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Resendes NM, Bradley J, Tang F, Hammel IS, Ruiz JG. The association of non-severe COVID-19 infection and progression to frailty among robust older veterans. J Nutr Health Aging 2024; 28:100296. [PMID: 38901116 DOI: 10.1016/j.jnha.2024.100296] [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: 04/01/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Studies have shown that frailty was increased in hospitalized COVID-19 patients. However, it is not clear whether non-severe COVID-19 increases the risk for pre-frailty and frailty development. Our study aimed to determine the risk of developing frailty and pre-frailty in robust veterans who contracted non-severe COVID-19. METHODS We conducted a retrospective cohort study to assess the association of SARS-CoV-2 infection with the development of pre-frailty and frailty status among robust U.S. veterans using VA COVID-19 Shared Data Resource. We included patients 55 years and older who had at least one SARS-CoV-2 testing between March 15, 2020, and November 30, 2020, had been active patients in the past 12 months, and had a VA frailty index of zero (robust status) at the time of testing. Cox proportional hazard model was used to assess the association between COVID-19 infection and developing frailty or pre-frailty and frailty. We also assessed the association by patients' age groups, sex, and race. FINDINGS We identified 82070 veterans mean age 68.3 ± 7.8, 74738 (91.1%) male, 53899 (65.7%) white, 7557 (9.2%) with mild COVID-19 infection. Over the follow up period of 36 months, testing positive for COVID-19 was associated with a 66% increase in the hazard of becoming frail (adjusted HR = 1.66, 95%CI: 1.32-2.08), and a 68% increase in the hazard of becoming pre-frail (adjusted HR = 1.68, 95%CI: 1.45-1.94). Among male patients, mild COVID-19 infection was associated with a 54% increase in the hazard of becoming frail (adjusted HR = 1.54, 95% CI: 1.21-1.96), while among female patients there was a 330% increase (adjusted HR = 4.30, 95% CI: 2.13-8.64). CONCLUSIONS AND RELEVANCE Non-severe COVID-19 infection that occurred in robust older adults increased the risk of developing frailty. Further multi-center prospective cohort studies evaluating the mechanism of action and clinical trials of treatment options for post-COVID frailty are indicated in Veterans to support clinical care.
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Affiliation(s)
- Natasha M Resendes
- Miami VA (Veterans Administration) Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, Florida, USA; Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Jerry Bradley
- Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fei Tang
- Miami VA (Veterans Administration) Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, Florida, USA
| | - Iriana S Hammel
- Miami VA (Veterans Administration) Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, Florida, USA; Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jorge G Ruiz
- Memorial Healthcare System, Hollywood, Florida, USA; Dept of Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
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Misiak MM, Bethell J, Chapman H, Sommerlad A. How can care home activities facilitate social connection in residents? A qualitative study. Aging Ment Health 2024:1-10. [PMID: 38669150 DOI: 10.1080/13607863.2024.2345130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Good social connection is associated with better physical and mental health but care home residents experience barriers to social connection. Activities present a potential avenue for improving social connection in care homes but residents often experience loneliness despite access to activity programmes. We therefore aimed to identify what aspects of activities facilitate social connection in care home residents. METHOD Qualitative study using semi-structured interviews that were analysed using Thematic Analysis. A purposive sample of 35 participants, including 12 residents, 10 family caregivers, nine care home staff and four clinicians, recruited from UK care homes. RESULTS We found four main themes describing features of activities important for facilitating social connection: (1) personalisation with respect to residents' interests, social preferences, and cognitive ability; (2) activities which foster a sense of community; (3) finding and emphasising things in common that residents share; and (4) facilitating a sense of involvement with others. CONCLUSION We identified the key aspects of activities which facilitate social connection in care homes. These findings can be applied to a range of existing and newly designed activities in care homes and inform the development and testing of psychosocial interventions aiming to improve social connection.
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Affiliation(s)
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute,University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Andrew Sommerlad
- Division of Psychiatry, University College London, UK
- Division of Psychiatry, Camden and Islington NHS Foundation Trust, London, UK
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3
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Puranen T, Hiltunen K, Kautiainen H, Suominen MH, Salminen K, Mäntylä P, Roitto HM, Pitkälä KH, Saarela RKT. Relationship between oral frailty, health-related quality of life, and survival among long-term care residents. Eur Geriatr Med 2023; 14:1307-1315. [PMID: 37728853 PMCID: PMC10754726 DOI: 10.1007/s41999-023-00859-x] [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: 11/24/2022] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE We evaluated oral frailty (OFr) and its association with health-related quality of life (HRQoL), energy and protein intake, and survival among older long-term care residents. METHODS This cross-sectional study with a 3-year follow-up for survival assessed 349 residents in long-term care facilities (73% female, mean age 82 years). We defined OFr with six signs (dry mouth, food residue on oral surfaces, unclear speech, inability to keep mouth open or pain expression during the clinical oral examination, diet pureed/soft) and OFr severity was categorized as Group 1, (mild) = 0-1 signs, Group 2 (moderate) = 2-4 signs, and Group 3 (severe) = 5-6 signs. We measured HRQoL with 15D instrument, and energy and protein intake by a 1- to 2-day food record. Mortality was retrieved from central registers on March 2021. RESULTS Of the residents, 15% had 0-1, 67% 2-4 and 18% 5-6 OFr signs. HRQoL decreased linearly from Group 1 to Group 3. OFr correlated with such dimensions of HRQoL as mobility, eating, speech, excretion, usual activities, mental function, and vitality. We found no association between OFr categories and energy and protein intake. Survival decreased linearly from Group 1 to Group 3. CONCLUSIONS OFr was common among older long-term care residents and OFr severity predicts poorer outcomes. The six oral signs denoting OFr may be used at the bedside to screen residents at risk for OFr.
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Affiliation(s)
- Taija Puranen
- Social Services, Health Care and Rescue Services Division, Development Support, City of Helsinki, P.O. Box 6008, 00099, Helsinki, Finland.
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
| | - Kaija Hiltunen
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Merja H Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Karoliina Salminen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Päivi Mäntylä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Hanna-Maria Roitto
- Department of Medicine, University of Helsinki, Helsinki, Finland
- Social Services, Health Care and Rescue Services, Helsinki Hospital, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Riitta K T Saarela
- Social Services, Health Care and Rescue Services Division, Oral Health Care, City of Helsinki, Helsinki, Finland.
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4
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AIoT-Based Ergometer for Physical Training in Frail Elderly with Cognitive Decline: A Pilot Randomized Control Trial. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00759-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose
Reduced physical activity is reported in the elderly, especially in institutional residents. Institutionalized older adults exhibit a high prevalence of frailty. In this work, we developed an artificial intelligence of things (AIoT)-based feedback assistive strengthening ergometer (AIFASE), for the physical strengthening of the elderly with intelligent assistance.
Methods
We conducted a 12-week intervention in a long-term care facility. In total, 16 participants (84.38 ± 6.0 years; 4 males and 12 females) were recruited with 1:1 randomization of exercise to control groups. The muscle strength of the lower extremities, timed up and go test (TUG), and Short-form Physical Performance Battery (SPPB) of the participants were measured. The AIFASE system allows the clinical staff to record the personal physical performance of the elderly and generates personalized exercise prescriptions accordingly. AIFASE also displays the current usage status of all ergometers and the users’ physiological conditions. The algorithms were developed to generate warning alerts when the training workload was too large by personal physiological detection. AIFASE automatically customized the exercise prescription according to the user’s exercise performance.
