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Nguyen KT, Brooks D, Macedo LG, Ellerton C, Goldstein R, Alison JA, Dechman G, Harrison SL, Holland AE, Lee AL, Marques A, Spencer L, Stickland MK, Skinner EH, Haines KJ, Beauchamp MK. Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis. Respir Med 2024; 230:107681. [PMID: 38821219 DOI: 10.1016/j.rmed.2024.107681] [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: 01/23/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. METHODS In a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures - Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test - were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. RESULTS Among 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88-0.97) and moderate convergent validity (r = 0.34-0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. CONCLUSION Though all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.
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Affiliation(s)
- Khang T Nguyen
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Dina Brooks
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada; Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Cindy Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer A Alison
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Allied Health, Sydney Local Health District, Sydney, Australia
| | - Gail Dechman
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Samantha L Harrison
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia; Respiratory Research, Monash University, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Annemarie L Lee
- Institute for Breathing and Sleep, Melbourne, VIC, Australia; Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA) and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Lissa Spencer
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Elizabeth H Skinner
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia; Physiotherapy Department, Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Marla K Beauchamp
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada; Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.
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Lach HW, Salas J, Scherrer JF. Changes in Emergency Department and Inpatient Encounters for Falls after the Onset of the COVID-19 Pandemic. J Appl Gerontol 2024:7334648241266434. [PMID: 39030725 DOI: 10.1177/07334648241266434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
OBJECTIVE This study investigates changes in clinical encounters due to falls before and after the onset of the COVID-19 pandemic. METHODS De-identified health record data from a large mid-western health system was used to examine the frequency of emergency department (ED) and inpatient (IP) encounters for falls by month among adults age 50+ (N = 485, 886 patients) using joinpoint regression analysis. Also, overall rates before and during the pandemic were compared using log-binomial models. RESULTS Fall rates increased following the onset of the COVID-19 pandemic for IP encounters but not for ED encounters. There were no differences by age, gender, race, or nSES. Monthly IP fall rates increased by 0.68% per month both before and after the onset of the COVID-19 pandemic. CONCLUSION Pandemics may occur in the future, and interventions are needed to prevent falls in older adults during the next public health emergency.
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Affiliation(s)
- Helen W Lach
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jeffery F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Saint Louis University, St. Louis, MO, USA
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Aldridge SJ, Schmidt AE, Thißen M, Bernal-Delgado E, Estupiñán-Romero F, González-Galindo J, Dolanski-Aghamanoukjan L, Mathis-Edenhofer S, Buble T, Križ K, Vuković J, Palmieri L, Unim B, Meulman I, Owen RK, Lyons RA. Has the COVID-19 pandemic changed existing patterns of non-COVID-19 health care utilization? A retrospective analysis of six regions in Europe. Eur J Public Health 2024; 34:i67-i73. [PMID: 38946449 DOI: 10.1093/eurpub/ckad180] [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] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. METHODS Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017-19), compared against post-pandemic data. RESULTS We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. CONCLUSION The strength of this study comes from the use of the European Population Health Information Research Infrastructure's (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises.
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Affiliation(s)
- Sarah J Aldridge
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Andrea E Schmidt
- Competence Centre Climate and Health, GÖG (Austrian National Public Health Institute), Vienna, Austria
| | - Martin Thißen
- Department for Health Monitoring and Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Enrique Bernal-Delgado
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Francisco Estupiñán-Romero
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Javier González-Galindo
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain
| | - Lorenz Dolanski-Aghamanoukjan
- International Affairs, Policy, Evaluation, Digitalisation, GÖG (Austrian National Public Health Institute), Vienna, Austria
| | - Stefan Mathis-Edenhofer
- Health Care Planning and System Development, GÖG (Austrian National Public Health Institute), Vienna, Austria
| | - Tamara Buble
- Croatian Institute of Public Health (HZJZ), Zagreb, Croatia
| | - Klea Križ
- Croatian Institute of Public Health (HZJZ), Zagreb, Croatia
| | - Jakov Vuković
- Croatian Institute of Public Health (HZJZ), Zagreb, Croatia
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Iris Meulman
- Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
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Hoffman GJ, Ha J, Li J. Association of Medicare Home Health Ratings With Older Adult Fall Injuries: An Instrumental Variables Analysis. J Am Med Dir Assoc 2024; 25:105013. [PMID: 38729215 DOI: 10.1016/j.jamda.2024.03.123] [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: 02/09/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To understand the role of high-quality home health care for fall prevention. DESIGN A 100% sample of national Medicare claims and home health survey data (2015-2017) were used to assess fall injuries and receipt of a fall risk assessment among recently hospitalized Medicare fee-for-service home health users aged ≥66 years. Subanalyses examined patients by prior fall history status and hospital admission diagnosis type (eg, neurologic, respiratory, cardiovascular, infection, and orthopedic diagnoses). An instrumental variables design addressed potential endogeneity in home health care use by patient fall risk. SETTING AND PARTICIPANTS Home health agencies and Medicare fee-for-service beneficiaries. METHODS Multivariate regression and instrumental variables. RESULTS Among 962,610 patients with hospital discharges to home health, being treated by home health agencies with the highest star ratings in a person's zip code was associated with a 1.8-percentage point (ppt) (95% CI: 0.1, 3.5; P = .03) higher likelihood of receipt of fall risk assessment. There was no overall change in 30-day (-0.6 ppt, 95% CI: -1.3, 0.1; P = .09), 15-day (-0.3 ppt, 95% CI: -0.0.8, 0.2; P = .35), or 7-day fall injury risk (-0.2 ppt, 95% CI: -0.5, 0.1; P = .22), but a 1.9-ppt (95% CI: -3.9, -0.02; P = .048) lower 30-day fall injury risk for individuals with a history of falls. Effects were directionally similar by diagnosis type. CONCLUSIONS AND IMPLICATIONS Fall injury risk is reduced at higher-rated home health agencies. Star ratings may be adequate indicators of quality for key outcomes not explicitly measured in the ratings.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jun Li
- Public Administration and International Affairs Department, Maxwell School of Citizenship & Public Affairs, Syracuse University, Syracuse, NY, USA; Aging Studies Institute, Syracuse University, Syracuse, NY, USA
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Fors Connolly F, Olofsson J, Josefsson M. Do reductions of daily activities mediate the relationship between COVID-19 restrictions and mental ill-health among older persons in Europe? Aging Ment Health 2024; 28:1058-1065. [PMID: 38353508 DOI: 10.1080/13607863.2024.2313726] [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: 06/29/2023] [Accepted: 01/22/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Previous research has shown that daily activities are crucial for mental health among older people, and that such activities declined during the COVID-19 pandemic. While previous studies have confirmed a link between stringent restrictions and an increase in mental ill-health, the role of daily activities as a mediator in this relationship remains underexplored. We analyzed whether reductions in daily activities mediated the impact of these COVID-19 restrictions on mental ill-health during the pandemic's initial phase. METHODS We used data from Wave 8 SHARE Corona Survey covering 41,409 respondents from 25 European countries and Israel as well as data on COVID-19 restrictions from the Oxford Government Response Tracker (OxCGRT). Multilevel regression and multilevel-mediation analysis were used to examine the relationships between restrictions, daily activities and mental ill-health. RESULTS Reductions in walking and shopping showed a notably stronger association with increases in mental ill-health compared to social activities. Furthermore, declines in walking could account for about a quarter of the relationship between restrictions and increased mental ill-health, but the mediating effects of the other activates were negligible. CONCLUSIONS The study highlights the essential role of maintaining daily activities, particularly walking, to mitigate the negative psychological effects of pandemic-related restrictions among older populations in Europe.
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Affiliation(s)
| | - Jenny Olofsson
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Maria Josefsson
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
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Li D, Jiang H, Sun Y, Chi X, Zhang X, Li H. The relationship between comprehensive geriatric assessment on the pneumonia prognosis of older adults: a cross-sectional study. BMC Pulm Med 2024; 24:276. [PMID: 38858647 PMCID: PMC11165758 DOI: 10.1186/s12890-024-03089-4] [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: 03/03/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The mortality of pneumonia in older adults surpasses that of other populations, especially with the prevalence of coronavirus disease 2019 (COVID-19). Under the influence of multiple factors, a series of geriatric syndromes brought on by age is one of the main reasons for the poor prognosis of pneumonia. This study attempts to analyze the impact of geriatric syndrome on the prognosis of pneumonia. METHODS This is a prospective cross-sectional study. Patients over 65 years old with COVID-19 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative community-acquired pneumonia (SN-CAP) were included in the research. General characteristics, laboratory tests, length of stay (LOS), and comprehensive geriatric assessment (CGA) were collected. Multivariate regression analysis to determine the independent predictors of the severity, mortality, and LOS of COVID-19. At the same time, the enrolled subjects were divided into three categories by clustering analysis of 10 CGA indicators, and their clinical characteristics and prognoses were analyzed. RESULTS A total of 792 subjects were included in the study, including 204 subjects of SN-CAP (25.8%) and 588 subjects (74.2%) of COVID-19. There was no significant difference between non-severe COVID-19 and SN-CAP regarding mortality, LOS, and CGA (P > 0.05), while severe COVID-19 is significantly higher than both (P < 0.05). The Barthel Index used to assess the activities of daily living was an independent risk factor for the severity and mortality of COVID-19 and linearly correlated with the LOS (P < 0.05). The cluster analysis based on the CGA indicators divided the geriatric pneumonia patients into three groups: Cluster 1 (n = 276), named low ability group, with the worst CGA, laboratory tests, severity, mortality, and LOS; Cluster 3 (n = 228), called high ability group with the best above indicators; Cluster 2 (n = 288), named medium ability group, falls between the two. CONCLUSION The Barthel Index indicates that decreased activities of daily living are an independent risk factor for the severity, mortality, and LOS of geriatric COVID-19. Geriatric syndrome can help judge the prognosis of pneumonia in older adults.
