-STS); the activities were measured using a three-dimension motion capture system and force plate. RESULTS After 4 weeks of comprehensive rehabilitation, the 10 m gait speed (p = 0.004), hand grip power (p = 0.022), hip extensor power (p = 0.002), Berg balance scale (p < 0.001), and modified Barthel index (MBI) (p = 0.001), respectively, were significantly improved. The force plate-derived (FPD) 30s-STS power and the number of repeats in the FPD 30s-STS showed a positive correlation with improvements in the hand grip power (Spearman's Rho = 0.477, p = 0.045), hip extensor power (Spearman's Rho = 0.482, p = 0.043), and MAI (Spearman's Rho = 0.481, p = 0.043), respectively. The STS capacity ratio was correlated with higher improvements in the 10 m gait speed (Spearman's Rho = 0.503, p = 0.034), hip extensor power (Spearman's Rho = 0.494, p = 0.037), and MBI (Spearman's Rho = 0.595, p = 0.009). Despite individual variability in the differences between the FPD and estimated STS power, the results for the correlation between the STS capacity ratio and clinical outcomes were consistent. CONCLUSIONS The STS capacity ratio showed a positive correlation with the clinical outcomes, including gait speed, and may reflect a part of the functional reserve excluding the individual variability of performance.
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Affiliation(s)
- Minhee Kim
- Biomedical Research Center, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea
| | - Nackhwan Kim
- Korea University Research Institute for Medical Bigdata Science, Korea University Anam Hospital, Seoul 02841, Korea
| | - Yuho Jeon
- Biomedical Research Center, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea
| | - Seung-Jong Kim
- Department of Biomedical Engineering, College of Medicine, Korea University, Seoul 02841, Korea
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13
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Frederiksen KO, Nørgaard B, Bruun IH. How to Improve Hospitalized Older Adults’ Activity Level: A Mixed Methods Study. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2121884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Inge Hansen Bruun
- Department of Physical and Occupational Therapy, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Fukuoka Y, Katzman WB, Gladin A, Lane NE, Yoo JO. Factors associated with the 6-minute walk test performance in older adults with hyperkyphosis. Geriatr Nurs 2022; 47:95-99. [PMID: 35901578 PMCID: PMC9675409 DOI: 10.1016/j.gerinurse.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/20/2022]
Abstract
Age-related hyperkyphosis is associated with adverse health outcomes, such as falls, fractures, and mortality. However, few studies investigated the relationship between the severity of hyperkyphosis and physical endurance in older adults. This study examined whether a degree of hyperkyphosis curvature was independently associated with the 6-minute walk test (6MWT) distance. We analyzed the baseline data of 112 older adults aged 60-92 enrolled in the Specialized Center of Research (SCOR) Kyphosis trial. The majority of the sample had at least a college degree and were white. On average, participants walked 503.9 (SD 82.3) meters in 6 minutes. Multivariate regression results showed that the degree of hyperkyphosis curvature was not independently associated with the 6MWT distance, but taller height, lighter weight, and less prescription medication were significant predictors of better performance on the 6MWT distance. Validation of the study findings in a large, diverse older adult population is warranted.
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Affiliation(s)
- Yoshimi Fukuoka
- Department of Physiological Nursing, University of California, San Francisco, CA, USA.
| | - Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Amy Gladin
- Department of Pain Medicine, Kaiser Permanente Northern California, San Francisco Medical Center, San Francisco, CA, USA
| | - Nancy E Lane
- Department of Medicine, Division of Rheumatology and Immunology, School of Medicine, University of California, Davis, CA, USA
| | - Jung Oh Yoo
- Department of Communication, University of California, Davis, CA, USA
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15
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Bruun IH, Frederiksen KO, Nørgaard B. Attendance of Physical and Occupational Therapists Improves Older Hospitalized Adults’ Activity Levels. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2116523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Inge Hansen Bruun
- Department of Physical and Occupational Therapy, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Ruiz-Grao MC, Sánchez-Jurado PM, Molina-Alarcón M, Garrido-Miguel M, Álvarez-Bueno C, Alcantud-Córcoles R, Andrés-Petrel F, Avendaño-Céspedes A, Gómez-Ballesteros C, Sánchez-Flor-Alfaro V, López-Bru R, Roldán-García B, Tabernero-Sahuquillo MT, Mas-Romero M, García-Molina R, Romero-Rizos L, Abizanda P. Frailty, depression risk and 10-year hospitalization in older adults. The FRADEA study. Geriatr Nurs 2022; 46:184-190. [PMID: 35728301 DOI: 10.1016/j.gerinurse.2022.05.015] [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: 03/30/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether the interaction between frailty status and depression risk is associated with hospitalization density in older adults. METHODS Ongoing cohort study in 794 subjects aged over 70 years from Albacete (Spain). Data were collected on depression risk, frailty, hospitalizations, and covariates. Participants were categorized into six groups. RESULTS Adjusted hospitalization risk was higher for groups of prefrail/-non depression risk (HR 1.48; 95% confidence interval (CI) 1.16-1.89), prefrail/depression risk (HR 1.73; 95% CI 1.29-2.30), frail/non depression risk (HR 1.79; 95% CI 1.22-2.62), and frail/depression risk (HR 2.12; 95% CI 1.49-3.02), compared with robust/non depression risk group (p<0.01). Frail and prefrail groups presented increased hospitalization density in the first four follow-up years. CONCLUSIONS Depression risk changes the yearly probabilities of hospitalization in prefrail and frail groups, increasing them in the first years. Depression risk should be monitored in prefrail and frail older adults as an independent risk factor for hospitalization.
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Affiliation(s)
- Marta Carolina Ruiz-Grao
- Universidad de Castilla-La Mancha, Facultad de Enfermería, s/n. 02071, Albacete, Spain; Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.
| | - Pedro Manuel Sánchez-Jurado
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain; CIBERFES, Ministerio de Economía y Competitividad, Spain; Universidad de Castilla-La Mancha, Facultad de Medicina. Albacete, Spain
| | | | - Miriam Garrido-Miguel
- Universidad de Castilla-La Mancha, Facultad de Enfermería, s/n. 02071, Albacete, Spain; Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | | | - Fernando Andrés-Petrel
- Department of Statistics, Foundation of the National Paraplegics Hospital of Toledo, Toledo, Spain
| | - Almudena Avendaño-Céspedes
- Universidad de Castilla-La Mancha, Facultad de Enfermería, s/n. 02071, Albacete, Spain; Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain; CIBERFES, Ministerio de Economía y Competitividad, Spain
| | | | | | - Rita López-Bru
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Belén Roldán-García
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | | | - Marta Mas-Romero
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Rafael García-Molina
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain
| | - Luis Romero-Rizos
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain; CIBERFES, Ministerio de Economía y Competitividad, Spain; Universidad de Castilla-La Mancha, Facultad de Medicina. Albacete, Spain
| | - Pedro Abizanda
- Department of Geriatrics, Complejo Hospitalario Universitario of Albacete, Albacete, Spain; CIBERFES, Ministerio de Economía y Competitividad, Spain; Universidad de Castilla-La Mancha, Facultad de Medicina. Albacete, Spain
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Witt UF, Nibe SM, Ole H, Lebech CS. A novel approach for predicting acute hospitalizations among elderly recipients of home care? A model development study. Int J Med Inform 2022; 160:104715. [DOI: 10.1016/j.ijmedinf.2022.104715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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Chen Y, Almirall‐Sánchez A, Mockler D, Adrion E, Domínguez‐Vivero C, Romero‐Ortuño R. Hospital-associated deconditioning: Not only physical, but also cognitive. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5687. [PMID: 35142397 PMCID: PMC9303382 DOI: 10.1002/gps.5687] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hospital-associated deconditioning (HAD) or post-hospital syndrome is well recognized as reduced functional performance after an acute hospitalization. Recommendations for the management of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions. MATERIALS AND METHODS We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as 'post-hospitalization syndrome' or 'deconditioning'. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality. RESULTS From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre-admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation. DISCUSSION In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting.