Results
After a 12-week AIFASE intervention, the intervention group exhibited significant improvements in the strength of the hip flexor, Semi-Tandem Stand, and Tandem Stand.
Conclusion
In this study, we developed an AIoT ergometer that delivered customized physical training prescriptions to improve the physical performance of long-term care facility residents. We believe that the application of AIFASE will help improve the quality of institutional care.
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An analysis of a novel Canadian pilot health information exchange to improve transitions between hospital and long-term care/skilled nursing facility. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-03-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of the article is to assess the effectiveness, compliance, adoption and lessons learnt from the pilot implementation of a data integration solution between an acute care hospital information system (HIS) and a long-term care (LTC) home electronic medical record through a case report.Design/methodology/approachUtilization statistics of the data integration solution were captured at one-month post implementation and again one year later for both the emergency department (ED) and LTC home. Clinician feedback from surveys and structured interviews was obtained from ED physicians and a multidisciplinary LTC group.FindingsThe authors successfully exchanged health information between a HIS and the electronic medical record (EMR) of an LTC facility in Canada. Perceived time savings were acknowledged by ED physicians, and actual time savings as high as 45 min were reported by LTC staff when completing medication reconciliation. Barriers to adoption included awareness, training efficacy and delivery models, workflow integration within existing practice and the limited number of facilities participating in the pilot. Future direction includes broader staff involvement, expanding the number of sites and re-evaluating impacts.Practical implicationsA data integration solution to exchange clinical information can make patient transfers more efficient, reduce data transcription errors, and improve the visibility of essential patient information across the continuum of care.Originality/valueAlthough there has been a large effort to integrate health data across care levels in the United States and internationally, the groundwork for such integrations between interoperable systems has only just begun in Canada. The implementation of the integration between an enterprise LTC electronic medical record system and an HIS described herein is the first of its kind in Canada. Benefits and lessons learnt from this pilot will be useful for further hospital-to-LTC home interoperability work.
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Amblàs-Novellas J, Torné A, Oller R, Martori JC, Espaulella J, Romero-Ortuno R. Transitions between degrees of multidimensional frailty among older people admitted to intermediate care: a multicentre prospective study. BMC Geriatr 2022; 22:722. [PMID: 36050635 PMCID: PMC9438217 DOI: 10.1186/s12877-022-03378-9] [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: 04/12/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Frailty is a dynamic condition that is clinically expected to change in older individuals during and around admission to an intermediate care (IC) facility. We aimed to characterize transitions between degrees of frailty before, during, and after admission to IC and assess the impact of these transitions on health outcomes. Methods Multicentre observational prospective study in IC facilities in Catalonia (North-east Spain). The analysis included all individuals aged ≥ 75 years (or younger with chronic complex or advanced diseases) admitted to an IC facility. The primary outcome was frailty, measured by the Frail-VIG index and categorized into four degrees: no frailty, and mild, moderate, and advanced frailty. The Frail-VIG index was measured at baseline (i.e., 30 days before IC admission) (Frail-VIG0), on IC admission (Frail-VIG1), at discharge (Frail-VIG2), and 30 days post-discharge (Frail-VIG3). Results The study included 483 patients with a mean (SD) age of 81.3 (10.2) years. At the time of admission, 27 (5.6%) had no frailty, and 116 (24%), 161 (33.3%), and 179 (37.1%) mild, moderate, and severe frailty, respectively. Most frailty transitions occurred within the 30 days following admission to IC, particularly among patients with moderate frailty on admission. Most patients maintained their frailty status after discharge. Overall, 135 (28%) patients died during IC stay. Frailty, measured either at baseline or admission, was significantly associated with mortality, although it showed a stronger contribution when measured on admission (HR 1.16; 95%CI 1.10–1.22; p < 0.001) compared to baseline (HR 1.10; 1.05–1.15; p < 0.001). When including frailty measurements at the two time points (i.e., baseline and IC admission) in a multivariate model, frailty measured on IC admission but not at baseline significantly contributed to explaining mortality during IC stay. Conclusions Frailty status varied before and during admission to IC. Of the serial frailty measures we collected, frailty on IC admission was the strongest predictor of mortality. Results from this observational study suggest that routine frailty measurement on IC admission could aid clinical management decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03378-9.
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Affiliation(s)
- Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Rambla Hospital 52, 08500, Vic, Barcelona, Spain. .,Geriatric and Palliative Care Department, Hospital Universitari de La Santa Creu and Hospital Universitari de Vic. Vic, Barcelona, Spain. .,Chronic Care Program, Ministry of Health, Generalitat de Catalunya, Catalonia, Spain.
| | - Anna Torné
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Rambla Hospital 52, 08500, Vic, Barcelona, Spain.,Geriatric and Palliative Care Department, Hospital Universitari de La Santa Creu and Hospital Universitari de Vic. Vic, Barcelona, Spain
| | - Ramon Oller
- Data Analysis and Modelling Research Group, Department of Economics and Business, University of Vic-Central University of Catalonia (UVIC-UCC), Barcelona, Spain
| | - Joan Carles Martori
- Data Analysis and Modelling Research Group, Department of Economics and Business, University of Vic-Central University of Catalonia (UVIC-UCC), Barcelona, Spain
| | - Joan Espaulella
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Rambla Hospital 52, 08500, Vic, Barcelona, Spain.,Geriatric and Palliative Care Department, Hospital Universitari de La Santa Creu and Hospital Universitari de Vic. Vic, Barcelona, Spain
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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7
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Jyväkorpi SK, Lindström M, Suominen MH, Kautiainen H, Salminen K, Niskanen RT, Pitkälä KH, Roitto HM. Relationship between frailty, nutrition, body composition, quality of life, and gender in institutionalized older people. Aging Clin Exp Res 2022; 34:1357-1363. [PMID: 35146701 PMCID: PMC9151503 DOI: 10.1007/s40520-022-02077-0] [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: 09/24/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
Our aim was to explore the relationship between frailty, nutrition, body composition, and how gender modifies this relationship among long-term care facility residents. We further investigated how body composition correlates with health-related quality of life (HRQoL) in both genders. In all, 549 residents (> 65 years of age) were recruited from 17 long-term care facilities for this cross-sectional study. Demographic information, diagnoses, use of medications, and nutritional supplements were retrieved from medical records. Participants' frailty status, cognition, nutritional status, HRQoL, and body composition were determined. Energy, protein, and fat intakes were retrieved from 1- to 2-day food diaries. The final sample consisted of 300 residents (77% women, mean age 83 years). The majority of participants, 62% of women and 63% of men, were identified as frail. Frail participants in both genders showed lower body mass index (p = 0.0013), muscle mass (MM) (p < 0.001), poorer nutritional status (p = 0.0012), cognition (p = 0.0021), and lower HRQoL (p < 0.001) than did prefrail participants. Women had higher fat mass, whereas men exhibited higher MM. The HRQoL correlated with the MM in both women, r = 0.48 [95% CI 0.38, 0.57] and men r = 0.49 [95% CI 0.38, 0.58]. Interventions aimed at strengthening and retaining MM of long-term residents may also support their HRQoL.