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Affiliation(s)
- Dongmei Li
- Department of Geriatric Respiratory Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Weiqi Road, Huaiyin District, Jinan, Shandong Province, China
| | - Hongjuan Jiang
- Department of Geriatric Respiratory Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Weiqi Road, Huaiyin District, Jinan, Shandong Province, China
| | - Yanhong Sun
- Department of Geriatric Respiratory Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Weiqi Road, Huaiyin District, Jinan, Shandong Province, China
| | - Xiangyu Chi
- Department of Geriatric Respiratory Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Weiqi Road, Huaiyin District, Jinan, Shandong Province, China
| | - Xuan Zhang
- Department of Geriatric Respiratory Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Weiqi Road, Huaiyin District, Jinan, Shandong Province, China
| | - Hongwen Li
- Department of Geriatric Respiratory Disease, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Weiqi Road, Huaiyin District, Jinan, Shandong Province, China.
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Ekegren CL, Ayton D, Skouteris H, Soh SE. The Exercise Right for Active Ageing Study: Participation in Community-Based Exercise Classes by Older Australians During the COVID-19 Pandemic. J Aging Phys Act 2024; 32:301-311. [PMID: 38194960 DOI: 10.1123/japa.2023-0199] [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: 06/04/2023] [Revised: 08/21/2023] [Accepted: 09/30/2023] [Indexed: 01/11/2024]
Abstract
The aim of this study was to determine factors associated with participation of community-dwelling older Australians (≥65 years) in the Exercise Right for Active Ageing program, consisting of 12 low- to moderate-intensity group exercise classes, delivered weekly, in person or online, by accredited exercise scientists and physiologists across Australia. Out of 6,949 participants recruited, 6,626 (95%) attended one or more classes and were included in the primary analysis, and 49% of participants attended all 12 classes. Factors associated with higher class attendance included participation in yoga/flexibility/mobility classes, attendance at a free trial class (adjusted incidence rate ratio [95% confidence interval]: 1.05 [1.03, 1.08]), and attending online classes (1.19 [1.11, 1.26]). Factors associated with lower class attendance included state of residence, living in inner regional areas (0.95 [0.93, 0.98]), and having two or more comorbidities (0.97 [0.95, 0.99]). High class attendance suggests that the Exercise Right for Active Ageing program was well received by older Australians, particularly in states less impacted by COVID-19 lockdowns.
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Affiliation(s)
- Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
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Hou T. Depressive Symptoms, Sleep Quality, and Pain Are Associated With Frailty in Nursing Home Residents During the COVID-19 Pandemic. Pain Manag Nurs 2024; 25:241-248. [PMID: 38413256 DOI: 10.1016/j.pmn.2024.02.001] [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: 10/14/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The COVID-19 pandemic has caused severe effects on older adults. Depressive symptoms, poor sleep quality, and pain are common in older adults with frailty. However, it is unknown the relationship between these symptoms and frailty in nursing home residents and the difference of importance between pain intensity and pain impact on frailty during the COVID-19 Pandemic. Therefore, this study aims to explore the associations between depressive symptoms, poor sleep quality, pain intensity, and pain impact with frailty in older adults living in nursing homes. METHODS In this cross-sectional population-based study, 172 older adults living in nursing homes from Changsha in China were included. We collected data on depressive symptoms, sleep quality, pain, and frailty using the Patient Health Questionnaire, the Pittsburgh Sleep Quality, the Brief Pain Inventory-short form, and the FRAIL-NH Scale. Generalized linear regression models were used to explore the interaction association between these symptoms with frailty. RESULTS Most older adults were between 80 and 90 years old. Approximately 11.6% of older adults experienced one of the following symptoms: depressive symptoms, poor sleep quality, pain intensity, or pain impact. Moreover, 76.7% of older adults experienced at least two of these symptoms. The most common overlapping symptoms were depressive symptoms and poor sleep quality (14.5%). Among nursing home residents, the most common sites of pain were the lower limbs, followed by the back. There was a strong correlation between depressive symptoms, sleep quality, pain intensity, pain impact, and frailty. After adjusting for covariates, the interaction term between any two or three symptoms of depressive symptoms, poor sleep quality, pain intensity, and pain impact was found to be associated with a higher likelihood of frailty in older adults residing in nursing homes (p< .05). CONCLUSIONS Depressive symptoms, poor sleep quality, pain intensity, and pain impact are common among nursing home residents. Furthermore, these symptoms interacted with each other. In future studies, multidisciplinary interventions aimed at releasing these symptoms and reducing the adverse outcome of frailty are needed.
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Affiliation(s)
- Tianxue Hou
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Krauss MJ, Holden BM, Somerville E, Blenden G, Bollinger RM, Barker AR, McBride TD, Hollingsworth H, Yan Y, Stark SL. Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial: Effect on Adverse Health Events. Arch Phys Med Rehabil 2024:S0003-9993(24)01004-9. [PMID: 38772517 DOI: 10.1016/j.apmr.2024.05.015] [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: 11/03/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To compare adverse health events in intervention versus control group participants in the Community Participation Transition After Stroke trial to reduce barriers to independent living for community-dwelling stroke survivors. DESIGN Randomized controlled trial. SETTING Inpatient rehabilitation (IR) to home and community transition. PARTICIPANTS Stroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183). INTERVENTIONS Participants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education. MAIN OUTCOME MEASURES Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR. RESULTS Time-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.050) but was not statistically significant. Fall rates did not significantly differ between the intervention group (5.6 falls per 1000 participant-days; 95% CI, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361). CONCLUSIONS A home-based occupational therapist-led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.
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Affiliation(s)
- Melissa J Krauss
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Brianna M Holden
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Gabrielle Blenden
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Rebecca M Bollinger
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Abigail R Barker
- Center for Advancing Health Services, Economics, and Policy Research, Institute for Public Health at Washington University in St Louis, St Louis, MO
| | - Timothy D McBride
- Center for Advancing Health Services, Economics, and Policy Research, Institute for Public Health at Washington University in St Louis, St Louis, MO
| | - Holly Hollingsworth
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO
| | - Susan L Stark
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO.
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Weerasinghe A, Thielman J, Li Y, Doguparty VB, Medeiros A, Keller-Olaman S, Carsley S, Richmond SA. Trends in falls among older adults before and during the COVID-19 pandemic in Ontario, Canada: A retrospective observational study. BMC Geriatr 2024; 24:418. [PMID: 38730402 PMCID: PMC11088052 DOI: 10.1186/s12877-024-05032-y] [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: 01/08/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The public health measures associated with the COVID-19 pandemic may have indirectly impacted other health outcomes, such as falls among older adults. The purpose of this study was to examine trends in fall-related hospitalizations and emergency department visits among older adults before and during the COVID-19 pandemic in Ontario, Canada. METHODS We obtained fall-related hospitalizations (N = 301,945) and emergency department visit (N = 1,150,829) data from the Canadian Institute for Health Information databases from 2015 to 2022 for adults ages 65 and older in Ontario. Fall-related injuries were obtained using International Classification of Diseases, 10th edition, Canada codes. An interrupted time series analysis was used to model the change in weekly fall-related hospitalizations and emergency department visits before (January 6, 2015-March 16, 2020) and during (March 17, 2020-December 26, 2022) the pandemic. RESULTS After adjusting for seasonality and population changes, an 8% decrease in fall-related hospitalizations [Relative Rate (RR) = 0.92, 95% Confidence Interval (CI): 0.85, 1.00] and a 23% decrease in fall-related emergency department visits (RR = 0.77, 95%CI: 0.59, 1.00) were observed immediately following the onset of the pandemic, followed by increasing trends during the pandemic for both outcomes. CONCLUSIONS Following an abrupt decrease in hospitalizations and emergency department visits immediately following the onset of the pandemic, fall-related hospitalizations and emergency department visits have been increasing steadily and are approaching pre-pandemic levels. Further research exploring the factors contributing to these trends may inform future policies for public health emergencies that balance limiting the spread of disease among this population while supporting the physical, psychological, and social needs of this vulnerable group.