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Affiliation(s)
- Yaohua Chen
- Global Brain Health InstituteTrinity College DublinDublinIreland
- University Lille, Inserm, CHU LilleLille Neurosciences & Cognition, UMR‐S1172, Degenerative and Vascular Cognitive DisordersLilleFrance
| | | | | | - Emily Adrion
- Global Brain Health InstituteTrinity College DublinDublinIreland
- Global Health Policy UnitUniversity of EdinburghScotlandUK
| | | | - Román Romero‐Ortuño
- Global Brain Health InstituteTrinity College DublinDublinIreland
- Discipline of Medical GerontologySchool of MedicineTrinity College DublinDublinIreland
- Mercer's Institute for Successful AgeingSt James's HospitalDublinIreland
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Levin C, Zisberg A, Gil E, Rand D, Agmon M. ‘Behind the scenes’ of accelerometer use to quantify in-hospital mobility of older adults. Arch Phys Med Rehabil 2022; 103:1676-1683.e1. [DOI: 10.1016/j.apmr.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
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Polhemus A, Delgado-Ortiz L, Brittain G, Chynkiamis N, Salis F, Gaßner H, Gross M, Kirk C, Rossanigo R, Taraldsen K, Balta D, Breuls S, Buttery S, Cardenas G, Endress C, Gugenhan J, Keogh A, Kluge F, Koch S, Micó-Amigo ME, Nerz C, Sieber C, Williams P, Bergquist R, Bosch de Basea M, Buckley E, Hansen C, Mikolaizak AS, Schwickert L, Scott K, Stallforth S, van Uem J, Vereijken B, Cereatti A, Demeyer H, Hopkinson N, Maetzler W, Troosters T, Vogiatzis I, Yarnall A, Becker C, Garcia-Aymerich J, Leocani L, Mazzà C, Rochester L, Sharrack B, Frei A, Puhan M. Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes. NPJ Digit Med 2021; 4:149. [PMID: 34650191 PMCID: PMC8516969 DOI: 10.1038/s41746-021-00513-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023] Open
Abstract
Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Gavin Brittain
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Michaela Gross
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachele Rossanigo
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Diletta Balta
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gabriela Cardenas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Christoph Endress
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Felix Kluge
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - M Encarna Micó-Amigo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Chloé Sieber
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magda Bosch de Basea
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Ellen Buckley
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Lars Schwickert
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Kirsty Scott
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Sabine Stallforth
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Janet van Uem
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrea Cereatti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Alison Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Letizia Leocani
- Department of Neurology, San Raffaele University, Milan, Italy
| | - Claudia Mazzà
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Nicolson PJA, Sanchez-Santos MT, Bruce J, Kirtley S, Ward L, Williamson E, Lamb SE. Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review. J Aging Phys Act 2021; 29:1053-1066. [PMID: 34348224 DOI: 10.1123/japa.2020-0482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.
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Alcantud Córcoles R, Andrés-Pretel F, Sánchez-Jurado PM, Avendaño Céspedes A, Gómez Ballesteros C, Sánchez-Flor Alfaro V, López Bru R, Tabernero Sahuquillo MT, Romero Rizos L, Hoogendijk EO, Abizanda P. The Functional Continuum Scale in Relation to Hospitalization Density in Older Adults: The FRADEA Study. J Gerontol A Biol Sci Med Sci 2021; 76:1512-1518. [PMID: 33475726 DOI: 10.1093/gerona/glab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a need to know the relationship between function and hospitalization risk in older adults. We aimed at investigating whether the Functional Continuum Scale (FCS), based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with hospitalization density in older adults across 12 years of follow-up. METHODS Cohort study, with a follow-up of 12 years. A total of 915 participants aged 70 years and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based study in Spain, were included. At baseline, the FCS, sociodemographic characteristics, comorbidity, number of medications, and place of residence were assessed. Associations with first hospitalization, number of hospitalizations, and 12-year density of hospitalizations were assessed using Kaplan-Meier curves, Poisson regression analyses, and density models. RESULTS The median time until the first hospitalization was shorter toward the less functionally independent end of the FCS, from 3917 days (95% confidence interval [CI] 3701-3995) to 1056 days (95% CI 785-1645) (p < .001). The incidence rate ratio (IRR) for all hospitalizations increased from the robust category until the frail one (IRR 1.89), and thereafter it decreased until the worse functional category. Those who were BADL dependent presented an increased hospitalization density in the first 4 follow-up years (58%), those who were frail in the third-to-sixth follow-up years (55%), while in those prefrail or robust the hospitalization density was homogeneous during the complete follow-up. CONCLUSIONS The FCS is useful for stratifying the risk of hospitalization and for predicting the density of hospitalizations in older adults.