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Affiliation(s)
| | - M Lindström
- City of Helsinki Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland
| | | | | | - K Salminen
- University of Helsinki, Clinicum, Finland
| | | | | | - H-M Roitto
- City of Helsinki Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland
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8
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Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes. BMC Geriatr 2022; 22:339. [PMID: 35439970 PMCID: PMC9017032 DOI: 10.1186/s12877-022-03012-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background U.S. nursing homes provide long-term care to over 1.2 million older adults, 60% of whom were physically frail and 68% had moderate or severe cognitive impairment. Limited research has examined the longitudinal experience of these two conditions in older nursing home residents. Methods This national longitudinal study included newly-admitted non-skilled nursing care older residents who had Minimum Data Set (MDS) 3.0 (2014–16) assessments at admission, 3 months, and 6 months (n = 266,001). Physical frailty was measured by FRAIL-NH and cognitive impairment by the Brief Interview for Mental Status. Separate sets of group-based trajectory models were fitted to identify the trajectories of physical frailty and trajectories of cognitive impairment, and to estimate the association between older residents’ characteristics at admission with each set of trajectories. A dual trajectory model was used to quantify the association between the physical frailty trajectories and cognitive impairment trajectories. Results Over the course of the first six months post-admission, five physical frailty trajectories [“Consistently Frail” (prevalence: 53.0%), “Consistently Pre-frail” (29.0%), “Worsening Frailty” (7.6%), “Improving Frailty” (5.5%), and “Consistently Robust” (4.8%)] and three cognitive impairment trajectories [“Consistently Severe Cognitive Impairment” (35.5%), “Consistently Moderate Cognitive Impairment” (31.8%), “Consistently Intact/Mild Cognitive Impairment” (32.7%)] were identified. One in five older residents simultaneously followed the trajectories of “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Characteristics associated with higher odds of the “Improving Frailty”, “Worsening Frailty”, “Consistently Pre-frail” and “Consistently Frail” trajectories included greater at-admission cognitive impairment, age ≥ 85 years, admitted from acute hospitals, cardiovascular/metabolic diagnoses, neurological diagnoses, hip or other fractures, and presence of pain. Characteristics associated with higher odds of the “Consistently Moderate Cognitive Impairment” and “Consistently Severe Cognitive Impairment” included worse at-admission physical frailty, neurological diagnoses, hip fracture, and receipt of antipsychotics. Conclusions Findings provided information regarding the trajectories of physical frailty, the trajectories of cognitive impairment, the association between the two sets of trajectories, and their association with residents’ characteristics in older adults’ first six months post-admission to U.S. nursing homes. Understanding the trajectory that the residents would most likely follow may provide information to develop a comprehensive care approach tailored to their specific healthcare goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03012-8.
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Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA. .,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Christine M Ulbricht
- Formerly: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Currently: National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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9
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Seiffert P, Konka A, Kasperczyk J, Kawa J, Lejawa M, Maślanka-Seiffert B, Zembala-John J, Bugdol M, Romanik M, Bułdak R, Marcisz C, Derejczyk J, Religa D. Immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in older residents of a long-term care facility: relation with age, frailty and prior infection status. Biogerontology 2022; 23:53-64. [PMID: 34923608 PMCID: PMC8684786 DOI: 10.1007/s10522-021-09944-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
Clinical and biological assessment of the COVID-19 vaccine efficacy in the frail population is of crucial importance. The study focuses on measuring the levels of anti-SARS-CoV-2 IgG antibodies before and after BNT162b2 mRNA COVID-19 vaccination among long-term care facility (LTCF) elderly residents. We conducted a prospective, single-center, observational study among LTCF residents. The study protocol was based on three blood sample acquisitions: first taken at baseline-5 days before the first dose of the vaccine, second-20 days after the first dose, and third-12 days after the second shot of the vaccine. The comparison was made for two cohorts: patients with and without prior COVID-19 infection. The data was collected from January to March 2021. A total number of 78 LTCF residents (55 women and 23 men) aged 62-104, 85.72 ± 7.59 years (mean ± SD), were enrolled in the study. All study participants were investigated for the presence of SARS-CoV-2 anti-spike (S) protein IgG, using a chemiluminescent immunoassay. Frailty was assessed with the Clinical Frailty Scale. Among elderly COVID-19 survivors in LTCF, a single dose of vaccine significantly increased anti-SARS-CoV-2 IgG antibody levels. IgG concentration after a single and double dose was comparable, which may suggest that elderly COVID-19 survivors do not require a second dose of vaccine. For residents without a previous history of COVID-19, two doses are needed to achieve an effective serological response. The level of anti-SARS-CoV-2 IgG antibodies after vaccination with BNT162b2 mRNA COVID-19 did not correlate with the frailty and age of the studied individuals.
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Affiliation(s)
- Piotr Seiffert
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Rheumatology Ward, Murcki Hospital, Katowice, Poland
| | - Adam Konka
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
| | - Janusz Kasperczyk
- Chair and Department of Medicine and Environmental Epidemiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jacek Kawa
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Mateusz Lejawa
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Joanna Zembala-John
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Chair and Department of Medicine and Environmental Epidemiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Silesian Center for Heart Diseases, Zabrze, Poland
| | - Monika Bugdol
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Małgorzata Romanik
- Department of Medical Microbiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Rafał Bułdak
- Silesian Park of Medical Technology Kardio-Med Silesia, Zabrze, Poland
- Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Czesław Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | | | - Dorota Religa
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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10
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Hiltunen K, Saarela RKT, Kautiainen H, Roitto HM, Pitkälä KH, Mäntylä P. Relationship between Fried's frailty phenotype and oral frailty in long-term care residents. Age Ageing 2021; 50:2133-2139. [PMID: 34473831 PMCID: PMC8581380 DOI: 10.1093/ageing/afab177] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND oral frailty (OFr) may be called a syndrome lacking a consensus on its definition. OBJECTIVE the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care. DESIGN the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition. SETTING participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs). SUBJECTS the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland. METHODS frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination. RESULTS a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties. CONCLUSIONS OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.