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Affiliation(s)
- Ashini Weerasinghe
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada.
| | - Justin Thielman
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Ye Li
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Canada
| | - Varsha B Doguparty
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Alexia Medeiros
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Sue Keller-Olaman
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
| | - Sarah Carsley
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah A Richmond
- Public Health Ontario, 661 University Ave, Suite 1701, Toronto, ON , M5G 1M1, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Canada
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11
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Gell NM, Dittus K, Caefer J, Martin A, Bae M, Patel KV. Remotely delivered exercise to older rural cancer survivors: a randomized controlled pilot trial. J Cancer Surviv 2024; 18:596-605. [PMID: 36374436 PMCID: PMC9662104 DOI: 10.1007/s11764-022-01292-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The study aimed to determine the feasibility of remotely delivered exercise (tele-exercise) for older, rural cancer survivors and to explore the effects of tele-exercise on physical function, physical activity, and patient-reported outcomes. METHODS Participants were rural cancer survivors age ≥ 60 years (79% female; mean age 70.4 ± 5.7) randomly assigned to the remotely delivered EnhanceFitness (tele-EF) exercise program, inclusive of aerobic, strength, and balance training and led by American Council on Exercise certified instructors for 1 h, 3 days/week for 16 weeks (n = 20) or to a waitlist control group (n = 19). We assessed feasibility, physical function, accelerometer-measured physical activity, and patient-reported outcomes at baseline and post intervention. RESULTS Among those screened as eligible, 44 (64%) consented to participate with 39 randomized after completing baseline measures. Attrition was equivalent between groups (n = 1, each) with 95% completing the study. The median class attendance rate was 86.9% (interquartile range: 79-94%). Compared to controls, tele-EF participants had statistically significant improvement in the five-time sit-to-stand test (- 3.4 vs. - 1.1 s, p = 0.03, effect size = 0.44), mean daily light physical activity (+ 38.5 vs 0.5 min, p = 0.03, effect size = 0.72) and step counts (+ 1977 vs. 33, p = 0.01, effect size = 0.96). There were no changes in self-efficacy for exercise, fatigue, or sleep disturbance between groups. CONCLUSIONS Findings indicate that tele-EF is feasible in older, rural cancer survivors and results in positive changes in physical function and physical activity. IMPLICATIONS FOR CANCER SURVIVORS Tele-EF addresses common barriers to exercise for older, rural cancer survivors, including limited accessible opportunities for professional instruction and supervision.
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Affiliation(s)
- Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, 306B Rowell 106 Carrigan Drive, Burlington, VT, 05405, USA.
- University of Vermont Cancer Center, Burlington, VT, USA.
| | - Kim Dittus
- University of Vermont Cancer Center, Burlington, VT, USA
- Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Jacqueline Caefer
- Department of Physical Therapy Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Anita Martin
- Department of Rehabilitation and Movement Science, University of Vermont, 306B Rowell 106 Carrigan Drive, Burlington, VT, 05405, USA
| | - Myeongjin Bae
- Department of Rehabilitation and Movement Science, University of Vermont, 306B Rowell 106 Carrigan Drive, Burlington, VT, 05405, USA
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, USA
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12
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Venema DM, Hester A, Clapper K, Kennel V, Quigley P, Reames C, Skinner A. Description and Implications of Falls in Patients Hospitalized Due to COVID-19. J Nurs Care Qual 2024; 39:121-128. [PMID: 37350615 DOI: 10.1097/ncq.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery. PURPOSE To describe and explore falls in patients hospitalized with COVID-19. METHODS We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test. RESULTS Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment. CONCLUSIONS Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.
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Affiliation(s)
- Dawn M Venema
- Author Affiliations: Departments of Health and Rehabilitation Sciences (Dr Venema) and Allied Health Professions Education, Research, and Practice (Dr Kennel and Ms Skinner), College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska; HD Nursing Patient Safety Organization, Benton, Arkansas (Dr Hester); Inpatient Rehab Services (Ms Clapper) and Nursing Professional Practice and Development (Ms Reames), Nebraska Medicine, Omaha, Nebraska; and Patricia A. Quigley Nurse Consultant, LLC, St Petersburg, Florida (Dr Quigley)
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13
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Murayama A, Higuchi D, Saida K, Tanaka S, Shinohara T. Fall Risk Prediction for Community-Dwelling Older Adults: Analysis of Assessment Scale and Evaluation Items without Actual Measurement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:224. [PMID: 38397713 PMCID: PMC10888445 DOI: 10.3390/ijerph21020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
The frequency of falls increases with age. In Japan, the population is aging rapidly, and fall prevention measures are an urgent issue. However, assessing fall risk during the coronavirus disease pandemic was complicated by the social distancing measures implemented to prevent the disease, while traditional assessments that involve actual measurements are complicated. This prospective cohort study predicted the risk of falls in community-dwelling older adults using an assessment method that does not require actual measurements. A survey was conducted among 434 community-dwelling older adults to obtain data regarding baseline attributes (age, sex, living with family, use of long-term care insurance, and multimorbidity), Frailty Screening Index (FSI) score, and Questionnaire for Medical Checkup of Old-Old (QMCOO) score. The participants were categorized into fall (n = 78) and non-fall (n = 356) groups. The binomial logistic regression analysis showed that it is better to focus on the QMCOO sub-item score, which focuses on multiple factors. The items significantly associated with falls were Q5 (odds ratio [OR] 1.95), Q8 (OR 2.33), and Q10 (OR 3.68). Our results were similar to common risk factors for falls in normal times. During the pandemic, being able to gauge the risk factors for falls without actually measuring them was important.
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Affiliation(s)
- Akihiko Murayama
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma University of Health and Welfare, Maebashi Plaza Genki 21 6-7F, 2-12-1 Hon-machi, Maebashi-shi 371-0023, Japan
| | - Daisuke Higuchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
| | - Kosuke Saida
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
| | - Shigeya Tanaka
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
| | - Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
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14
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Tekkus B, Mutluay F. Effect of community-based group exercises combined with action observation on physical and cognitive performance in older adults during the Covid-19 pandemic: A randomized controlled trial. PLoS One 2023; 18:e0295057. [PMID: 38051723 PMCID: PMC10697542 DOI: 10.1371/journal.pone.0295057] [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: 07/01/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE This study investigates the impact of community-based exercises with action observation therapy (AOT) on the physical and cognitive performance of older adults experiencing social isolation during the COVID-19 pandemic. METHODS One hundred participants aged 65-80 years were randomly divided into two groups: the AOT group, which engaged in balance, strengthening, and mobility exercises guided by 15-minute action observation videos before a 45-minute exercise session, and the control group, which performed the same exercises without action observation. Both groups underwent three sessions per week for eight weeks (24 sessions in total). The assessment tools used in this study included the following: For evaluating mobility and fall risk in older adults, the Timed Up-and-Go (TUG) Test was employed. To assess functional strength of lower extremities, balance, and fall risk, the Five Times Sit-to-Stand (5XSST) Test was administered. Balance and gait were measured using the Tinetti Balance and Gait Assessment (TBGA), utilizing the Tinetti Scale. Individuals' confidence in performing daily activities without falling or losing balance was assessed using the Activities-Specific Balance Confidence Scale (ABC). Furthermore, cognitive functions across multiple domains, including attention-concentration, executive function, memory, language, visual construction skills, abstract thinking, calculation, and orientation, were evaluated using the Montreal Cognitive Assessment (MoCA) Tests. RESULTS Results revealed significant improvements in both groups. Group I, which received Action Observation Therapy (AOT) in addition to exercise, demonstrated superior outcomes in the 5XSit-to-Stand test (Δ = -1.92, p < 0.0001, Cohen's d = 0.77), Tinetti Balance and Gait Scale (Balance: Δ = 2.77, p < 0.0001, Cohen's d = 0.91), and Timed Up and Go test (Δ = -1.98, p < 0.0005, Cohen's d = 0.83). On the other hand, Group II, which received exercise only, exhibited substantial gains in the Tinetti Balance and Gait Scale (Walking: Δ = 0.52, p < 0.01, Cohen's d = 0.27) and Activity-Specific Balance Confidence Scale (Δ = 5.77, p < 0.0001, Cohen's d = 0.26). CONCLUSION These findings underscore the effectiveness of AOT-enhanced community-based exercises in enhancing both physical and cognitive performance among older adults facing social isolation during the pandemic, with Group I (AOT + exercise) showing particularly promising results. TRIAL REGISTRATION This study was registered with ClinicalTrials.gov Identifier: NCT04759690, ClinicalTrials Protocol ID: p3957ghb.
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Affiliation(s)
- Bagdat Tekkus
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Fatma Mutluay
- Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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15
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Arslan T, Saraç ZF, Ersel M, Savas S. Evaluation of falls in older persons in the emergency department during the early Coronavirus-2019 pandemic and pre-pandemic periods. Eur Geriatr Med 2023; 14:1373-1381. [PMID: 37935942 DOI: 10.1007/s41999-023-00882-y] [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: 05/06/2023] [Accepted: 10/05/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE This study aimed to investigate the clinical characteristics, outcomes and healthcare costs of older patients presented to the emergency department (ED) with falls in the periods before and during the Coronavirus disease-2019 (COVID-19) pandemic. METHODS Hospital records one year before and after the onset of the COVID-19 pandemic were retrospectively analyzed through "International Statistical Classification of Diseases-10th Revision" codes. Age, gender, falls, triage classification, length of stay (LOS) in the hospital and the ED, COVID-19 status, Glasgow Coma scale, consultations-comorbidities, injury status, outcomes in the ED, and costs were recorded. RESULTS The study comprised of 3187 patients aged ≥ 65 years admitted to the ED of a university hospital between March 2019 and 2021. In terms of pre-pandemic and pandemic periods; older patients presenting with falls to the ED, consultations, Charlson Comorbidity Index, and LOS in the ED were lower in the pandemic period, but costs were higher (p = 0.03, p = 0.01, p = 0.01, p = 0.01 and p = 0.02, respectively). Hospitalization/mortality rates were higher in COVID-19 positive patients (77.2%) than in COVID-19 negative patients (4.6%) within the pandemic period and the patients in the pre-pandemic period (22.8%), and the costs, as well (both p = 0.01). CONCLUSION Though the number of fall-related presentations of older persons to the ED, comorbidity burden, consultations, and the LOS in the ED was lower, direct costs were higher during the pandemic period, particularly for COVID-19 positive older patients admitted to ED with falls than the pre-pandemic period, and those patients were with poorer outcomes.