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Affiliation(s)
| | | | - Pedro Manuel Sánchez-Jurado
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | - Almudena Avendaño Céspedes
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Rita López Bru
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain
| | | | - Luis Romero Rizos
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, the Netherlands
| | - Pedro Abizanda
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, Madrid, Spain
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23
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Sprung J, Laporta M, Knopman DS, Petersen RC, Mielke MM, Weingarten TN, Vassilaki M, Martin DP, Schulte PJ, Hanson AC, Schroeder DR, Vemuri P, Warner DO. Gait Speed and Instrumental Activities of Daily Living in Older Adults After Hospitalization: A Longitudinal Population-Based Study. J Gerontol A Biol Sci Med Sci 2021; 76:e272-e280. [PMID: 33650631 DOI: 10.1093/gerona/glab064] [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: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospitalization can impair physical and functional status of older adults, but it is unclear whether these deficits are transient or chronic. This study determined the association between hospitalization of older adults and changes in long-term longitudinal trajectories of two measures of physical and functional status: gait speed (GS) and Instrumental Activities of Daily Living measured with Functional Activities Questionnaire (FAQ). METHODS Linear mixed effects models assessed the association between hospitalization (non-elective vs. elective, and surgical vs. medical) and outcomes of GS and FAQ score in participants (>60 years old) enrolled in the Mayo Clinic Study of Aging who had longitudinal assessments. RESULTS Of 4,902 participants, 1,879 had ≥1 hospital admission. Median GS at enrollment was 1.1 m/s. The slope of the annual decline in GS before hospitalization was -0.015 m/s. The parameter estimate [95%CI] for additional annual change in GS trajectory after hospitalization was -0.009 [-0.011 to -0.006] m/s, P<0.001. The accelerated GS decline was greater for medical vs. surgical hospitalizations (-0.010 vs. -0.003 m/s, P=0.005), and non-elective vs. elective hospitalizations (-0.011 vs -0.006 m/s, P=0.067). The odds of a worsening FAQ-score increased on average by 4% per year. Following hospitalization, odds of FAQ-score worsening further increased (multiplicative annual increase in odds ratio per year [95%C] following hospitalization was 1.05 [1.03, 1.07], P<0.001). CONCLUSIONS Hospitalization of older adults is associated with accelerated long-term decline in GS and functional limitations, especially after non-elective admissions and those for medical indications. However, for most well-functioning participants these changes have little clinical significance.