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Affiliation(s)
- Kaija Hiltunen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Riitta K T Saarela
- City of Helsinki, Department of Social Services and Health Care, Oral Health Care, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Folkhälsan, Helsinki, Finland
| | - Hanna-Maria Roitto
- City of Helsinki, Department of Social Services and Health Care, Oral Health Care, Helsinki, Finland
- Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Päivi Mäntylä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
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11
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Kanwar A, Roger VL, Lennon RJ, Gharacholou SM, Singh M. Poor quality of life in patients with and without frailty: co-prevalence and prognostic implications in patients undergoing percutaneous coronary interventions and cardiac catheterization. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:591-600. [PMID: 32821905 DOI: 10.1093/ehjqcco/qcaa065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022]
Abstract
AIMS We hypothesize that poor quality of life (QOL) is highly prevalent in frail older adults and is associated with worse prognosis. METHODS AND RESULTS Predismissal standardized tests for frailty and QOL were prospectively administered to patients included in two cohorts. In Cohort 1, 629 patients ≥65 years who underwent percutaneous coronary intervention (PCI) from 2005 to 2008, frailty (Fried criteria), and QOL [SF-36 and Seattle Angina Questionnaires (SAQ)] were ascertained. Cohort 2 included 921 patients ≥55 years who underwent cardiac catheterization (535 had PCI) from 2014 to 2018 and frailty was determined by Rockwood criteria and QOL by single-item, self-reported health questionnaire. In Cohort 1, 19% were frail and 20% patients in Cohort 2 were frail with a frailty index >0.30. The median SAQ for physical limitation (58.9 vs. 82.2, P < 0.001), physical (29.5 vs. 43.9, P < 0.001), and mental (49.2 vs. 57.4, P < 0.001) component scores of SF-36 in Cohort 1 were lower and self-rating of fair/poor health (56% vs 18%, P < 0.001) in Cohort 2 was significantly higher in frail patients. As compared to patients without frailty, frail patients were five times more likely (59% vs. 11%, P < 0.001) in Cohort 1 and seven times more likely (56% vs. 8%) in Cohort 2 to be classified with poor QOL. Age- and gender-adjusted 3-year all-cause death and death or myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; [hazard ratio (95% confidence interval) death, 4.20 (2.63-6.68, P < 0.001) and death or MI hazard ratio (HR) 2.72 (1.91-3.87, P < 0.001)] and with poor QOL [HR death 2.47 (1.59-3.84, P < 0.001)] and death or MI 1.61 (1.16-2.24, P < 0.001). There was no significant interaction between frailty and QOL (P = 0.64) and only modest attenuation was observed when considered together indicating their independent prognostic influence. CONCLUSION In elderly patients undergoing cardiac catheterization or PCI, poor QOL is seen more frequently in frail patients. Both frailty and poor QOL had significant and independent association with long-term survival.
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Affiliation(s)
- Amrit Kanwar
- Department of Internal Medicine, Loma Linda University, Loma Linda, California
| | - Veronique L Roger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Lennon
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | - Mandeep Singh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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12
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Prevalence and determinants of frailty in older adult patients with chronic coronary syndrome: a cross-sectional study. BMC Geriatr 2021; 21:519. [PMID: 34592947 PMCID: PMC8482732 DOI: 10.1186/s12877-021-02426-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Frailty is an expression of vulnerability and decline of physical, mental, and social activities, more commonly found in older adults. It is also closely related to the occurrence and poor prognosis of coronary artery disease (CAD). Little investigation has been conducted on the prevalence and determinants of frailty in older adult patients with chronic coronary syndrome (CCS). METHODS A cross-sectional study was conducted, simple random sampling was used in this study. 218 older adults (age ≥ 60 years) with CCS with an inpatient admission number ending in 6 were randomly selected who hospitalized in Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, between January and December 2018. For measurement and assessment, we used the 5-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight), demographic characteristics, Barthel Index(BI), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Mini Nutrition Assessment Shor-Form (MNA-SF), Morse Fall Scale (MFS), Caprini risk assessment, polypharmacy, and Numerical Rating Scale (NRS). Multivariate logistic regression analysis was used to confirme determinants. RESULTS The FRAIL scale showed 30.3% of the subjects suffered from frailty. Determinants were aging (OR1.12; 95% CI 1.04 ~ 1.62), out-of-pocket (OR18.93; 95% CI 1.11 ~ 324.07), hearing dysfunction (OR9.43; 95% CI 1.61 ~ 55.21), MNA-SF score (OR0.71; CI 0.57 ~ 0.89), GDS-15 score (OR1.35; 95% CI 1.11 ~ 1.64), and Caprini score (OR1.34; 95% CI 1.06 ~ 1.70). CONCLUSIONS The FRAIL scale confirmed that the prevalence of frailty in patients with CCS was slightly lower than CAD. Aging, malnutrition, hearing dysfunction, depression, and VTE risk were significantly associated with frail for older adult patients with CCS. A comprehensive assessment of high-risk patients can help identify determinants for frailty progression. In the context of CCS, efforts to identify frailty are needed, as are interventions to limit or reverse frailty status in older CCS patients.
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Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Physical frailty and cognitive impairment in older nursing home residents: a latent class analysis. BMC Geriatr 2021; 21:487. [PMID: 34493211 PMCID: PMC8425049 DOI: 10.1186/s12877-021-02433-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the heterogeneous clinical profile of physical frailty and its association with cognitive impairment in older U.S. nursing home (NH) residents. METHODS Minimum Data Set 3.0 at admission was used to identify older adults newly-admitted to nursing homes with life expectancy ≥6 months and length of stay ≥100 days (n = 871,801). Latent class analysis was used to identify physical frailty subgroups, using FRAIL-NH items as indicators. The association between the identified physical frailty subgroups and cognitive impairment (measured by Brief Interview for Mental Status/Cognitive Performance Scale: none/mild; moderate; severe), adjusting for demographic and clinical characteristics, was estimated by multinomial logistic regression and presented in adjusted odds ratios (aOR) and 95% confidence intervals (CIs). RESULTS In older nursing home residents at admission, three physical frailty subgroups were identified: "mild physical frailty" (prevalence: 7.6%), "moderate physical frailty" (44.5%) and "severe physical frailty" (47.9%). Those in "moderate physical frailty" or "severe physical frailty" had high probabilities of needing assistance in transferring between locations and inability to walk in a room. Residents in "severe physical frailty" also had greater probability of bowel incontinence. Compared to those with none/mild cognitive impairment, older residents with moderate or severe impairment had slightly higher odds of belonging to "moderate physical frailty" [aOR (95%CI)moderate cognitive impairment: 1.01 (0.99-1.03); aOR (95%CI)severe cognitive impairment: 1.03 (1.01-1.05)] and much higher odds to the "severe physical frailty" subgroup [aOR (95%CI)moderate cognitive impairment: 2.41 (2.35-2.47); aOR (95%CI)severe cognitive impairment: 5.74 (5.58-5.90)]. CONCLUSIONS Findings indicate the heterogeneous presentations of physical frailty in older nursing home residents and additional evidence on the interrelationship between physical frailty and cognitive impairment.
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Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Christine M Ulbricht
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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14
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Burrell A, Chahine S, Diachun LL. Factors Associated with a Label of Failure to Cope in Older Medical Inpatients: a Case-Control Study. Can Geriatr J 2021; 24:118-124. [PMID: 34079605 PMCID: PMC8137458 DOI: 10.5770/cgj.24.484] [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] [Indexed: 11/22/2022] Open
Abstract
Background The term failure to cope (FTC) is often used to dismissively describe hospitalized older adults. The purpose of this study was to identify the factors associated with receiving a label of FTC. Methods Age-matched, case-control study with electronic and paper chart review identifying patient characteristics and admission details. Results One hundred eighty-five patients 70 years of age or older admitted to a general medicine team over two years: 99 patients with the label of FTC and 86 controls. No patients labelled with FTC came from long-term care. Characteristics associated with a label of FTC included living alone (aOR 3.8, 95% CI 1.9–7.8), falls (aOR 3.8, 95% CI 1.9–7.8), rehospitalization (aOR 3.6, 95% CI 1.7–8.0), and living in an independent dwelling (aOR 2.4, 95% CI 1.0–5.5). A higher number of chronic medications was associated with a lower likelihood of being labelled with FTC (aOR 0.9, 95% CI 0.8–1.0). Conclusions The results suggest that FTC is a label based predominantly on social factors and has no role in a medical assessment. The patient’s home setting was the key factor in being labelled with FTC, most medical factors did not play a significant role, and a pervasive language of blame was present.
