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Olender RT, Roy S, Jamieson HA, Hilmer SN, Nishtala PS. Drug Burden Index Is a Modifiable Predictor of 30-Day Hospitalization in Community-Dwelling Older Adults With Complex Care Needs: Machine Learning Analysis of InterRAI Data. J Gerontol A Biol Sci Med Sci 2024; 79:glae130. [PMID: 38733108 PMCID: PMC11215698 DOI: 10.1093/gerona/glae130] [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: 02/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Older adults (≥65 years) account for a disproportionately high proportion of hospitalization and in-hospital mortality, some of which may be avoidable. Although machine learning (ML) models have already been built and validated for predicting hospitalization and mortality, there remains a significant need to optimize ML models further. Accurately predicting hospitalization may tremendously affect the clinical care of older adults as preventative measures can be implemented to improve clinical outcomes for the patient. METHODS In this retrospective cohort study, a data set of 14 198 community-dwelling older adults (≥65 years) with complex care needs from the International Resident Assessment Instrument-Home Care database was used to develop and optimize 3 ML models to predict 30-day hospitalization. The models developed and optimized were Random Forest (RF), XGBoost (XGB), and Logistic Regression (LR). Variable importance plots were generated for all 3 models to identify key predictors of 30-day hospitalization. RESULTS The area under the receiver-operating characteristics curve for the RF, XGB, and LR models were 0.97, 0.90, and 0.72, respectively. Variable importance plots identified the Drug Burden Index and alcohol consumption as important, immediately potentially modifiable variables in predicting 30-day hospitalization. CONCLUSIONS Identifying immediately potentially modifiable risk factors such as the Drug Burden Index and alcohol consumption is of high clinical relevance. If clinicians can influence these variables, they could proactively lower the risk of 30-day hospitalization. ML holds promise to improve the clinical care of older adults. It is crucial that these models undergo extensive validation through large-scale clinical studies before being utilized in the clinical setting.
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Affiliation(s)
| | - Sandipan Roy
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah N Hilmer
- Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney and Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Prasad S Nishtala
- Department of Life Sciences & Centre for Therapeutic Innovation, University of Bath, Bath, UK
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Song Q, Shu X, Li Y, Zhao Y, Yue J. Association of handgrip strength asymmetry and weakness with functional disability among middle-aged and older adults in China. J Glob Health 2024; 14:04047. [PMID: 38549505 PMCID: PMC10979250 DOI: 10.7189/jogh.14.04047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024] Open
Abstract
Background Little is known about the association of handgrip strength (HGS) asymmetry with functional disability in China. We aimed to examine the individual and combined association of HGS asymmetry and weakness with functional disability among middle-aged and older Chinese adults. Methods We included participants aged ≥45 years from two waves of the China Health and Retirement Longitudinal Study (2011 and 2015). HGS weakness was defined as the maximal HGS<28 kg for men and <18 kg for women. HGS asymmetry was measured by dividing the maximal nondominant HGS (kg) by the maximal dominant HGS (kg), with the value <0.90 or >1.10 considered as asymmetry. Functional disability was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL) and was defined as encountering difficulty in completing one or more ADL/IADL tasks. The logistic regression models were used to explore the association between HGS measures and functional disability. Results 11 950 (mean age 59.2 ± 9.6 years, 47.9% males) and 7540 (mean age 57.5 ± 8.6 years, 50.1% males) participants were included in the cross-sectional and prospective study, respectively. HGS asymmetry and weakness, individually or simultaneously, were associated with an increased prevalence of functional disability. During the four-year follow-up, 1822 (24.2%) participants had incident functional disability. The separate exposure to HGS asymmetry (odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.05-1.32) or weakness (OR = 1.59; 95% CI = 1.30-1.95) was independently associated with functional disability. For combined associations, those with both weakness and asymmetry showed the greatest risk of new-onset functional disability (OR = 1.91; 95% CI = 1.45-2.52). Conclusions HGS asymmetry and weakness were associated with a higher risk of functional disability. Assessing HGS asymmetry together with weakness may help to better identify those at risk of functional disability to enable early interventions.