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Affiliation(s)
- Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota, USA
| | - Mariana Laporta
- Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota, USA
| | | | | | | | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota, USA
| | | | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota, USA
| | - Phillip J Schulte
- Division of Biomedical Statistics and Informatics Rochester, Minnesota, USA
| | - Andrew C Hanson
- Division of Biomedical Statistics and Informatics Rochester, Minnesota, USA
| | | | - Prashanthi Vemuri
- Division of Radiology, All from Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Rochester, Minnesota, USA
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24
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MejiaCruz Y, Franco J, Hainline G, Fritz S, Jiang Z, Caicedo JM, Davis B, Hirth V. Walking speed measurement technology: A review. CURRENT GERIATRICS REPORTS 2021; 10:32-41. [PMID: 33816062 DOI: 10.1007/s13670-020-00349-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of review This article presents an overview of the main technologies used to estimate gait parameters, focusing on walking speed (WS). Recent findings New wearable and environmental technologies to estimate WS have been developed in the last five years. Wearable technologies refer to sensors attached to parts of the patient's body that capture the kinematics during walking. Alternatively, environmental technologies capture walking patterns using external instrumentation. In this review, wearable and external technologies have been included.From the different works reviewed, external technologies face the challenge of implementation outside controlled facilities; an advantage that wearable technologies have, but have not been fully explored. Additionally, systems that can track WS changes in daily activities, especially at-home assessments, have not been developed. Summary Walking speed is a gait parameter that can provide insight into an individual's health status. Image-based, walkways, wearable, and floor-vibrations technologies are the most current used technologies for estimating WS. In this paper, research from the last five years that explore each technology's capabilities on WS estimation and an evaluation of their technical and clinical aspects is presented.
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Affiliation(s)
- Yohanna MejiaCruz
- San Francisco State University, 1600 Holloway Ave, San Francisco, CA 94132
| | - Jean Franco
- University of South Carolina, 300 Main St, Columbia SC, 29201
| | - Garret Hainline
- University of South Carolina, 300 Main St, Columbia SC, 29201
| | - Stacy Fritz
- University of South Carolina, 300 Main St, Columbia SC, 29201
| | - Zhaoshuo Jiang
- San Francisco State University, 1600 Holloway Ave, San Francisco, CA 94132
| | - Juan M Caicedo
- University of South Carolina, 300 Main St, Columbia SC, 29201
| | - Benjamin Davis
- Advanced Smart Systems and Evaluation Technologies (ASSET), LLC, 1400 Laurel Street, Suite 1B, Columbia, South Carolina 29201
| | - Victor Hirth
- Geriatric Health and Wellness, LTD, One Still Hopes Drive, West Columbia, SC 29169
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25
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Sunde S, Hesseberg K, Skelton DA, Ranhoff AH, Pripp AH, Aarønæs M, Brovold T. Effects of a multicomponent high intensity exercise program on physical function and health-related quality of life in older adults with or at risk of mobility disability after discharge from hospital: a randomised controlled trial. BMC Geriatr 2020; 20:464. [PMID: 33176703 PMCID: PMC7656746 DOI: 10.1186/s12877-020-01829-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022] Open
Abstract
Background Many older people suffer from mobility limitations and reduced health-related quality of life (HRQOL) after discharge from hospital. A consensus regarding the most effective exercise-program to optimize physical function and HRQOL after discharge is lacking. This study investigates the effects of a group-based multicomponent high intensity exercise program on physical function and HRQOL in older adults with or at risk of mobility disability after discharge from hospital. Methods This single blinded parallel group randomised controlled trial recruited eighty-nine home dwelling older people (65–89 years) while inpatient at medical wards at a general hospital in Oslo, Norway. Baseline testing was conducted median 49 (25 percentile, 75 percentile) (26, 116) days after discharge, before randomisation to an intervention group or a control group. The intervention group performed a group-based exercise program led by a physiotherapist twice a week for 4 months. Both groups were instructed in a home-based exercise program and were encouraged to exercise according to World Health Organisation’s recommendations for physical activity in older people. The primary outcome, physical performance, was measured by the Short Physical Performance Battery (SPPB). Secondary outcomes were 6-min walk test (6MWT), Berg Balance Scale (BBS), grip strength, Body Mass Index (BMI), and HRQOL (the Short-Form 36 Health Survey (SF-36)). Data were analysed according to the intention-to-treat principle. Between-group differences were assessed using independent samples t-test. Results The groups were comparable at baseline. Intention-to-treat analysis showed that the intervention group improved their functional capacity (6MWT) and the physical component summary of SF-36 significantly compared to the control group. No further between group differences in change from baseline to 4 months follow-up were found. Conclusions A high intensity multicomponent exercise program significantly improved functional capacity and physical HRQOL in older adults with or at risk of mobility disability after discharge from hospital. The study suggests that this population can benefit from systematic group exercise after hospital-initial rehabilitation has ended. Trial registration ClinicalTrials.gov. NCT02905383. September 19, 2016. Supplementary information Supplementary information accompanies this paper at 10.1186/s12877-020-01829-9.