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Affiliation(s)
- Alishya Burrell
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Saad Chahine
- Faculty of Education, Queens University, Kingston, ON
| | - Laura L Diachun
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON.,Centre for Education and Research Innovation, Schulich School of Medicine & Dentistry, London, ON, Canada
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15
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Rutman MP, Horn JR, Newman DK, Stefanacci RG. Overactive Bladder Prescribing Considerations: The Role of Polypharmacy, Anticholinergic Burden, and CYP2D6 Drug‒Drug Interactions. Clin Drug Investig 2021; 41:293-302. [PMID: 33713027 PMCID: PMC8004492 DOI: 10.1007/s40261-021-01020-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 12/11/2022]
Abstract
Overactive bladder (OAB) is a common disorder in the general population, and the prevalence increases with age. Adults with OAB typically have a greater number of comorbid conditions, such as hypertension, depression, and dementia, compared with adults without OAB. Subsequent to an increased number of comorbidities, adults with OAB take a greater number of concomitant medications, which may increase the risk of potentially harmful drug‒drug interactions. There are two important considerations for many of the medications approved for the treatment of OAB in the USA: anticholinergic burden and potential for drug‒drug interactions, notably related to cytochrome P450 (CYP) 2D6, which is responsible for the metabolism of approximately 25% of all drugs. A substantial number of drugs used for the treatment of OAB and comorbid conditions (e.g., cardiovascular and neurologic disorders) are CYP2D6 substrates or inhibitors. Furthermore, a substantial number of drugs with CYP2D6 properties also have strong anticholinergic properties. Here, we review polypharmacy associated with OAB and its common comorbidities, identify drugs with reported anticholinergic properties, and provide an overview of clinically relevant drug‒drug interactions in the treatment of OAB as they relate to CYP2D6 metabolism. This review aims to provide clinicians with essential information necessary for making treatment decisions when managing OAB.
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Affiliation(s)
- Matthew P Rutman
- Columbia University, 11th Floor, HIP, 161 Ft. Washington Avenue, New York, NY, 10032, USA.
| | - John R Horn
- School of Pharmacy, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard G Stefanacci
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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Hao W, Li J, Fu P, Zhao D, Jing Z, Wang Y, Yu C, Yuan Y, Zhou C. Physical frailty and health-related quality of life among Chinese rural older adults: a moderated mediation analysis of physical disability and physical activity. BMJ Open 2021; 11:e042496. [PMID: 33419914 PMCID: PMC7799141 DOI: 10.1136/bmjopen-2020-042496] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this study is to explore the mediating effect of physical disability as well as the role of physical activity (PA) as a moderator in the relationship between physical frailty and health-related quality of life (HRQoL) among rural older adults in China. DESIGN Cross-sectional analysis. SETTING Rural households in Shandong of China (Rushan, Qufu, Laolin). PARTICIPANTS AND METHODS A survey was conducted among 3243 rural older adults. The data were collected using questionnaires measuring physical frailty, physical disability, HRQoL and PA. Bootstrap analyses were employed to explore the mediating effect of physical disability and also the moderating role of PA on physical frailty and HRQoL. RESULTS After controlling for age and education, physical disability partially mediated the effect of physical frailty on HRQoL (indirect effect=-0.143, 95% CI -0.175 to -0.113), with the mediating effect accounting for 33.71% of the total effect. PA moderated the relationship between physical frailty and physical disability as well as the relationship between physical disability and HRQoL. Specifically, the interaction term between physical frailty and PA significantly predicted physical disability (β=-0.120, t=-7.058, p<0.001), and the interaction term between physical disability and PA also had a significant predictive effect on HRQoL (β=0.115, t=6.104, p<0.001). CONCLUSIONS PA appears to moderate the indirect effect of physical disability on the association between physical frailty and HRQoL. This study provides support for potential mechanisms in the association between physical frailty and HRQoL. Encouraging rural older adults to increase PA appropriately might improve HRQoL for older adults with physical frailty and physical disability problems.
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Affiliation(s)
- Wenting Hao
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jie Li
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Peipei Fu
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Dan Zhao
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhengyue Jing
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yi Wang
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Caiting Yu
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yemin Yuan
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
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de Oliveira LFS, Wanderley RL, de Medeiros MMD, de Figueredo OMC, Pinheiro MA, Rodrigues Garcia RCM, Almeida LDFDD, Cavalcanti YW. Health-related quality of life of institutionalized older adults: Influence of physical, nutritional and self-perceived health status. Arch Gerontol Geriatr 2020; 92:104278. [PMID: 33069111 DOI: 10.1016/j.archger.2020.104278] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Institutionalized older adults have higher risks of diseases and worse health-related quality of life (HRQoL) than noninstitutionalized. OBJECTIVE To evaluate the influence of physical state, nutritional status and self-perceived general health and oral health on the quality of life of institutionalized older adults in two Brazilian cities. METHODS A multicenter cross-sectional study was conducted in 17 homes for the aged of two Brazilian cities. Six trained researchers interviewed 344 older adults. The performance of activities of daily living (Katz scale) and frailty status (Fried scale) were applied to evaluate the physical state. The Mini Nutritional Assessment Short-Form (MNA-SF®) and the body composition were used to screening the nutritional status. A hand dynamometer was used to measure the dominant hand grip strength. The 12-Item Short Form Survey for self-perceived health (SF-12) was used to determine the HRQoL. A Likert scale was used to assess the general and oral health self-perception. Multiple Poisson regression model was applied to analyze the data (α = 0.05). RESULTS The mean (SD) score of the SF-12 was 60.89 (14.50) points. The factors associated with the highest SF-12 score were being able to walk, being nonfrail, being normal nourished, taking fewer medications, having greater dominant hand grip strength and higher self- perceived general health (p < 0.05). CONCLUSION Better HRQoL in institutionalized older adults was associated with better physical state, nutritional status and self-perceived general health.
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Affiliation(s)
- Luiz Fabrício Santos de Oliveira
- Graduate Program in Dentistry, Department of Social Medicine and Dentistry, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba, Brazil
| | - Rayssa Lucena Wanderley
- Graduate Program in Dentistry, Department of Social Medicine and Dentistry, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba, Brazil
| | - Mariana Marinho Davino de Medeiros
- Graduate Program in Dentistry, Department of Clinical Dentistry, Dental Prosthesis Area, State University of Campinas (Universidade Estadual de Campinas), Piracicaba, São Paulo, Brazil
| | - Olívia Maria Costa de Figueredo
- Graduate Program in Dentistry, Department of Clinical Dentistry, Dental Prosthesis Area, State University of Campinas (Universidade Estadual de Campinas), Piracicaba, São Paulo, Brazil
| | - Mayara Abreu Pinheiro
- Graduate Program in Dentistry, Department of Clinical Dentistry, Dental Prosthesis Area, State University of Campinas (Universidade Estadual de Campinas), Piracicaba, São Paulo, Brazil
| | - Renata Cunha Matheus Rodrigues Garcia
- Graduate Program in Dentistry, Department of Clinical Dentistry, Dental Prosthesis Area, State University of Campinas (Universidade Estadual de Campinas), Piracicaba, São Paulo, Brazil
| | - Leopoldina de Fátima Dantas de Almeida
- Graduate Program in Dentistry, Department of Social Medicine and Dentistry, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba, Brazil
| | - Yuri Wanderley Cavalcanti
- Graduate Program in Dentistry, Department of Social Medicine and Dentistry, Federal University of Paraíba (Universidade Federal da Paraíba), João Pessoa, Paraíba, Brazil.