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Affiliation(s)
- Tuğba Arslan
- Faculty of Health Sciences, Çankırı Karatekin University, Çankırı, Turkey
| | - Zeliha Fulden Saraç
- Geriatrics Section, Department of Internal Medicine, Medical Faculty, Ege University, Izmir, Turkey
| | - Murat Ersel
- Department of Emergency Medicine, Medical Faculty, Ege University, Izmir, Turkey
| | - Sumru Savas
- Geriatrics Section, Department of Internal Medicine, Medical Faculty, Ege University, Izmir, Turkey.
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16
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Morse JL, Fischer IC, Na PJ, Afari N, Pietrzak RH. Functional decline during the COVID-19 pandemic among U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Int J Geriatr Psychiatry 2023; 38:e6040. [PMID: 38072628 DOI: 10.1002/gps.6040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES The coronavirus disease-2019 pandemic has contributed to widespread social and economic stressors, along with substantial health problems, including loss of life. To date, however, relatively few studies have examined the prevalence and correlates of declines in mental and physical functioning in U.S. military veterans, an older and potentially vulnerable segment of the U.S. adult population. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 3078 veterans. Veterans were surveyed prior to the pandemic (pre-pandemic) and 1 year later during the height of the pandemic (peri-pandemic). Multivariable analyses were conducted to identify risk and protective variables associated with pre-to-peri pandemic declines in self-reported physical and mental functioning. RESULTS The prevalence of veterans who experienced functional decline (≥0.5 standard deviation reductions) pre-to-peri-pandemic was 18.1% (N = 541) for physical functioning and 18.3% (N = 547) for mental functioning. Older age, greater adverse childhood experiences (ACEs), and pandemic-related posttraumatic stress symptoms were the strongest correlates of physical functional decline, while greater ACEs, loneliness, pandemic-related posttraumatic and social restriction stress symptoms, and lower protective psychosocial characteristics were the strongest correlates of mental functional decline. CONCLUSIONS Although the majority of U.S. Veterans showed functional maintenance or improvement 1 year into the pandemic, nearly one-in-five experienced a decline in physical or mental functioning. Results could help inform identification of veterans who may be at risk for functional decline during large-magnitude stressors, such as national or global pandemics.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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17
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Kennedy M, Liu SW. Geriatric Emergency Medicine: The Need Has Never Been Greater. Clin Geriatr Med 2023; 39:xv-xvii. [PMID: 37798074 DOI: 10.1016/j.cger.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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18
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Lim ML, van Schooten KS, Radford KA, Hadjistavropoulos T, Everett B, Zijlstra R, Delbaere K. Theoretical framework of concerns about falling in older people: the role of health literacy. Health Promot Int 2023; 38:daad122. [PMID: 37804516 DOI: 10.1093/heapro/daad122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023] Open
Abstract
Adherence and participation can be improved in health programs for older people with concerns about falling. While health literacy empowers older people to have greater control over their health, little is known about the extent to which health literacy influences health behaviours associated with concerns about falling in older people. This study aimed to synthesise current findings on health literacy, concerns about falling and falls to propose a multicomponent theoretical model on health literacy and concerns about falling. The model was developed based on a review of the literature, existing frameworks and models on health literacy and concerns about falling. Existing evidence on the relationship between health literacy and concerns about falling in older people is limited. Evidence from other research areas, however, shows that health literacy is closely related to many of the determinants of concerns about falling. More research is needed to clarify the impact of health literacy on intervention adherence and decision-making processes of older people with concerns about falling. Our model offers a novel perspective on the role of health literacy in health behaviours associated with concerns about falling, suggesting new research directions and providing insights for clinicians to consider health literacy when managing older patients with concerns about falling.
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Affiliation(s)
- Mei Ling Lim
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Kylie A Radford
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | | | - Bronwyn Everett
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Rixt Zijlstra
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Public Health Service Flevoland (GGD Flevoland), Department of Health Policy and Research, Lelystad, The Netherlands
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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19
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Wilkins JM, Locascio JJ, Gomez-Isla T, Hyman BT, Blacker D, Forester BP, Okereke OI. Potential impact of the COVID-19 pandemic on everyday preferences for persons with cognitive impairment. Int Psychogeriatr 2023:1-6. [PMID: 37622323 PMCID: PMC10894308 DOI: 10.1017/s1041610223000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The COVID-19 pandemic and subsequent social distancing guidelines and restrictions brought on changes in the everyday experiences of older adults. It is not clear, however, to what extent the pandemic has impacted the importance of everyday preferences for persons with cognitive impairment (CI) or the proxy ratings of those preferences. The sample of this study included 27 dyads of persons with CI and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI; care partners completed concurrent proxy assessments. Mixed random and fixed effects longitudinal models were used to evaluate changes in ratings and concordance levels between persons with CI and care partners prior to and during the COVID-19 pandemic. Persons with CI rated autonomous choice preferences as significantly more important during the COVID-19 pandemic than before; there was no association between the COVID-19 pandemic and change in other everyday preferences domains or discrepancy in proxy assessments of everyday preferences. Identifying avenues to support and provide for autonomy in the decision-making of older adults with CI may offer a way forward in mitigating the psychological and behavioral impacts of the COVID-19 pandemic in this population.
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Affiliation(s)
- James M. Wilkins
- McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA
| | - Joseph J. Locascio
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
- Harvard Catalyst Biostatistical Consulting, Harvard Catalyst/CTSA; Harvard Medical School, Boston, MA
| | - Teresa Gomez-Isla
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Bradley T. Hyman
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Deborah Blacker
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Olivia I. Okereke
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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20
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Heinz T, Wild M, Eidmann A, Weißenberger M, Rak D, Nedopil AJ, Rudert M, Stratos I. Impact of COVID-19 on Fracture Incidence in Germany: A Comparative Age and Gender Analysis of Pre- and Post-Outbreak Periods. Healthcare (Basel) 2023; 11:2139. [PMID: 37570379 PMCID: PMC10418784 DOI: 10.3390/healthcare11152139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
In March 2020, Germany imposed a nationwide lockdown to curb the spread of COVID-19, prompting questions about the impact on the incidence of common fractures. This study examined 15 fracture types in pre-outbreak (2010-2019) and post-outbreak (2020-2021) periods, using data categorized by age (18-64 years, >65 years) and sex (male, female). Linear regression assessed annual growth rates, and mean fracture numbers were compared across periods for significant differences. Results indicated a positive correlation between fracture incidence rates and time for various types, such as cervical, thoracic, lumbar, and pelvic spine fractures, rib fractures, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures. Frequencies of proximal humerus, distal radius, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures in 2020 and 2021 were within predicted ranges from previous years. However, rib fractures and spinal fractures (cervical, thoracic, lumbar, and pelvic spine) occurred less frequently during this time. Notably, this study found a consistent decline in most fracture types for individuals aged 18-64 after the pandemic's onset, while the fracture incidence of hip fractures, often referred to as fragility fractures, for those over 65 remained unchanged. Fibula fractures showed the most considerable decrease in both age groups. In conclusion, the COVID-19 pandemic substantially impacted fracture incidence, with lower rates among individuals under 65 and unchanged fragility fractures in the elderly population.
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Affiliation(s)
- Tizian Heinz
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Moritz Wild
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Annette Eidmann
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Manuel Weißenberger
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Dominik Rak
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Alexander Johannes Nedopil
- Department of Orthopedic Surgery, Orthopedic Surgeon Adventist Health Lodi Memorial, Lodi, CA 95240, USA;
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany (M.W.); (A.E.); (D.R.)
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21
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Sahin UK, Durdu H, Korkmaz N. The role of frailty on quality of life in older adults during the COVID-19 pandemic. Aging Clin Exp Res 2023:10.1007/s40520-023-02469-w. [PMID: 37335461 DOI: 10.1007/s40520-023-02469-w] [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: 01/20/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
AIM The impact of frailty, a physiological state characterized by reduced reserve for stressors and related to worse outcomes, on older adults during the pandemic is unclear. Our aim was to identify the effects of frailty among older adults during the COVID-19 pandemic. METHODS A total of 197 older adults who were not exposed to COVID-19 were assessed with an online survey one year after the pandemic began in Turkey. Frailty, quality of life, and fear of COVID-19 were assessed with the Tilburg Frailty Indicator, the Nottingham Health Profile, and the Fear of COVID-19 Scale, respectively. Since March 2020, changes in pain severity and localization, fatigue, and fear of falling were assessed. Multiple linear regression analyses were conducted. RESULTS In this study, 62.5% of the participants were frail. The prevalence of pain was significantly increased during the COVID-19 pandemic, but only among the frail. The increases in pain severity, fear of falling, and fatigue were significantly higher for the frail than the non-frail. The model including physical and psychological components of frailty and pain severity explained 49% of the variation in quality of life (R = 0.696; R2 = 0.485; p < 0.001). The physical component of frailty had the highest impact on quality of life (B = 20.591; β = 0.334). CONCLUSION This study focused on negative outcomes that were experienced more by frail older adults compared to non-frail older adults when they were locked down at home for an extended period of time during the COVID-19 pandemic. It is necessary to quickly improve and maintain the health of these affected individuals.