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Affiliation(s)
- Sylvia Sunde
- Institute of Physiotherapy, OsloMet - Oslo Metropolitan University (OsloMet), PO Box 4, St. Olavs Plass, 0130, Oslo, Norway. .,Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway.
| | - Karin Hesseberg
- Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Anette Hylen Ranhoff
- Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Are Hugo Pripp
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Marit Aarønæs
- Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway
| | - Therese Brovold
- Institute of Physiotherapy, OsloMet - Oslo Metropolitan University (OsloMet), PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
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26
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Frisoli A, Paes AT, Borges J, Ingham SM, Cartocci MM, Lima E, de Camargo Carvalho AC. The association between low lean mass and osteoporosis increases the risk of weakness, poor physical performance and frailty in Brazilian older adults: data from SARCOS study. Eur J Clin Nutr 2020; 75:446-455. [PMID: 32948866 DOI: 10.1038/s41430-020-00753-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/31/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To characterize the phenotypes of older adults with low lean mass and osteoporosis, concomitantly or isolated, in regards to poor physical performance and frailty status. DESIGN Cross-sectional analysis of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). SETTING Outpatient geriatric cardiology clinic. PARTICIPANTS AND METHOD 385 older adults underwent DXA analysis. Low lean mass was diagnosed according to FNIH and low BMD by a T-score ≤ -2.5 SD. Subjects were grouped into: I-Low lean mass and Osteoporosis (LLMO); II-Low lean mass (LLM); III-Osteoporosis (OP), and IV-Controls. Poor physical performance was diagnosed by weakness or slow walking speed or impaired mobility. Frailty was diagnosed by CHS criteria. RESULTS The mean age was 78.22 ± 7.16 years. The prevalence of LLMO, LLM, and OP were 14.8%, 39.5%, and 19.2%, respectively. LLMO subjects were older, predominantly women, with a high percentage of body fat (HTBF). LLM was represented by obese men, while individuals with OP were preferably women, older and leaner. In a regression analyses, LLMO presented an OR: 6.42 (2.63‒15.65; p < 0.001) for weakness, OR: 2.55 (1.09‒5.95; p = 0.030) for impaired mobility, and OR: 14.75 (2.72‒79.94; p = 0.002) for frailty. After adjusting for HTBF, the OR for frailty, decreased to 7.25 (1.11-47.21; p = 0.038). LLM and OP were associated only with weakness with an OR: 3.06 (1.36-6.84; p = 0.006) and OR: 3.14 (1.29-7.62; p = 0.011), respectively. CONCLUSION In Brazilian older community-dwelling outpatient adults, the phenotype characterized by low lean mass and osteoporosis presents a higher association with impaired mobility, weakness and frailty status compared to the others phenotyeps and controls. A high percentage of body fat presents a synergistic effect with low lean mass and osteoporosis phenotype in regards to frailty.