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Tegegne TK, Tran LD, Nourse R, Gurrin C, Maddison R. Daily Activity Lifelogs of People With Heart Failure: Observational Study. JMIR Form Res 2024; 8:e51248. [PMID: 38381484 PMCID: PMC10918541 DOI: 10.2196/51248] [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: 07/26/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Globally, heart failure (HF) affects more than 64 million people, and attempts to reduce its social and economic burden are a public health priority. Interventions to support people with HF to self-manage have been shown to reduce hospitalizations, improve quality of life, and reduce mortality rates. Understanding how people self-manage is imperative to improve future interventions; however, most approaches to date, have used self-report methods to achieve this. Wearable cameras provide a unique tool to understand the lived experiences of people with HF and the daily activities they undertake, which could lead to more effective interventions. However, their potential for understanding chronic conditions such as HF is unclear. OBJECTIVE This study aimed to determine the potential utility of wearable cameras to better understand the activities of daily living in people living with HF. METHODS The "Seeing is Believing (SIB)" study involved 30 patients with HF who wore wearable cameras for a maximum of 30 days. We used the E-Myscéal web-based lifelog retrieval system to process and analyze the wearable camera image data set. Search terms for 7 daily activities (physical activity, gardening, shopping, screen time, drinking, eating, and medication intake) were developed and used for image retrieval. Sensitivity analysis was conducted to compare the number of images retrieved using different search terms. Temporal patterns in daily activities were examined, and differences before and after hospitalization were assessed. RESULTS E-Myscéal exhibited sensitivity to specific search terms, leading to significant variations in the number of images retrieved for each activity. The highest number of images returned were related to eating and drinking, with fewer images for physical activity, screen time, and taking medication. The majority of captured activities occurred before midday. Notably, temporal differences in daily activity patterns were observed for participants hospitalized during this study. The number of medication images increased after hospital discharge, while screen time images decreased. CONCLUSIONS Wearable cameras offer valuable insights into daily activities and self-management in people living with HF. E-Myscéal efficiently retrieves relevant images, but search term sensitivity underscores the need for careful selection.
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Gholami M, Zohrabi Salari F, Yarahmadi R, Mokhayeri Y, Veiskaramian A, Amin A. Effects of balance training on cognitive function and activities of daily living in older adult patients with heart failure: a randomized controlled trial. Ir J Med Sci 2024; 193:111-121. [PMID: 37365444 DOI: 10.1007/s11845-023-03436-0] [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: 05/27/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The potential of the effect of balance training on improving cognitive functions and functional activities in vulnerable groups, including the older adults with heart failure (HF), is unknown. AIM The aim of the present study was to determine the effect of a simple balance training supervised by nurses on cognitive functions and activities of daily living (ADLs) of the older adults with HF. METHODS In this clinical trial study, 75 older adults with HF were allocated to two groups of balance training (BT) and usual care (UC) using stratified block randomization. The intervention consisted of a set of dynamic and static BT, 4 times/session per week, each session lasting 30 min, for 8 weeks, which was performed at the participant's home under the supervision of a nurse. For the control group, UC was provided. The outcomes of the study, including cognitive function, basic ADLs, and instrumental ADLs (IADLs), were measured by the Montreal cognitive assessment-basic (MoCA-B), Barthel index-ADL, and Lawton scale-IADL before and after the intervention. RESULTS The between-group analysis showed, in two groups, a statistically significant difference between the changes in the mean scores: all subscales of cognitive function and MoCA-B total score (P < 0.001), as well as basic ADLs and IADLs (P < 0.001), before and after the intervention. Compared with the control group/UC, the cognitive function, basic ADL, and IADL of the intervention group/BT were improved significantly at 8 weeks. CONCLUSION The results suggested that home-based balance training led by nurse can improve global cognitive function and basic ADL and IADL in the older adults with HF. TRIAL REGISTRATION Clinical trials registration number IRCT20150919024080N18.
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Affiliation(s)
- Mohammad Gholami
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Faezeh Zohrabi Salari
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Reza Yarahmadi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Yaser Mokhayeri
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Atefeh Veiskaramian
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Arash Amin
- Cardiovascular Research Center, Shahid Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
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Adam CE, Fitzpatrick AL, Leary CS, Ilango SD, Phelan EA, Semmens EO. The impact of falls on activities of daily living in older adults: A retrospective cohort analysis. PLoS One 2024; 19:e0294017. [PMID: 38170712 PMCID: PMC10763967 DOI: 10.1371/journal.pone.0294017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment. METHOD Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall. RESULTS Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall. CONCLUSIONS Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.