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Affiliation(s)
- Ulku Kezban Sahin
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Giresun University, Giresun, Turkey.
| | - Habibe Durdu
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Giresun University, Giresun, Turkey
| | - Nurhayat Korkmaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
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22
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Thomas S, Machuel P, Foubert J, Nafilyan V, Bannister N, Colvin H, Routen A, Morriss R, Khunti K, Farooqi A, Armstrong N, Gray L, Gordon A. Study protocol for the use of time series forecasting and risk analyses to investigate the effect of the COVID-19 pandemic on hospital admissions associated with new-onset disability and frailty in a national, linked electronic health data setting. BMJ Open 2023; 13:e067786. [PMID: 37208137 DOI: 10.1136/bmjopen-2022-067786] [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] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Older people were at particular risk of morbidity and mortality during COVID-19. Consequently, they experienced formal (externally imposed) and informal (self-imposed) periods of social isolation and quarantine. This is hypothesised to have led to physical deconditioning, new-onset disability and frailty. Disability and frailty are not routinely collated at population level but are associated with increased risk of falls and fractures, which result in hospital admissions. First, we will examine incidence of falls and fractures during COVID-19 (January 2020-March 2022), focusing on differences between incidence over time against expected rates based on historical data, to determine whether there is evidence of new-onset disability and frailty. Second, we will examine whether those with reported SARS-CoV-2 were at higher risk of falls and fractures. METHODS AND ANALYSIS This study uses the Office for National Statistics (ONS) Public Health Data Asset, a linked population-level dataset combining administrative health records with sociodemographic data of the 2011 Census and National Immunisation Management System COVID-19 vaccination data for England. Administrative hospital records will be extracted based on specific fracture-centric International Classification of Diseases-10 codes in years preceding COVID-19 (2011-2020). Historical episode frequency will be used to predict expected admissions during pandemic years using time series modelling, if COVID-19 had not occurred. Those predicted admission figures will be compared with actual admissions to assess changes in hospital admissions due to public health measures comprising the pandemic response. Hospital admissions in prepandemic years will be stratified by age and geographical characteristics and averaged, then compared with pandemic year admissions to assess more granular changes. Risk modelling will assess risk of experiencing a fall, fracture or frail fall and fracture, if they have reported a positive case of COVID-19. The combination of these techniques will provide insight into changes in hospital admissions from the COVID-19 pandemic. ETHICS AND DISSEMINATION This study has approval from the National Statistician's Data Ethics Advisory Committee (NSDEC(20)12). Results will be made available to other researchers via academic publication and shared via the ONS website.
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Affiliation(s)
| | | | | | - Vahe Nafilyan
- Office for National Statistics, Newport, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK
| | - Richard Morriss
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK
- Psychiatry, University of Nottingham, Nottingham, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK
| | - Azhar Farooqi
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Laura Gray
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Adam Gordon
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Leicester, UK
- Academic Unit of Injury, Rehabilitation and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
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23
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Choi Y, Lee DH. The Pattern of Injuries in the Emergency Room during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11101483. [PMID: 37239769 DOI: 10.3390/healthcare11101483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has obviously caused a remarkable change in patients' emergency department (ED) visits; however, data from multicenter studies are lacking. We aimed to present a comprehensive analysis of injury-related ED visits in Republic of Korea before and during the COVID-19 pandemic. MATERIALS AND METHODS Data from 23 tertiary hospitals based on Emergency Department-based Injury In-depth Surveillance were used for this retrospective cross-sectional study. A total of 541,515 ED visits (age ≥ 20 years) between 1 January 2018 and 31 December 2020 were included, and the trend of injuries related to motor vehicular accidents, falls, self-harm and suicide, assault, and poisoning were compared between the pre-COVID-19 time period and during the COVID-19 pandemic. RESULTS In the first year of the COVID-19 period, a decline in the number of ED visits was observed (41,275, 21%) compared to the previous year. Injuries caused by motor vehicles (36,332 in 2019 vs. 27,144 in 2020), falls and slips (61,286 in 2019 vs. 49,156 in 2020), assaults (10,528 in 2019 vs. 8067 in 2020), and poisonings (7859 in 2019 vs. 7167 in 2020) decreased, whereas self-harm and suicide (8917 in 2019 vs. 8911 in 2020) remained unchanged. The hospitalization (16.6% in 2019 vs. 18.8% in 2020) and ED mortality rate (0.6% in 2019 vs. 0.8% in 2020) also increased. CONCLUSION The COVID-19 pandemic led to a decline in the overall number of trauma patients seeking medical care; however, the proportion of patients requiring hospitalization or intensive care unit admission increased, indicating more severe injuries among those who did seek care. Suicide attempt rates remained unchanged, highlighting the need for targeted care and support for vulnerable patients. During the pandemic, EDs had to continue to provide care to patients with medical emergencies unrelated to COVID-19, which requires a delicate and adaptable approach to ED operations. To manage the increased stress and workload caused by the pandemic, increased resources and support for healthcare workers were needed.
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Affiliation(s)
- Yunhyung Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
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24
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Olofsson J, Fors Connolly F, Malmberg G, Josefsson M, Stattin M. Sociodemographic Factors and Adjustment of Daily Activities During the COVID-19 Pandemic - Findings from the SHARE Corona Survey. J Aging Soc Policy 2023:1-23. [PMID: 37125862 DOI: 10.1080/08959420.2023.2206077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In the wake of the COVID-19 pandemic in 2020, older people across Europe have adjusted their daily activities as personal risk avoidance and as an amendment to policy recommendations and restrictions. In this study, we use multilevel logistic regressions to examine to what extent sociodemographic factors are associated with activity reduction among the older population (50+) in Europe and whether these associations are moderated by governmental policy responses to COVID-19. By combining data for~35,000 respondents from the SHARE Corona Survey on reported changes in daily activities and stringency of restrictions at the national level, we find that older age, poorer health and being female versus male were (consistently) associated with greater activity reduction across all activities both in countries with weak and in those with strong restrictions. Associations between education, employment and living situation, on the one hand, and activity reduction, on the other, were weaker and less consistent. We conclude that differences between sociodemographic groups are rather similar for countries with weak and those with strong restrictions and hence argue that group-specific policy recommendation are relevant independent of stringency recommendations.
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Affiliation(s)
- Jenny Olofsson
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | | | - Gunnar Malmberg
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
- Department of Geography, Umeå University, Umeå, Sweden
| | - Maria Josefsson
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
- Department of Statistics, USBE, Umeå University, Umeå, Sweden
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25
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Leung KK, Carr FM, Kennedy M, Russell MJ, Sari Z, Triscott JA, Korownyk C. Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e069543. [PMID: 37085313 PMCID: PMC10124284 DOI: 10.1136/bmjopen-2022-069543] [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] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Falls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The COVID-19 pandemic has significantly increased the uptake of telehealth, but the effectiveness of virtual, home-based fall prevention programmes is not clearly known. We aim to synthesise the trials on telerehabilitation and home-based falls prevention programmes to determine their effectiveness in reducing falls and adverse outcomes, as well as to describe the safety risks associated with telerehabilitation. METHODS AND ANALYSIS This protocol was developed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Database searches from inception to August 2022 will be conducted without language restrictions of MEDLINE, EMBASE, Ovid HealthSTAR, CINAHL, SPORTDiscus, Physiotherapy EvidenceDatabase (PEDro) and the Cochrane Library. Grey literature including major geriatrics conference proceedings will be reviewed. Using Covidence software, two independent reviewers will in duplicate determine the eligibility of randomised controlled trials (RCTs). Eligible RCTs will compare telerehabilitation and home-based fall prevention programmes to usual care among community-dwelling older adults and will report at least one efficacy outcome: falls, fractures, hospitalisations, mortality or quality of life; or at least one safety outcome: pain, myalgias, dyspnoea, syncope or fatigue. Secondary outcomes include functional performance in activities of daily living, balance and endurance. Risk of bias will be assessed using the Cochrane Collaboration tool. DerSimonian-Laird random effects models will be used for the meta-analysis. Heterogeneity will be assessed using the I2 statistic and Cochran's Q statistic. We will assess publication bias using the Egger's test. Prespecified subgroup analyses and univariate meta-regression will be used. ETHICS AND DISSEMINATION Ethics approval is not required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022356759.
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Affiliation(s)
- Karen K Leung
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Frances M Carr
- Department of Internal Medicine (Geriatrics), University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Megan Kennedy
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | | | - Zainab Sari
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Jean Ac Triscott
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Pitluk Barash M, Shuper Engelhard E, Elboim-Gabyzon M. Feasibility and Effectiveness of a Novel Intervention Integrating Physical Therapy Exercise and Dance Movement Therapy on Fall Risk in Community-Dwelling Older Women: A Randomized Pilot Study. Healthcare (Basel) 2023; 11:healthcare11081104. [PMID: 37107938 PMCID: PMC10137670 DOI: 10.3390/healthcare11081104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/15/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
This pilot study presents a novel fall prevention intervention that integrates physical therapy exercise (PTE) and dance movement therapy (DMT) to address both physical and emotional fall risk factors, as well as factors influencing adherence to treatment. The aim of this study was to examine the feasibility and effectiveness of the intervention in a sample of eight older women (median = 86 [81.25-90.75] years) from a day center for senior citizens. The intervention, based on the Otago Exercise Program and DMT techniques, aimed to address the emotional experience during physical exercise. Participants were randomly assigned to either a PTE+DMT intervention group (n = 5) or a PTE control group (n = 3). A pre-post intervention battery of physical and emotional fall risk assessments, therapist-patient bond, and home exercise adherence was conducted. Non-parametric tests results showed significant improvement in the PTE+DMT group in measures of balance and fear of falling compared to the PTE group. However, no other significant differences were found between the groups in terms of falls-related psychological concerns, self-perceived health status, therapist-patient bond, and home exercise adherence. These findings demonstrate the feasibility and potential benefits of an intervention that integrates both physical and emotional aspects to reduce fall risk in older adults, and provide a basis for further studies and modifications in the research protocol.