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Affiliation(s)
- Alberto Frisoli
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil. .,Elderly Vulnerability Disease Research Group-Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | | | - Jairo Borges
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Elderly Vulnerability Disease Research Group-Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sheila McNeill Ingham
- Elderly Vulnerability Disease Research Group-Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Maria Cartocci
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eliene Lima
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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27
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Smichenko J, Gil E, Zisberg A. Relationship Between Changes in Sedative-Hypnotic Medications Burden and Cognitive Outcomes in Hospitalized Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:1699-1705. [PMID: 31942612 DOI: 10.1093/gerona/glaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sedative-hypnotic medications (SHMs) are frequently used in hospitalized older patients, despite undesirable effects on cognitive status. Although previous studies found a significant number of patients experience changes in SHM use during hospitalization, it is unclear which pattern of change leads to hospital-associated cognitive decline (HACD). This study tested the association between patterns of SHM change and HACD. METHODS This secondary analysis study included 550 patients age 70+ who were cognitively intact at admission (Short Portable Mental Status Questionnaire [SPMSQ] ≥8). HACD was defined as at least 1-point decline in SPMSQ between admission and discharge. Changes in sedative burden (SB) before and during hospitalization (average SB of all hospitalization days) were coded using the Drug Burden Index sorting study participants into four groups: without SB (n = 254), without SB changes (n = 132), increased SB (n = 82), and decreased SB (n = 82). RESULTS Incidence of HACD was 233/550 (42.4%). In multivariate logistic analysis controlling for demographic characteristics, length of stay, severity of acute illness, comorbidity, SB score at home, pain on admission and depression, the odds of HACD were 2.45 (95% CI: 1.16 to 5.13) among participants with increased SB, 2.10 (95% CI: 1.13 to 3.91) among participants without SB changes, compared with participants with decreased SB. CONCLUSION Older patients whose SB is increased or does not change are at higher risk for acquired cognitive decline than are those whose SB is reduced. Identifying patients with a potential increase in SB and intervening to reduce it may help to fight HACD.
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Affiliation(s)
- Juliana Smichenko
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Haifa, Israel
| | - Efrat Gil
- Clalit Health Services, Haifa and West Galilee and Carmel Hospital, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Haifa, Israel
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28
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Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Sato N, Wada A, Kiyama R, Tsutsumimoto K, Ohishi M, Kiuchi Y, Kubozono T, Takenaka T. Effects of a Multicomponent Exercise Program in Physical Function and Muscle Mass in Sarcopenic/Pre-Sarcopenic Adults. J Clin Med 2020; 9:jcm9051386. [PMID: 32397192 PMCID: PMC7291119 DOI: 10.3390/jcm9051386] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022] Open
Abstract
This study aimed to assess the effects of a multicomponent exercise program on physical function and muscle mass in older adults with sarcopenia or pre-sarcopenia. Moreover, we aim to standardize the exercise program for easy incorporation in the daily life of community-dwelling older adults as a secondary outcome. A single-blind randomized controlled trial was conducted with individuals (≥60 years) who had sarcopenia or pre-sarcopenia (n = 72). Participants were randomly assigned to the exercise and control groups. The exercise program consisted of 12 weekly 60-min sessions that included resistance, balance, flexibility, and aerobic training. Outcome measures were physical function and muscle mass. Assessments were conducted before and immediately after the intervention. Among the 72 participants (mean age: 75.0 ± 6.9 years; 70.8% women), 67 (93.1%) completed the trial. Group-by-time interactions on the chair stand (p = 0.02) and timed “up and go” (p = 0.01) tests increased significantly in the exercise group. Although the exercise group showed a tendency to prevent loss of muscle mass, no significant interaction effects were observed for cross-sectional muscle area and muscle volume. The 12-week exercise program improved physical function in the intervention group. Although it is unclear whether the program is effective in increasing muscle mass, a multicomponent exercise program would be an effective treatment for physical function among older adults with sarcopenia.
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Affiliation(s)
- Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (Y.N.); (R.K.)
- Correspondence: ; Tel.: +81-99-275-5111; Fax: +81-99-275-6804
| | - Yuki Nakai
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (Y.N.); (R.K.)
| | - Kazutoshi Tomioka
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Yoshiaki Taniguchi
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Department of Physical Therapy, Kagoshima Medical Professional College, Kagoshima 891-0133, Japan
| | - Nana Sato
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Ayumi Wada
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
| | - Ryoji Kiyama
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan; (Y.N.); (R.K.)
| | - Kota Tsutsumimoto
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu 474-5811, Japan;
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan; (M.O.); (T.K.)
| | - Yuto Kiuchi
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; (K.T.); (Y.T.); (N.S.); (A.W.); (Y.K.)