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Affiliation(s)
- Claire E. Adam
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Annette L. Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Cindy S. Leary
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Sindana D. Ilango
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Elizabeth A. Phelan
- Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Erin O. Semmens
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
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Mapelli M, Salvioni E, Mattavelli I, Gugliandolo P, Bonomi A, Palermo P, Rossi M, Stolfo D, Gustafsson F, Piepoli M, Agostoni P. Activities of daily living in heart failure patients and healthy subjects: when the cardiopulmonary assessment goes beyond traditional exercise test protocols. Eur J Prev Cardiol 2023; 30:ii47-ii53. [PMID: 37819228 DOI: 10.1093/eurjpc/zwad155] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 10/13/2023]
Abstract
Heart failure (HF) patients traditionally report dyspnoea as their main symptom. Although the cardiopulmonary exercise test (CPET) and 6 min walking test are the standardized tools in assessing functional capacity, neither cycle ergometers nor treadmill maximal efforts do fully represent the actual HF patients' everyday activities [activities of daily living (ADLs)] (i.e. climbing the stairs). New-generation portable metabolimeters allow the clinician to measure task-related oxygen intake (VO2) in different scenarios and exercise protocols. In the last years, we have made considerable progress in understanding the ventilatory and metabolic behaviours of HF patients and healthy subjects during tasks aimed to reproduce ADLs. In this paper, we describe the most recent findings in the field, with special attention to the relationship between the metabolic variables obtained during ADLs and CPET parameters (i.e. peak VO2), demonstrating, for example, how exercises traditionally thought to be undemanding, such as a walk, instead represent supramaximal efforts, particularly for subjects with advanced HF and/or artificial heart (left ventricular assist devices) wearers.
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Affiliation(s)
- Massimo Mapelli
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Festa del Perdono 7 - 20122 Milano, Italy
| | | | - Irene Mattavelli
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Paola Gugliandolo
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Alice Bonomi
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Pietro Palermo
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
| | - Maddalena Rossi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Finn Gustafsson
- Department of Cardiology and Clinical Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Piepoli
- Clinical Cardiology, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
- Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Piergiuseppe Agostoni
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Festa del Perdono 7 - 20122 Milano, Italy
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Lopes DG, Mendonça N, Henriques AR, Branco J, Canhão H, Rodrigues AM. Trajectories and determinants of ageing in Portugal: insights from EpiDoC, a nationwide population-based cohort. BMC Public Health 2023; 23:1564. [PMID: 37592343 PMCID: PMC10433601 DOI: 10.1186/s12889-023-16370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION The population in Portugal is ageing due to increased life expectancy and reduced fertility rates. We aimed to estimate the health trajectories of Portuguese older adults (60 + years old) in a 10-year period and to assess associated sociodemographic, lifestyle factors and multimorbidity status. METHODS Using the population-based EpiDoC cohort, we estimated the trajectories of health-related quality of life and physical function of 4135 Portuguese older adults over 10 years using linear mixed models. Factors associated to health-related quality of life and physical function were assessed using linear mixed models and random intercept tobit regression, respectively. RESULTS The physical disability of participants increased by 0.263 (0.240, 0.286), and health-related quality of life declined by 0.074 (-0.084, -0.063), over 10 years. With advancing age, older adults reported a faster reduction in health-related quality of life and faster increase in physical disability. In general, women were in worse health than men at baseline, albeit with a similar rate of change throughout the follow-up. Higher education and regular exercise were associated with better health-related quality of life and physical function while multimorbidity and excess weight were associated with worse reporting of these outcomes. CONCLUSIONS These findings, based on longitudinal data with 10 years of follow-up, are essential to effectively plan resource allocation, plan better healthcare and design informed public health policies in Portugal. This study characterizes ageing in Portugal showing increased physical disability and decreased health-related quality of life with advancing age older adults, helping to develop public health policies.