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Affiliation(s)
- Michal Pitluk Barash
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Einat Shuper Engelhard
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
- The Graduate School of Creative Art Therapies, Faculty of Humanities & Social Sciences, Kibbutzim College of Education, Tel Aviv 6250769, Israel
| | - Michal Elboim-Gabyzon
- Physical Therapy Department, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
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27
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Katewongsa P, Widyastari DA, Haemathulin N, Khanawapee A, Penmai S. Recovery shape of physical activity after COVID-19 pandemic. JOURNAL OF SPORT AND HEALTH SCIENCE 2023:S2095-2546(23)00020-0. [PMID: 36868376 PMCID: PMC9977470 DOI: 10.1016/j.jshs.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/30/2022] [Accepted: 01/20/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Since the shutdowns associated with the coronavirus disease 2019 pandemic, there has been limited discourse on physical activity (PA) recovery (i.e., the ability of individuals to resume PA at pre-pandemic levels), including recovery rate, speed of recovery, which individuals are able to return quickly, who is left behind, and what are the causes of those differences. This study aimed to estimate the level and shape of PA recovery rate in Thailand. METHODS This study employed 2 rounds (2020 and 2021) of Thailand's Surveillance on Physical Activity dataset for the analysis. Each round included over 6600 samples from individuals aged 18 years or older. PA was assessed subjectively. Recovery rate was calculated from the relative difference in the cumulative minutes of MVPA from 2 different periods. RESULTS The Thai population experienced a medium level of recession of PA (-26.1%) and a moderate level of recovery of PA (37.44%). PA recovery in the Thai population resembled an imperfect V shape, reflecting a sharp decline followed by an immediate upturn; still, recovered PA remained lower than pre-pandemic levels. The quickest recovery was found among older adults, whereas students, young adults, residents of Bangkok, the unemployed, and those who had a negative attitude toward PA experienced the highest recession of PA and were among the slowest to recover. CONCLUSION The level of recovery of PA among Thai adults is largely determined by the preventive behaviors demonstrated by groups within the population who have a higher awareness of their health. The effect of the mandatory coronavirus disease 2019 containment measures on PA was temporary. However, the slower recovery rate of PA among some individuals was caused by a combination of restrictive measures and socioeconomic inequality, which required more time and effort to overcome.
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Affiliation(s)
- Piyawat Katewongsa
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Dyah Anantalia Widyastari
- Institute for Population and Social Research, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand.
| | - Narumol Haemathulin
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Aunyarat Khanawapee
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Surasak Penmai
- Thailand Physical Activity Knowledge Development Centre (TPAK), Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand
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Sari YM, Burton E, Lee DCA, Hill KD. A Telehealth Home-Based Exercise Program for Community-Dwelling Older People with Dementia in Indonesia: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3397. [PMID: 36834093 PMCID: PMC9966659 DOI: 10.3390/ijerph20043397] [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: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: This study aimed to evaluate the feasibility of a telehealth home-based exercise program for older people with dementia living in Indonesia with support from their informal carers. (2) Methods: Pre-post intervention single group study with three assessment time-points (baseline, 12 and 18 weeks). Participants with dementia underwent a 12-week physiotherapist-delivered telehealth exercise program, with informal carer supervision between supervised online sessions, and continued the exercises for a further six weeks without physiotherapist online supervision. (3) Results: Thirty dyads of older people with dementia and their informal carers were recruited; four (13.3%) withdrew across the 12-week intervention and one (3.3%) in the 6-week self-maintenance period. Median adherence was 84.1% (IQR [25, 75] = 17.1) during the 12-week intervention, and 66.7% (IQR [25, 75] = 16.7) in the self-maintenance period. No falls/adverse events were reported. Physical activity level, some aspects of function and disability, health-related benefits of exercise, exercise enjoyment and quality of life of older people with dementia improved significantly at 12 and 18 weeks. (4) Conclusions: The telehealth exercise program is feasible and safe and may have benefits for the health outcomes of community-living older people with dementia in Indonesia. Additional strategies are necessary to enhance longer-term adherence to the program.
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Affiliation(s)
- Yulisna Mutia Sari
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth 6102, Australia
- enAble Institute, Curtin University, Perth 6845, Australia
| | - Den-Ching A. Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne 3199, Australia
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne 3199, Australia
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Xie H, Chen E, Zhang Y. Association of walking pace and fall-related injury among Chinese older adults: Data from the SAGE survey. Complement Ther Clin Pract 2023; 50:101710. [PMID: 36455493 DOI: 10.1016/j.ctcp.2022.101710] [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: 09/23/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Falls are an important public health issue that poses a threat to the health of senior people and reduces their ability to maintain independence, which in turn reduces poor quality of life. Several studies have demonstrated a positive relationship between physical function and fall, it remains unclear whether there is an association between gait speed and fall-related injuries among the aging population, which represent the largest proportion of older adults in China. Therefore, the aim of this study was to examine the association between gait speed and fall-related injuries among older Chinese adults. METHODS Data from the Global Ageing and Adult Health Survey (2007-2010) were analyzed. A stratified multi-stage cluster sampling design was used to collect the survey data. A total of 7558 Chinese adults aged 60 or older were included in this study. A 4-m walking test was used to assess gait speed. Fall-related injuries were self-reported by study participants. The binary logistic regression model was employed to examine the association between gait speed and fall-related injuries while controlling for age, sex, education years, smoking, alcohol consumption, and chronic diseases. RESULTS The mean age of the sample of older Chinese adults was 69.70 ± 7.10 years (females accounted for 52.6%). The results showed that a normal gait speed was negatively correlated with fall-related injury (odds ratio = 1.20) when adjusting for all covariates. Moreover, a binary regression analysis showed that a normal gait speed was only negatively correlated with fall-related injury in male participants (odds ratio = 1.32). There were no significant results in rapid gait speed and fall-related injuries. CONCLUSION The results suggest that a slow gait speed may predict a higher risk of fall-related injuries among older Chinese adults, especially older male adults. Further studies are needed to verify our findings.
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Affiliation(s)
| | - Erle Chen
- Shenzhen College of International Education, China.
| | - Yanjie Zhang
- Physical Education Unit, School of Humanities and Social Science, The Chinese University of Hong Kong-Shenzhen, Shenzhen, China.
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Factors Influencing Mobility During the COVID-19 Pandemic in Community-Dwelling Older Adults. Arch Phys Med Rehabil 2023; 104:34-42. [PMID: 36055379 PMCID: PMC9424116 DOI: 10.1016/j.apmr.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe and identify factors influencing mobility among older adults during the first 5 months of the COVID-19 pandemic. DESIGN A cross-sectional telesurvey. SETTING Community dwelling older adults, situated within the first 5 months of the COVID-19 pandemic, in Hamilton, Canada. PARTICIPANTS A random sample of 2343 older adults were approached to be in the study, of which 247 completed the survey (N=247). Eligible participants were aged ≥65 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mobility was measured using global rating of change items and the Late Life Function Instrument (LLFI). Multivariate linear regression models were used to examine the association between mobility and related factors based on Webber's model. RESULTS 247 older adults (29% male, mean age 78±7.3 years) completed surveys between May and August 2020. Respectively, 26%, 10%, and 9%, rated their ability to engage in physical activity, housework, and move around their home as worse compared with the start of the pandemic. The mean LLFI score was 60.9±13.4. In the model, walking volume (β=0.03 95% confidence interval 0.013, 0.047), fall history (β=-0.04, 95% confidence interval -0.08, -0.04), male sex (β=0.06, 95% confidence interval 0.02, 0.09), unpleasant neighborhood (β=-0.06, 95% confidence interval -0.11, -0.02), musculoskeletal pain (β=-0.07, 95% confidence interval -0.11, -0.03), and self-reported health (β=0.08, 95% confidence interval 0.03, 0.13) had the strongest associations with LLFI scores and explained 64% of the variance in the LLFI score. CONCLUSIONS Physical and environmental factors may help explain poorer mobility during lockdowns. Future research should examine these associations longitudinally to see if factors remain consistent over time and could be targeted for rehabilitation.
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Kari T, Makkonen M, Carlsson C. Physical Activity Tracker Application in Promoting Physical Activity Behavior among Older Adults: A 24-month Follow-Up Study. J Aging Health 2022:8982643221135812. [DOI: 10.1177/08982643221135812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives To investigate whether and how PA tracker application use supports PA behavior among older adults during the first 24 months of use. Methods: The changes in PA levels (i.e., time spent in different PA intensities) and between PA categories (i.e., low, moderate, or high based on total PA) were examined between three different time points: before taking the application into use (t0), after 12 months of use (t1), and after 24 months of use (t2). The data was collected by using the International Physical Activity Questionnaire modified for the elderly (IPAQ-E). Results: A statistically significant increase was observed in walking (χ2 (2) = 29.741, p < .001), moderate PA (χ2 (2) = 6.327, p = .042), and total PA levels (χ2 (2) = 11.489, p = .003). The increase was observed between t0 and t1 as well as between t0 and t2. The overall changes between PA categories were statistically significant between t0 and t1 (χ2 (3) = 15.789, p = .001) as well as between t0 and t2 (χ2 (3) = 14.745, p = .002). There were more increasingly active (moved to a higher PA category) than decreasingly active (moved to a lower PA category) participants. Discussion: Overall, the results indicate that PA tracker application use can promote PA behavior among older adults. Stakeholders that work with PA programs and PA promotion, as well as individual users, can utilize digital wellness technologies in supporting PA promotion, especially in exceptional times, like the COVID-19 pandemic, when health care restrictions prevent general gatherings.