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan; (M.O.); (T.K.)
| | - Toshihiro Takenaka
- Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Kagoshima 891-2124, Japan;
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Giebel C, Harvey D, Akpan A, Chamberlain P. Reducing hospital admissions in older care home residents: a 4-year evaluation of the care home innovation Programme (CHIP). BMC Health Serv Res 2020; 20:94. [PMID: 32028940 PMCID: PMC7006107 DOI: 10.1186/s12913-020-4945-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Older care home residents frequently attend emergency departments with a high conversion to admissions. For this purpose, a novel Care Home Innovation Programme (CHIP) was introduced with the aim of reducing potentially avoidable hospital admissions by 30%. The aim of this study is to evaluate the implementation of this innovative service in practice. Methods A total of 32 care homes with 1314 beds in South Sefton, Merseyside were invited to sign up to CHIP which was launched in April 2015 and continued in its entirety until June 2018. As part of the CHIP, care home matrons were introduced, new protocols were developed to address common presentations, a 24-h 7–day a week televideo system installed across all homes, and a quarterly training collaborative brought care homes together to learn and share good practices together. Data on emergency calls and calls resulting in conveyances were recorded over a four-year period, and analysed using frequency analysis. Results In comparison to the 12 months prior to launch, over a four-year period, implementation of the CHIP resulted in a 15% reduction of emergency calls, and in a 19% reduction of conveyances to hospital. Conclusions The South Sefton CHIP demonstrated itself an effective programme in reducing conveyances and consequently, hospital admissions of care home residents. This model will be superseded by the enhanced health in care homes being promoted by the NHS Long Term Care Plan.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Waterhouse Building B Block, Brownlow Street, Liverpool, L69 3GL, England. .,NIHR ARC NWC, Liverpool, England.
| | - Debbie Harvey
- South Sefton Clinical Commissioning Group, Liverpool, England
| | - Asangaedem Akpan
- NIHR ARC NWC, Liverpool, England.,Liverpool University Hospitals NHS FT, Liverpool, England.,Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, England
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30
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Fettrow T, Reimann H, Grenet D, Crenshaw J, Higginson J, Jeka J. Walking Cadence Affects the Recruitment of the Medial-Lateral Balance Mechanisms. Front Sports Act Living 2019; 1:40. [PMID: 33344963 PMCID: PMC7739695 DOI: 10.3389/fspor.2019.00040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/16/2019] [Indexed: 12/04/2022] Open
Abstract
We have previously identified three balance mechanisms that young healthy adults use to maintain balance while walking. The three mechanisms are: (1) The lateral ankle mechanism, an active modulation of ankle inversion/eversion in stance; (2) The foot placement mechanism, an active shift of the swing foot placement; and (3) The push-off mechanism, an active modulation of the ankle plantarflexion angle during double stance. Here we seek to determine whether there are changes in neural control of balance when walking at different cadences and speeds. Twenty-one healthy young adults walked on a self-paced treadmill while immersed in a 3D virtual reality cave, and periodically received balance perturbations (bipolar galvanic vestibular stimulation) eliciting a perceived fall to the side. Subjects were instructed to match two cadences specified by a metronome, 110 bpm (High) and 80 bpm (Low), which in this experiment, led to faster and slower gait speeds, respectively. The results indicate that subjects altered the use of the balance mechanisms at different cadences. The lateral ankle mechanism was used more in the Low condition, while the foot placement mechanism was used more in the High condition. There was no difference in the use of the push-off mechanism between cadence conditions. These results suggest that neural control of balance is altered when gait characteristics, such as cadence change, suggesting a flexible balance response that is sensitive to the constraints of the gait cycle. We speculate that the use of the balance mechanisms may be a factor resulting in well-known characteristics of gait in populations with compromised balance control, such as slower gait speed in older adults or higher cadence in people with Parkinson's disease.
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Affiliation(s)
- Tyler Fettrow
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - David Grenet
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Jeremy Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Jill Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States
| | - John Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
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