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Affiliation(s)
- David G Lopes
- EpiDoC Unit, NOVA Medical School, CHRC, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5, Lisboa, 1150-082, Portugal.
| | - Nuno Mendonça
- EpiDoC Unit, NOVA Medical School, CHRC, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5, Lisboa, 1150-082, Portugal
| | - Ana Rita Henriques
- EpiDoC Unit, NOVA Medical School, CHRC, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5, Lisboa, 1150-082, Portugal
| | - Jaime Branco
- EpiDoC Unit, NOVA Medical School, CHRC, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5, Lisboa, 1150-082, Portugal
- Centro Hospitalar Lisboa Ocidental (CHLO-E.P.E.), Serviço de Reumatologia do Hospital Egas Moniz, Lisboa, Portugal
| | - Helena Canhão
- EpiDoC Unit, NOVA Medical School, CHRC, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5, Lisboa, 1150-082, Portugal
- Centro Hospitalar Lisboa Ocidental (CHLO-E.P.E.), Serviço de Reumatologia do Hospital Egas Moniz, Lisboa, Portugal
| | - Ana M Rodrigues
- EpiDoC Unit, NOVA Medical School, CHRC, Universidade NOVA de Lisboa, Rua do Instituto Bacteriológico, nº5, Lisboa, 1150-082, Portugal
- Rheumatology Unit, Hospital dos Lusíadas, Lisboa, Portugal
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Bonares M, Le LW, Zimmermann C, Wentlandt K. Specialist Palliative Care Referral Practices Among Oncologists, Cardiologists, Respirologists: A Comparison of National Survey Studies. J Pain Symptom Manage 2023; 66:e1-e34. [PMID: 36796528 DOI: 10.1016/j.jpainsymman.2023.01.014] [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: 11/08/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
CONTEXT Although patients with nonmalignant diseases have palliative care needs similar to those of cancer patients, they are less likely to receive specialist palliative care (SPC). Referral practices of oncologists, cardiologists, and respirologists could provide insight into reasons for this difference. OBJECTIVES We compared referral practices to SPC among cardiologists, respirologists, and oncologists, discerned from surveys (the Canadian Palliative Cardiology/Respirology/Oncology Surveys). METHODS Descriptive comparison of survey studies; multivariable linear regression analysis of association between specialty and referral frequency. Surveys for each specialty were disseminated to physicians across Canada in 2010 (oncologists) and 2018 (cardiologists, respirologists). RESULTS The combined response rate of the surveys was 60.9% (1568/2574): 603 oncologists, 534 cardiologists, and 431 respirologists. Perceived availability of SPC services was higher for cancer than for noncancer patients. Oncologists were more likely to make a referral to SPC for a symptomatic patient with a prognosis of CONCLUSION For cardiologists and respirologists in 2018, perceived availability of SPC services was poorer, timing of referral later, and frequency of referral lower than among oncologists in 2010. Further research is needed to identify reasons for differences in referral practices and to develop interventions to overcome them.
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Affiliation(s)
- Michael Bonares
- Division of Palliative Medicine (M.B.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Palliative Medicine (M.B., C.Z.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Lisa W Le
- Department of Biostatistics (L.W.L.), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Division of Palliative Medicine (M.B., C.Z.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Supportive Care (C.Z., K.W.), University Health Network, Toronto, Ontario, Canada
| | - Kristen Wentlandt
- Department of Supportive Care (C.Z., K.W.), University Health Network, Toronto, Ontario, Canada; Division of Palliative Care (K.W.), Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
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Miyazaki D, Tarasawa K, Fushimi K, Fujimori K. Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database. TOHOKU J EXP MED 2023; 259:151-162. [PMID: 36543246 DOI: 10.1620/tjem.2022.j114] [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: 12/24/2022]
Abstract
Heart failure is a major disease, and its 30-day readmission (readmission within 30-day after discharge) negatively impacts patients and society. Thus, we need to stratify the risk and prevent readmission. We aimed to investigate risk factors associated with 30-day readmission and examine the impact of length of hospital stay (LOS) on 30-day readmission. Using the Diagnosis-Procedure-Combination database from April 2018 to March 2021, we conducted multiple logistic regression to investigate risk factors with 30-day readmission. Also, we conducted subgroup analysis in the short LOS group. To examine the association between LOS and 30-day readmission, we performed propensity score matching between the short and middle LOS groups. As a result, we categorized 10,283 patients and 169,842 patients into the readmission group and the no-readmission group. We identified the following factors as the risk of readmission: short LOS, female, smoking, older age, lower body mass index, lower barthel index, artificial ventilator, beta-blockers, thiazides, tolvaptan, loop diuretics, carperitides, class Ⅲ antiarrhythmic agents, myocardial infarction, diabetes, renal disease, atrial fibrillation, dilated cardiomyopathy, and discharge to home. As a subgroup analysis in the short LOS group, we revealed that the short LOS group risk factors differed from overall. After propensity score matching in the short LOS group and middle LOS group, 37,199 pairs were matched, and we revealed that shorter LOS increases the risk of readmission. These results demonstrated that shortened LOS increases 30-day readmission, and risk factors are unique to each LOS. We suggest stratifying the readmission risk and being careful with early discharge.