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Affiliation(s)
- Tuomas Kari
- Institute for Advanced Management Systems Research, Turku, Finland
- Natural Resources Institute Finland (Luke), Helsinki, Finland
| | - Markus Makkonen
- Institute for Advanced Management Systems Research, Turku, Finland
- University of Jyvaskyla, Faculty of Information Technology, Jyvaskyla, Finland
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Arkkukangas M, Strömqvist Bååthe K, Ekholm A, Tonkonogi M. Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15140. [PMID: 36429859 PMCID: PMC9690656 DOI: 10.3390/ijerph192215140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20-6.71), the self-rated health score (2.80, 1.42-5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04-4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6-9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults' physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.
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Affiliation(s)
- Marina Arkkukangas
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
- School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, 721 23 Vasteras, Sweden
- Research and Development in Sörmland, Region Sörmland, 632 17 Eskilstuna, Sweden
| | - Karin Strömqvist Bååthe
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
| | - Anna Ekholm
- Research and Development in Sörmland, Region Sörmland, 632 17 Eskilstuna, Sweden
| | - Michail Tonkonogi
- School of Health and Welfare, Department of Medicine and Sport Sciences, Dalarna University, 791 88 Falun, Sweden
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Nguyen HT, Nguyen CC, Le Hoang T. Falls Among Older Adults During the COVID-19 Pandemic: A Multicenter Cross-Sectional Study in Vietnam. Clin Interv Aging 2022; 17:1393-1404. [PMID: 36172531 PMCID: PMC9511889 DOI: 10.2147/cia.s382649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/14/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose We aimed to investigate the prevalence and factors associated with falls in older adult outpatients during the coronavirus disease (COVID-19) pandemic in Vietnam. Patients and Methods From February 2022 to June 2022, this cross-sectional study included 814 patients (aged ≥60 years; mean age 71.8 ± 7.3 years; women, 65.2%) attending three geriatric clinics for a comprehensive geriatric assessment. Self-reported fall events in the past 12 months and post-COVID-19 falls were assessed. Factors associated with falls were determined using logistic regression analysis. Results In total, 188 patients (23.1%) had falls (single fall, 75.5%; recurrent falls, 24.5%). The most frequent location, time, and circumstance of falls were the bedroom (43.1%), morning (54.3%), and dizziness (34.6%), respectively. Most patients experienced health issues after falls (bruise/grazes, 53.7%; fracture, 12.8%; immobility, 9.6%; hospital admission, 14.9%). In the adjusted model, factors associated with falls were being underweight (odds ratio [OR] 2.50, 95% confidence interval [CI] 1.37–4.56, P = 0.003), limitations in instrumental activities of daily living (OR 2.03, 95% CI 1.05–3.95, P = 0.036), poor sleep quality (OR 1.83, 95% CI 1.10–3.05, P = 0.020), and fear of falling (OR 3.45, 95% CI 2.23–5.33, P <0.001). Among 357 COVID-19 infected patients, post-COVID-19 falls occurred in 35 patients (9.8%) and were associated with fear of falling (OR 3.14, 95% CI 1.18–8.40, P = 0.023) and post-COVID-19 lower limb weakness (OR 2.55, 95% CI 1.07–6.10, P = 0.035). Conclusion Our study found a substantial prevalence of falls among older outpatients during the COVID-19 pandemic in Vietnam. Management of factors associated with falls may be needed to reduce the burden of falls in the older population.
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Affiliation(s)
- Huan Thanh Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam
| | - Chanh Cong Nguyen
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam
| | - Thien Le Hoang
- Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh city, Vietnam
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Wingood M, Peters DM, Gell NM, Brach JS, Bean JF. Physical Activity and Physical Activity Participation Barriers Among Adults 50 Years and Older During the COVID-19 Pandemic. Am J Phys Med Rehabil 2022; 101:809-815. [PMID: 35473919 PMCID: PMC9377368 DOI: 10.1097/phm.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined changes in physical activity from pre-COVID-19 to during the COVID-19 pandemic and the factors associated with reduced physical activity levels among adults 50 yrs and older. DESIGN Participants of a validation study were stratified into being "less active than before" or "equally or more active than before" COVID-19. Multivariable manual backward analyses were used to identify self-reported barriers associated with the reduction in physical activity. RESULTS Reduced physical activity levels during COVID-19 were reported among 244 of 503 participants (43%). After adjusting for demographics and health conditions, factors that increased the odds of reduced physical activity levels during COVID-19 were lacking access to workout places, feeling too anxious, and difficulty committing to physical activity. Factors that decreased the odds of reduced physical activity levels during COVID-19 were self-identifying a heart- or lung-associated diagnosis that impacts physical activity and having a 12-mo retrospective history of falling. CONCLUSIONS The physical activity participation barriers identified to be associated with a reduction in physical activity can be used as a starting point for a conversation regarding physical activity participation during COVID-19. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Describe the changes in physical activity levels among adults 50 yrs and older from pre-COVID-19 to during the COVID-19 pandemic; (2) Differentiate between the COVID-19 related factors associated with reduced physical activity levels among adults 50 yrs and older and younger adults; and (3) Identify the physical activity-related factor that decreased the odds of reduced physical activity levels during COVID-19 among adults 50 yrs and older. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Kiyoshi-Teo H, Izumi S(S, Stoyles S, McMahon SK. Older Adults’ Biobehavioral Fall Risks Were Affected by the COVID-19 Pandemic: Lessons Learned for Future Fall Prevention Research to Incorporate Multilevel Perspectives. Innov Aging 2022; 6:igac033. [PMID: 36161144 PMCID: PMC9495495 DOI: 10.1093/geroni/igac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives Examining the impact of coronavirus disease 2019 (COVID-19) pandemic on fall risks may provide insight into how multilevel factors as described in National Institute of Nursing Research's (NINR’s) draft strategic plan can guide future fall prevention research. This article describes the affect of COVID-19 on fall risks from the perspective of older adults who live in assisted living facilities (ALFs), and explores the needs and approaches to implement fall prevention interventions at individual, social, community, and policy levels. Research Design and Methods Exploratory survey study. Participants from a fall prevention study at 2 ALFs in Oregon were invited to the study. Survey questions asked about COVID experience, and changes in fall risks and day-to-day activities in Spring 2020. Quantitative responses were analyzed using descriptive statistics and Cohen’s d effect sizes. Qualitative responses were analyzed using conventional content analysis. Results Thirteen participants (age: M = 87.08, standard deviation = 6.52) responded. More participants reported feeling unsteady compared to pre-COVID data (38% vs. 62%), while the proportion of those worried about falling remained the same at 38%. Participants reported negligible decreases in importance of fall prevention and small decreases in confidence of fall prevention (Cohen’s d = −0.13 and −0.21, respectively). The themes related to the affect of COVID on fall risks were: not to worry about fall risks but be cautious and physical activity is important, but it’s hard during COVID. Impact of COVID on day-to-day activities were: varying degrees of concern for COVID, lack of social and community support, and finding unique ways to cope with COVID. Discussion and Implications These individual-level perspectives suggest that older adults were at increased risk for falling. Results exemplify the influence of broader-level factors (e.g., social, community, and policy) on individual biobehavioral factors (e.g., fall risks and health behaviors), and illustrate the value of examining multilevel factors in future fall prevention research.
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Affiliation(s)
- Hiroko Kiyoshi-Teo
- School of Nursing, Oregon Health and Science University , Portland, Oregon , USA
| | | | - Sydnee Stoyles
- School of Nursing, Oregon Health and Science University , Portland, Oregon , USA
| | - Siobhan K McMahon
- School of Nursing, University of Minnesota , Minneapolis, Minnesota , USA
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Emerson PN. Fall-Risk Assessment and Intervention to Reduce Fall-related Injuries and Hospitalization among Older Adults. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sharma H, Pankratz VS, Demark-Wahnefried W, Pestak CR, Blair CK. Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors. Healthcare (Basel) 2022; 10:1421. [PMID: 36011078 PMCID: PMC9407773 DOI: 10.3390/healthcare10081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To examine potential factors associated with maintaining or improving self-reported physical function (PF) among older cancer survivors participating in a gardening intervention impacted by the Coronavirus 2019 (COVID-19) pandemic. Methods: Thirty cancer survivors completed a home-based gardening intervention to encourage a healthier diet and a more active lifestyle. Device-based measures of physical activity (PA) and surveys to evaluate quality of life (QOL; PROMIS-57 questionnaire) were administered at baseline, mid-intervention (6 months), and post-intervention (9 months). Results: Depression, fatigue, and sleeplessness at baseline were significantly associated with worse average PF scores across follow-up (2.3 to 4.9 points lower for every decrease of 5 points in the QOL score; p-values < 0.02). Worsening of these QOL domains during the intervention was also associated with an additional decrease of 2.1 to 2.9 points in PF over follow-up (p values < 0.01). Better social participation and PA at baseline were significantly associated with better average PF scores during the intervention (2.8 to 5.2 points higher for every 5-point increase in social participation or 30 min more of PA; p values < 0.05). Every 5-point increase in pain at baseline, or increases in pain during the intervention, was associated with decreases of 4.9 and 3.0 points, respectively, in PF. Conclusions: Worse QOL scores before and during the intervention were significantly associated with worse PF over follow-up. Encouraging social participation and PA through interventions such as home-based gardening may improve long-term health among older cancer survivors.