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Furtado GE, Caldo A, Vieira-Pedrosa A, Letieri RV, Hogervorst E, Teixeira AM, Ferreira JP. Emotional Well-Being and Cognitive Function Have Robust Relationship With Physical Frailty in Institutionalized Older Women. Front Psychol 2020; 11:1568. [PMID: 32765358 PMCID: PMC7378677 DOI: 10.3389/fpsyg.2020.01568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Frailty associated to core dimensions of psychological well-being (PwB) has appeared as a possible new frailty phenotype named psychological frailty, implying a parallel to physical frailty (PF). Very little is known about the associations between mental well-being, especially emotional, mood, and self-perception dimensions, and the frailty syndrome in institutionalized older populations. The present study aims to examine the interlink between the PF phenotype and the core dimensions of PwB in Portuguese institution-dwelling older women. Methods Cross-sectional data were collected. A total of 358 older women, aged 75 years or more, were recruited from four nursing homes within the city of Coimbra and asked to complete a sociodemographic and a general health assessment survey. The main PwB dimensions were assessed in all participants: (i) global cognitive status was assessed using The Montreal Cognitive Assessment (MoCA) Neuropsychology Test, (ii) self-perception was screened using the General Self-Efficacy Scale (GSES) and Global Self-Esteem Scale, (iii) CES-D of depression and Perceived Stress Scale (PSS) were used to screen mood states, and (iv) subjective happiness, satisfaction with life, and attitudes to aging psychometric rating scales were used to screen for emotional well-being. The syndrome of PF was assessed using Fried’s PF phenotype that includes weight loss, weakness, slowness, exhaustion, and low physical activity (PA) level assessments. Results Frail older women had a poor score in all PwB outcomes, except for global self-esteem and satisfaction with life. A hierarchical regression model analysis showed that global cognitive status and emotional well-being of subjective happiness and attitude to aging showed a significant negative relationship with PF in both unadjusted and adjusted models (explaining 34 and 40% of variance, respectively). Conclusion Emotional well-being and global cognitive performance are strongly associated with PF. Implementing active lifestyle interventions to improve positive psychological outcomes using geriatric assessments could assist in the older institutionalized patients’ physical and mental health care.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Adriana Caldo
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Ana Vieira-Pedrosa
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Rubens Vinícius Letieri
- Multidisciplinary Research Nucleus in Physical Education (NIMEF), Physical Education Department, Federal University of Tocantins (UFT), Tocantinópolis, Brazil
| | - Eef Hogervorst
- Applied Cognitive Research NCSEM, Loughborough University, Loughborough, United Kingdom
| | - Ana Maria Teixeira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - José Pedro Ferreira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
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Sebastião E. Activity behavior and cognitive performance in older adults living in a senior housing facility: the impact of frailty status. Aging Clin Exp Res 2020; 32:703-709. [PMID: 31243743 DOI: 10.1007/s40520-019-01254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Frailty, a condition characterized by a reduced physiological reserve and resilience, is highly prevalent among older adults. AIMS This study examined differences in physical activity (PA) level, sedentary behavior (SB) time, and cognitive performance in older adults living in a senior housing facility (SHF) as a function of frailty status. METHODS This study assessed 100 older adults from a SHF in the Midwest area of the United States. Participants were categorized as frail or non-frail according to scores observed in the short physical performance battery (SPPB), using the cutoff of nine previously stated in the literature. PA level and SB time were self-reportedly assessed using the physical activity scale for the elderly (PASE) and SB using a specific questionnaire developed for the older adult population. Cognitive performance was assessed using a collection of tests measuring cognitive processing speed, verbal learning, visuospatial memory, and verbal fluency. RESULTS Frail and non-frail older adults reported similar PA level and SB time (P > .05). Frail older adults performed significantly (P < .05) worse than their counterparts, non-frail in all measures of cognitive function. However, after controlling the analysis for age, only processing speed (SDMT scores) remained statistically different (P < .05) between groups. DISCUSSION/CONCLUSION Older adults living in a SHF with different frailty status (i.e., frail vs. non-frail) report similar levels of PA level and SB time; but our findings suggest that non-frail older adults appear to have better cognitive function in terms of processing speed compared to the frail group.
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Carneiro JA, Gomes CAD, Durães W, Jesus DRD, Chaves KLL, Lima CDA, Costa FMD, Caldeira AP. Negative self-perception of health: prevalence and associated factors among elderly assisted in a reference center. CIENCIA & SAUDE COLETIVA 2020; 25:909-918. [PMID: 32159661 DOI: 10.1590/1413-81232020253.16402018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/06/2018] [Indexed: 11/21/2022] Open
Abstract
The negative self-perception of health is a relevant construct for the analysis of the elderly population health conditions and should be recognized as a guiding tool for health promotion actions. We aimed to verify the prevalence and the associated factors to a negative self-perception of health by elderly assisted in a reference center. This is an analytical cross-sectional study with convenience sampling conducted in 2015. The negative self-perception association with health-related sociodemographic variables was investigated. Bivariate analysis followed by multiple analysis by Poisson regression was performed to verify the variables associated with the outcome. Three hundred sixty elderly were evaluated. The negative self-perception of health prevalence was 60.5%. The following associated factors were identified in the final model: age range 65-79 years (PR=1; CI95%=0.648-0.974; p=0.027); frailty (PR=1.28; CI95%=1.07-1.54; p=0.007); depressive symptoms (PR=1.40; CI95%=1.19-1.67; p=0.000); and providing care to someone (PR=1.49; CI95%=1.18-1.88; p=0.001). The elevated prevalence of negative self-perception of health and the associated factors point to the need for effective health promotion actions and more specific care for the elderly assisted in the reference center.