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Affiliation(s)
- Daisuke Miyazaki
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
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Roussia S, Muthu P, Ilesanmi RE. Self-care Management in Heart Failure Using Roy Adaptation Theory-guided Intervention in the United Arab Emirates. SAGE Open Nurs 2023; 9:23779608231160484. [PMID: 36895709 PMCID: PMC9989373 DOI: 10.1177/23779608231160484] [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: 11/25/2022] [Revised: 01/05/2023] [Accepted: 02/12/2023] [Indexed: 03/08/2023] Open
Abstract
Purpose To assess the knowledge and practice of self-care management among patients with heart failure (HF) after Roy adaptation theory-guided educational program. Methodology One group quasi-experimental pretest-posttest design of 30 purposively selected patients with HF was conducted. Outcomes were examined under three domains: knowledge, self-care maintenance, and monitoring pre- and post-intervention, using a validated instrument based on four adaptive modes of Roy's theory. Major results Most of the respondents were male (76.6%) and 56.7% were over 60 years of age. At the pretest, only 16.7% demonstrated adequate knowledge of self-care, and 76.7% reported poor practices in the domains of self-care maintenance and monitoring. Also, 90% scored poorly in self-care management. Knowledge of self-care practices increased at post-test (93.3%). There was a significant difference in knowledge (t = 15.79, df = 29, p < .001) and practice (t = 9.35, df = 29, p < .001) pre- and post-intervention. However, there was no significant association between selected demographic characteristics, knowledge, and self-care practice (p > .05). Conclusion Knowledge and practice of self-care management are poor among patients with HF. However, theory-driven practice can enhance care and patients' quality of life.
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Affiliation(s)
- Soufiane Roussia
- RAK Medical and Health Sciences University, Ras Alkhiama, UAE.,Cardiac Intensive Care Unit, Sheik Shakhbout Medical City, Abu Dhabi, UAE
| | - Priyalatha Muthu
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Rose Ekama Ilesanmi
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE.,Department of Nursing, University of Ibadan, Ibadan, Nigeria
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Lu J, Wang M, Zhang Y, Mao L, Chen X, Yin R, Shi X. The Prevalence of Activities of Daily Living Impairment in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:952926. [PMID: 35911563 PMCID: PMC9330145 DOI: 10.3389/fcvm.2022.952926] [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: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe prevalence of activities of daily living (ADL) in patients with heart failure (HF) reported in current studies were inconsistent, ranging from 11.1 to 70.5%. The purpose of this study is to quantify the prevalence of ADL impairment in HF patients.MethodsPubMed, Embase, Cochrane, CINAHL, CNKI, SinoMed, VIP, and Wanfang databases were systematically searched for relevant studies (up to March 2, 2022). Cross-sectional, case-control, or cohort studies with detailed descriptions of overall ADL impairment in HF were included. Stata 16.0 was used for statistical analysis. Fixed-effect or random-effect model was adopted according to heterogeneity which was evaluated by Cochran’s Q and I2 values. Sensitivity analysis, subgroup analysis, and meta-regression were performed to investigate the sources of heterogeneity.ResultsA total of 12 studies with 15,795 HF patients were included in the meta-analysis, and the pooled prevalence of ADL impairment in patients with HF was 38.8% (95%CI: 28.2–49.3%; I2 = 99.5%, P < 0.001). No possible sources of heterogeneity were found in subgroup analysis and meta-regression. Funnel plots and Egger’s test showed no publication bias (P = 0.595).ConclusionThe prevalence of ADL impairment is relatively high in HF patients. Differences in the prevalence of ADL impairment in patients with HF may be influenced by country, region, and assessment time. We suggest that more researchers could focus on the changes of ADL impairment in HF patients during different disease periods in different regions and countries.