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Affiliation(s)
- Harsh Sharma
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
| | - Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Claire R. Pestak
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
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İnal Ö, Keklicek H, Karahan M, Uluçam E. Postural stability and flexibility responses of yoga training in women: Are improvements similar in both sexes? Health Care Women Int 2022; 44:718-733. [PMID: 35797446 DOI: 10.1080/07399332.2022.2061971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The researchers' aim is to examine the postural stability and flexibility responses of yoga training in women. The authors conducted the yoga training program 2 days a week and they assessed flexibility using the sit and reach test, trunk hyperextension test and trunk lateral flexion test. The researchers measured static and dynamic balance employing the device and database system. Then, the authors repeated all assesments were at the end of the first, the fifth and the tenth sessions. As a result of this study, the researchers revealed that the male participants had significantly poorer results in a single parameter (longitudinal sway) when compared with the female group, but the groups were statistically equivalent in this parameter after the first yoga training session. The authors also revealed that yoga was effective in improving flexibility among healthy young adults of both sexes, although the males showed greater improvement than females in the flexibility results.
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Affiliation(s)
- Özgü İnal
- Faculty of Gülhane Health Science, Department of Occupational Therapy, Health Science University, Ankara, Turkey
| | - Hilal Keklicek
- Faculty of Health Sciences, Department of Physiotherapy, Trakya University, Edirne, Turkey
| | - Menekşe Karahan
- Department of Anatomy, School of Medicine, Kırklareli University, Kırklareli, Turkey
| | - Enis Uluçam
- Faculty of Medicine, Department of Basic Sciences, Trakya University, Edirne, Turkey
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Bowling CB, Wei RX, Qian L, Shimbo D, Schwartz JE, Muntner P, Cannavale KL, Harrison TN, Reynolds K. Changes in fall rates from before to during the COVID-19 pandemic: Findings from the prospective AMBROSIA study. J Gerontol A Biol Sci Med Sci 2022; 78:624-629. [PMID: 35690355 PMCID: PMC9214135 DOI: 10.1093/gerona/glac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 11/14/2022] Open
Abstract
Background COVID-19 social distancing policies resulted in reductions in community movement, however fall rates during this time have not been described. Methods This prospective study included adults ≥65 years old participating in the Ambulatory Blood Pressure in Older Adults (AMBROSIA) cohort and who completed ≥1 monthly falls calendar (August 2019-March 2021; n=250). Months were grouped to correspond to the fall 2020 phased re-opening (August-October) and the shelter-in-place policy during the winter 2020 surge (November-January) in Los Angeles, California and compared to the same months, one year earlier (i.e., before the pandemic). Results Participants had a mean (SD) age of 75.2 (6.1) years, 49.6% were White, and 53.2% were women. We obtained 2,795 falls calendars during follow-up. Overall, 110 (44.0%) participants reported a total of 421 falls (rate 15.1 per 100 calendar months). The highest monthly fall rate during the pandemic was 22.9 (95% CI 16.4-31.1) per 100 calendar-months in August 2020. The lowest fall rate during the pandemic was 8.6 (95% CI 3.5-17.8) per 100 calendar-months in February 2021. During the pandemic, fall rates in August, September, and October 2020 were higher than the previous year (rate ratio 1.8 [95% CI 1.1-2.9]) and fall rates in November and December 2020 and January 2021 were lower than the previous year (rate ratio 0.5 [95% CI 0.4-0.8]). Conclusions As the pandemic continues and older adults resume community mobility after a shelter-in-place period, providers should pay attention to the risk of falls.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC.,Department of Medicine, Duke University, Durham, NC
| | - Rong X Wei
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E Schwartz
- Center for Behavioral and Cardiovascular Health, Columbia University Irving Medical Center, New York, NY.,Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Kimberly L Cannavale
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Teresa N Harrison
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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Marom P, Zalcman BG, Dankner R. Association between Self-Classification of COVID-19 Risk Levels and Adverse Lifestyle Changes among Physically Active Older Adults Following the Coronavirus Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127039. [PMID: 35742285 PMCID: PMC9222379 DOI: 10.3390/ijerph19127039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has imposed barriers to a healthy lifestyle, especially for older adults who are considered to be at a high-risk of infection. This study examined the associations between negative changes and the self-classification to COVID-19 risk level among physically active older adults who are members of a nationwide health club chain. A cross-sectional digital survey was sent to 19,160 older adults (age ≥ 65). The data collected included information on the subjects’ self-classification to the COVID-19 high-risk group (HRG) and changes in physical activity (PA), body weight, and smoking habits since the outbreak. Logistic regression models were used to investigate the associations between the dependent variables of ‘experienced a negative change’ and the independent variables. Of the 1670 survey respondents, 78.3% classified themselves as COVID-19 HRG. Over half of the respondents reported a reduction in PA hours, 26.6% reported weight gain, and 17.7% of smokers increased their amount of smoking. A self-classification to the HRG was associated with 1.46 (95%CI 1.10−1.93, p < 0.009) and 1.67 (95%CI 1.21−2.31, p < 0.002) greater odds for reduced hours of exercise and weight gain compared to the not high-risk group, respectively. Decision makers should consider how policies may cause barriers to a healthy lifestyle and develop risk communication strategies to encourage positive health-related behaviors, even during a pandemic.
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Affiliation(s)
- Pnina Marom
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel-Aviv 6772829, Israel;
| | - Beth G. Zalcman
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel-Aviv 6772829, Israel;
| | - Rachel Dankner
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel;
- Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel-Aviv 6772829, Israel;
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Ramat Gan 5262100, Israel
- Correspondence: ; Tel.: +972-73-2701613
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Weerahandi H, Rao M, Boockvar KS. Post-acute sequelae of SARS-CoV-2 infection in nursing homes: Do not forget the most vulnerable. J Am Geriatr Soc 2022; 70:1352-1354. [PMID: 35323991 PMCID: PMC9106869 DOI: 10.1111/jgs.17760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Himali Weerahandi
- Division of Hospital Medicine, Department of MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
- Division of Healthcare Delivery Science, Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Mana Rao
- ArchCareNew YorkNew YorkUSA
- Essen Medical AssociatesBronxNew YorkUSA
| | - Kenneth S. Boockvar
- Research Institute on AgingThe New Jewish HomeNew YorkNew YorkUSA
- Brookdale Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Plantinga LC, Hoge C, Dunlop-Thomas C, Pearce BD, Lim SS, Drenkard C, Bowling CB. Association of COVID-19 pandemic-related concern and health routine changes with functioning among individuals with systemic lupus erythematosus. Lupus Sci Med 2022; 9:e000658. [PMID: 35177480 PMCID: PMC8889448 DOI: 10.1136/lupus-2022-000658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether pandemic-related issues were associated with physical functioning, community mobility and cognition among individuals with SLE. METHODS Participants were recruited (6 October 2020-11 November 2021) for this cross-sectional study from a population-based cohort of individuals with validated SLE in metropolitan Atlanta, as part of an ongoing ancillary study. Pandemic-related issues (concern about the pandemic (very vs somewhat/not at all concerned); changes in physical activity and sleep (less vs more/same); difficulty obtaining food and medications and accessing routine care (any vs none)) were self-reported. Self-reported physical functioning and episodic and working memory performance were reported as t-scores (such that a score of 50=population mean and a 10-point difference=1 SD) and community mobility scores ranged from 0 to 120, with higher scores representing better functioning for all domains. Differences in scores were assessed via t-tests and age-adjusted, sex-adjusted and race-adjusted linear regression. RESULTS Among 245 participants (mean age, 46 years; 95% female, 77% black), physical functioning t-scores (mean=44) were consistently lower (by 3-5 points) for those who reported concern about the pandemic, less physical activity and sleep, difficulty obtaining food and medications, and accessing routine care. Similarly, community mobility scores (mean=48) were lower (by 10-20 points) for these individuals. There were no substantial differences in episodic memory and working memory t-scores (mean=50 and 47, respectively) by pandemic-related issues. CONCLUSION We found that physical functioning and community mobility, but not cognition, were lower among those who reported more concern about the pandemic or greater disruptions to health routines. Future studies should explore interventions among these vulnerable individuals with SLE, who already disproportionately suffer from functional impairment, to maintain functioning and prevent adverse outcomes during times of crisis.
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Affiliation(s)
- Laura C Plantinga
- Department of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Courtney Hoge
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Brad D Pearce
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Cristina Drenkard
- Department of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
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van Dam van Isselt EF, Schols JMGA, Gordon AL, Achterberg WP, van Haastregt J, Becker C, Grund S, Bauer JM. Post-acute COVID-19 geriatric rehabilitation : A European perspective. Z Gerontol Geriatr 2022; 55:655-659. [PMID: 36434130 PMCID: PMC9702857 DOI: 10.1007/s00391-022-02128-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) poses a threat to the health and independence of older people in particular. In this article we elaborate on the content and importance of post-acute COVID-19 geriatric rehabilitation from a European perspective. We explain the geriatric rehabilitation paradox and how this can and should be solved. We also present what post-acute COVID-19 geriatric rehabilitation should entail. This might not only help us to develop better geriatric rehabilitation services, but it should also inform pandemic preparedness in the future.
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Affiliation(s)
- E. F. van Dam van Isselt
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J. M. G. A. Schols
- Department of Health Services Research, Focusing on Value-based Care and Ageing, Caphri—Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - A. L. Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK ,NIHR Applied Research Collaboration-East Midlands, Nottingham, UK
| | - W. P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J. van Haastregt
- Department of Health Services Research, Focusing on Value-based Care and Ageing, Caphri—Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C. Becker
- Netzwerk Alternsforschung der Universität Heidelberg, Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - S. Grund
- Netzwerk Alternsforschung der Universität Heidelberg, Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany ,Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - J. M. Bauer
- Netzwerk Alternsforschung der Universität Heidelberg, Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany ,Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany
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