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Affiliation(s)
- Jair Almeida Carneiro
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Caio Augusto Dias Gomes
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Weliton Durães
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - David Rodrigues de Jesus
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Keitlen Lara Leandro Chaves
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Cássio de Almeida Lima
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | | | - Antônio Prates Caldeira
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
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Giebel C, Harvey D, Akpan A, Chamberlain P. Reducing hospital admissions in older care home residents: a 4-year evaluation of the care home innovation Programme (CHIP). BMC Health Serv Res 2020; 20:94. [PMID: 32028940 PMCID: PMC7006107 DOI: 10.1186/s12913-020-4945-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Older care home residents frequently attend emergency departments with a high conversion to admissions. For this purpose, a novel Care Home Innovation Programme (CHIP) was introduced with the aim of reducing potentially avoidable hospital admissions by 30%. The aim of this study is to evaluate the implementation of this innovative service in practice. Methods A total of 32 care homes with 1314 beds in South Sefton, Merseyside were invited to sign up to CHIP which was launched in April 2015 and continued in its entirety until June 2018. As part of the CHIP, care home matrons were introduced, new protocols were developed to address common presentations, a 24-h 7–day a week televideo system installed across all homes, and a quarterly training collaborative brought care homes together to learn and share good practices together. Data on emergency calls and calls resulting in conveyances were recorded over a four-year period, and analysed using frequency analysis. Results In comparison to the 12 months prior to launch, over a four-year period, implementation of the CHIP resulted in a 15% reduction of emergency calls, and in a 19% reduction of conveyances to hospital. Conclusions The South Sefton CHIP demonstrated itself an effective programme in reducing conveyances and consequently, hospital admissions of care home residents. This model will be superseded by the enhanced health in care homes being promoted by the NHS Long Term Care Plan.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Waterhouse Building B Block, Brownlow Street, Liverpool, L69 3GL, England. .,NIHR ARC NWC, Liverpool, England.
| | - Debbie Harvey
- South Sefton Clinical Commissioning Group, Liverpool, England
| | - Asangaedem Akpan
- NIHR ARC NWC, Liverpool, England.,Liverpool University Hospitals NHS FT, Liverpool, England.,Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, England
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22
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Salminen KS, Suominen MH, Kautiainen H, Pitkälä KH. Associations between Nutritional Status, Frailty and Health-Related Quality of Life among Older Long-Term Care Residents in Helsinki. J Nutr Health Aging 2020; 24:319-324. [PMID: 32115614 PMCID: PMC7064461 DOI: 10.1007/s12603-019-1320-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to examine how nutritional status modifies the association between frailty and health-related quality of life (HRQoL) among older nursing home residents. We also investigated how residents' energy intake is linked to frailty score. DESIGN AND PARTICIPANTS A total of 486 older (> 65 years of age) nursing home residents living in Helsinki, Finland were included to this cross-sectional study. METHODS We collected data on the residents' background information, HRQoL by 15D, nutritional status by Mini Nutritional Assessment (MNA), frailty status (Fried's phenotype criteria; pre-frail: 1-2 criteria and frail: 3-5) and energy intake (one- or two-day food records). RESULTS The frail residents were more often malnourished and had lower HRQoL than those in the prefrail group. Energy and protein intakes were significantly lower among frail women than prefrail women. Energy intake was linearly associated with frailty points. When residents in the frail and prefrail groups were divided according to their nutritional status, both nutritional status and frailty were associated with HRQoL, but there was no interaction. CONCLUSIONS Both nutritional status and frailty were associated with HRQoL, and lower energy intake indicated a higher frailty score. An adequate energy intake may promote residents' HRQoL and prevent frailty in long-term care.
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Affiliation(s)
- K S Salminen
- K.S. Salminen, Department of General Practice and Primary Health Care, University of Helsinki, Finland. POB 20, FIN-00014 University of Helsinki, Finland.
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Hughes MSA, Dosa DM, Caffrey AR, Appaneal HJ, Jump RLP, Lopes V, LaPlante KL. Antibiograms Cannot Be Used Interchangeably Between Acute Care Medical Centers and Affiliated Nursing Homes. J Am Med Dir Assoc 2019; 21:72-77. [PMID: 31537479 DOI: 10.1016/j.jamda.2019.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether antibiograms for Veterans Affairs (VA) nursing homes (NHs), termed Community Living Centers, are similar to those from their affiliated acute care medical centers. DESIGN Descriptive study. SETTING AND PARTICIPANTS We compared the 2017 antibiograms for VA NHs to their affiliated VA medical centers (VAMCs). Antibiograms included antibiotic susceptibility rates for commonly observed bacteria in this setting (Staphylococcus aureus, Enterococcus spp, Escherichia coli, Klebsiella spp, Proteus mirabilis, and Pseudomonas aeruginosa). METHODS Antibiograms were considered to be in complete agreement when the overall susceptibility rate between the NH and affiliated VAMC was either at or above 80% or below 80% across all bacteria and antibiotics. Average percentage of bacteria-antibiotic comparisons in disagreement per facility pair, and number of facilities with agreement for specific bacteria-antibiotic comparisons were also assessed. The chi-square test was used to compare disagreement between NH-VAMC facilities based on geographic proximity of the NH to the VAMC, culture source, and bed size. RESULTS A total of 119 NH-VAMC affiliate pairs were included in this analysis, with 71% (84/119) on the same campus and 29% (35/119) on geographically distinct campuses. None of the NH-VAMC pairs demonstrated complete agreement (all bacteria vs all antibiotics) between their antibiograms. On average, 20% of the bacteria-antibiotic comparisons from the antibiogram disagreed clinically per NH-VAMC pair, and almost twice as often the nursing home had lower susceptibility (higher resistance) than the acute care facility. Some bacteria-antibiotic comparisons agreed in all facilities (eg, E coli-imipenem; S aureus-linezolid; S aureus-vancomycin), while others showed greater disagreement (eg, Klebsiella spp-cefazolin; Klebsiella spp-ampicillin-sulbactam; P aeruginosa-ciprofloxacin). Rates of clinical disagreement were similar by geographic proximity of the NH to the VAMC, culture source, and bed size. CONCLUSIONS AND IMPLICATIONS Overall, this study showed a moderate lack of agreement between VA NH antibiograms and their affiliate VAMC antibiograms. Our data suggest that antibiograms of acute care facilities are often not accurate approximations of the nursing home resistance patterns and therefore should be used with caution (if at all) in guiding empiric antibiotic therapy.
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Affiliation(s)
- Maria-Stephanie A Hughes
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI; Center of Innovation for Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; University of Rhode Island, Department of Pharmacy Practice, College of Pharmacy, Kingston, RI
| | - David M Dosa
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI; Center of Innovation for Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; University of Rhode Island, Department of Pharmacy Practice, College of Pharmacy, Kingston, RI; School of Public Health, Brown University, Providence, RI
| | - Aisling R Caffrey
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI; Center of Innovation for Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; University of Rhode Island, Department of Pharmacy Practice, College of Pharmacy, Kingston, RI; School of Public Health, Brown University, Providence, RI
| | - Haley J Appaneal
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI; Center of Innovation for Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; University of Rhode Island, Department of Pharmacy Practice, College of Pharmacy, Kingston, RI; School of Public Health, Brown University, Providence, RI
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC) and the Specialty Care Center of Innovation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Vrishali Lopes
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI
| | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI; Center of Innovation for Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; University of Rhode Island, Department of Pharmacy Practice, College of Pharmacy, Kingston, RI; Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI.
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Toyama M, Fuller HR. Longitudinal Stress-Buffering Effects of Social Integration for Late-Life Functional Health. Int J Aging Hum Dev 2019; 91:501-519. [DOI: 10.1177/0091415019871196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stress can negatively affect multiple aspects of health, including functional health, among older adults, who are likely to face unique, age-related stressful experiences. Previous research has addressed the protective effects of social relations (i.e., social ties, social participation, and social integration) for physical and mental health outcomes, yet few studies have examined functional health. This study aimed to investigate the longitudinal stress-buffering effects of social integration on late-life functional health. Using three-wave data from 399 older adults (aged older than 60 years), two-level hierarchical linear modeling analysis was conducted and the results indicated that in addition to its main effect on functional (activity of daily living) limitations, social integration moderated the negative effect of stress on the longitudinal trajectory of functional limitations. The findings suggest important directions of future research to identify the mechanisms of such buffering effects over time and develop effective interventions to enhance late-life functional health while promoting social integration.