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Affiliation(s)
- Jing Lu
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Meng Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yue Zhang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Lifen Mao
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoxiao Chen
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Rulan Yin
- Department of Rheumatology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Faculty of Nursing, Chiang Mai University, Chiangmai, Thailand
| | - Xiaoqing Shi
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Xiaoqing Shi,
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Yau PN, Foo CJE, Cheah NLJ, Tang KF, Lee SWH. The prevalence of functional disability and its impact on older adults in the ASEAN region: a systematic review and meta-analysis. Epidemiol Health 2022; 44:e2022058. [PMID: 35843601 PMCID: PMC9754909 DOI: 10.4178/epih.e2022058] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/12/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Functional disability is a common consequence of the ageing process and can lead to poor health outcomes due to the inability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL) independently. However, the prevalence of functional disability among older adults in the Association of Southeast Asian Nations (ASEAN) region is poorly documented. This study aimed to assess the prevalence of functional disability and its impact on older adults in the ASEAN region. METHODS A systematic literature search was performed on 4 databases from inception until March 2021 to identify studies examining individuals aged 60 years and above reporting functional disabilities in the ASEAN region. Information on the prevalence and impact of functional disability was extracted, assessed for bias, summarised, and analysed using a random-effects meta-analysis. RESULTS Thirty-four studies with 59,944 participants were included. The pooled prevalence of ADL disability was 21.5% (95% confidence interval [CI], 16.2 to 27.3) and that of IADL disability was 46.8% (95% CI, 35.5 to 58.3). Subgroup analyses showed higher prevalence among those of advanced age and women. Adverse impacts included increased years of life with disability and poor health-related quality of life. CONCLUSIONS Nearly a quarter of the older adult population in the ASEAN region experience functional disability. These findings highlight the need for further research on the burden and impact of functional disability within this region to allow decision-makers to gauge the severity of the issue, develop policies to reduce the risk of developing functional disabilities, and foster healthy ageing.
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Affiliation(s)
- Phei Nie Yau
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | | | - Kar Foong Tang
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia,School of Pharmacy, Taylor’s University, Subang Jaya, Malaysia,Correspondence: Shaun Wen Huey Lee School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Malaysia E-mail:
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Posri N, Srisatidnarakul B, Hickman RL. Development of a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. BELITUNG NURSING JOURNAL 2022; 8:75-83. [PMID: 37521078 PMCID: PMC10386804 DOI: 10.33546/bnj.1968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/12/2021] [Accepted: 01/08/2022] [Indexed: 08/01/2023] Open
Abstract
Background The transition from hospital to home among patients with stroke is quite challenging. If the patients are not ready for hospital discharge, their condition may worsen, which also causes a high rate of readmission. Although instruments to measure readiness for hospital discharge exist, none of them fit with the Thailand context. Objective This study aimed to develop a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. Methods The study was conducted from February to September 2020, which consisted of several steps: 1) conducting an extensive literature review, 2) content validity with five experts, 3) pilot testing with 30 samples, and 4) field testing with 348 participants. Content validity index (CVI) was used to measure the content validity, Cronbach's alpha and inter-item correlation to evaluate reliability, and multiple logistic regression analysis to measure the construct validity. Results The findings showed good validity and reliability, with I-CVI of 0.85, Cronbach's alpha of 0.94, and corrected item-total correlation ranging from 0.43 to 0.86. The construct validity was demonstrated through the results of regression analysis showing that the nine variables include level of consciousness (OR = 0.544; CI 95% = 0.311 - 0.951), verbal response (OR = 0.445; 95% CI 0.272- 0.729), motor power right leg (OR = 0.165; 95% CI 0.56- 0.485), visual field (OR = 0.188; 95% CI 0.60-0.587), dysphagia (OR = 0.618; 95% CI 0.410-0.932), mobility (OR = 0.376; 95% CI 0.190 - 0.741), self-feeding (OR = 0.098; 95% CI 0.036 -0.265), bathing (OR = 0.099; 95% CI 0.026-0.378), and bladder control (OR = 0.589; 95% CI 0.355-0.977) that significantly influenced the hospital readmission within 30 days in patients with stroke. Conclusion The Readiness for Hospital Discharge assessment tool is valid and reliable. Healthcare providers, especially nurses, can use this tool to assess discharge conditions for patients with stroke with greater accuracy in predicting hospital readmission.
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Affiliation(s)
| | | | - Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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