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Affiliation(s)
- Masahiro Toyama
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
| | - Heather R. Fuller
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
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Paes de Andrade FLJ, Jerez-Roig J, Belém LNM, de Lima KC. Frailty among institutionalized older people: a cross-sectional study in Natal (Brazil). J Frailty Sarcopenia Falls 2019; 4:51-60. [PMID: 32300718 PMCID: PMC7155304 DOI: 10.22540/jfsf-04-051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Verify the prevalence of frailty and its associated factors in institutionalized older people. METHODS Cross-sectional study carried out in 10 nursing homes in Natal (Brazil), between October/2013 and January/2014. All institutionalized older people 60+ that were not hospitalized, in terminal state, coma or under palliative care were included in the study. The dependent variable of the study was the presence/absence of frailty, classified according to the following criteria: severe cognitive decline and/or impossibility of independent walking or being bedridden. The 5 criteria (muscular weakness, unintentional weight loss, low physical activity level, slowness and exhaustion) of Fried et al. were considered for those with preserved cognitive and walking capacity. The chi-square test or Fisher's test and logistic regression were used for bivariate and multiple analysis, respectively. Sociodemographic, institution-related and health-related variables were also included. RESULTS Of the 321 participating older people, 80.1% were considered frail, 16.8% pre-frail and 3.1% non-frail. The final model demonstrated association of frailty with age (OR=2.67; 95%CI 1.39-5.14; p=0.003), presence of chronic diseases (OR=10.27; 95%CI 3.42-30.90; p<0.001), systemic arterial hypertension (OR=0.11; 95%CI 0.05-0.27; p<0.001) and institutionalization due to lack of caregiver (OR=2.55; 95%CI 1.36-4.76; p=0.003) adjusted by sex and type of institution. DISCUSSION Frailty was highly prevalent in institutionalized older people and its association with multi-factor aspects suggested that action of health services and government representations could aid in the prevention or delay of frailty onset, improving the life quality of older people.
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Affiliation(s)
| | - Javier Jerez-Roig
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal-RN, Brazil
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Spain
| | | | - Kenio Costa de Lima
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal-RN, Brazil
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van Rijckevorsel-Scheele J, Willems RCWJ, Roelofs PDDM, Koppelaar E, Gobbens RJJ, Goumans MJBM. Effects of health care interventions on quality of life among frail elderly: a systematized review. Clin Interv Aging 2019; 14:643-658. [PMID: 31040654 PMCID: PMC6453553 DOI: 10.2147/cia.s190425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Many health care interventions have been developed that aim to improve or maintain the quality of life for frail elderly. A clear overview of these health care interventions for frail elderly and their effects on quality of life is missing. PURPOSE To provide a systematic overview of the effect of health care interventions on quality of life of frail elderly. METHODS A systematic search was conducted in Embase, Medline (OvidSP), Cochrane Central, Cinahl, PsycInfo and Web of Science, up to and including November 2017. Studies describing health care interventions for frail elderly were included if the effect of the intervention on quality of life was described. The effects of the interventions on quality of life were described in an overview of the included studies. RESULTS In total 4,853 potentially relevant articles were screened for relevance, of which 19 intervention studies met the inclusion criteria. The studies were very heterogeneous in the design: measurement of frailty, health care intervention and outcome measurement differ. Health care interventions described were: multidisciplinary treatment, exercise programs, testosterone gel, nurse home visits and acupuncture. Seven of the nineteen intervention studies, describing different health care interventions, reported a statistically significant effect on subdomains of quality of life, two studies reported a statistically significant effect of the intervention on the overall quality of life score. Ten studies reported no statistically significant difference between the intervention and control groups. CONCLUSION Reported effects of health care interventions on frail elderly persons' quality of life are inconsistent, with most of the studies reporting no differences between the intervention and control groups. As the number of frail elderly persons in the population will continue to grow, it will be important to continue the search for effective health care interventions. Alignment of studies in design and outcome measurements is needed.
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Affiliation(s)
| | - Renate C W J Willems
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Pepijn D D M Roelofs
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Elin Koppelaar
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marleen J B M Goumans
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands,
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Lachance CC, Korall AMB, Russell CM, Feldman F, Robinovitch SN, Mackey DC. Hand forces exerted by long-term care staff when pushing wheelchairs on compliant and non-compliant flooring. APPLIED ERGONOMICS 2018; 71:95-101. [PMID: 29764620 DOI: 10.1016/j.apergo.2018.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
Purpose-designed compliant flooring and carpeting have been promoted as a means for reducing fall-related injuries in high-risk environments, such as long-term care. However, it is not known whether these surfaces influence the forces that long-term care staff exert when pushing residents in wheelchairs. We studied 14 direct-care staff who pushed a loaded wheelchair instrumented with a triaxial load cell to test the effects on hand force of flooring overlay (vinyl versus carpet) and flooring subfloor (concrete versus compliant rubber [brand: SmartCells]). During straight-line pushing, carpet overlay increased initial and sustained hand forces compared to vinyl overlay by 22-49% over a concrete subfloor and by 8-20% over a compliant subfloor. Compliant subflooring increased initial and sustained hand forces compared to concrete subflooring by 18-31% when under a vinyl overlay. In contrast, compliant flooring caused no change in initial or sustained hand forces compared to concrete subflooring when under a carpet overlay.
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Affiliation(s)
- Chantelle C Lachance
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada; Knowledge Translation Program, Li Ka Shing Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Ontario, Canada.
| | - Alexandra M B Korall
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada; George and Fay Yee Centre for Healthcare Innovation, Third Floor Chown Building, 753 McDermot Avenue, Winnipeg, R3E 0T6, Manitoba, Canada
| | - Colin M Russell
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada; Patient Safety and Injury Prevention, Central City Tower, 400-13450 102nd Ave, Surrey, V3T 5X3, British Columbia, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada; Centre for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada.
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Lan X, Xiao H, Chen Y, Zhang X. Effects of Life Review Intervention on Life Satisfaction and Personal Meaning Among Older Adults With Frailty. J Psychosoc Nurs Ment Health Serv 2018. [DOI: 10.3928/02793695-20180305-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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De Vriendt P, Cornelis E, Vanbosseghem R, Desmet V, Van de Velde D. Enabling meaningful activities and quality of life in long-term care facilities: The stepwise development of a participatory client-centred approach in Flanders. Br J Occup Ther 2018. [DOI: 10.1177/0308022618775880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Meaningful activities of daily living promote the quality of life of residents of long-term care facilities. This project aimed to develop an approach to enable meaningful activities of daily living and to guide long-term care facilities in a creative and innovative attitude towards residents' meaningful activities of daily living. Method The approach was developed in six steps: (1) in-depth-interviews with 14 residents; (2) a survey with 171 residents; (3) a systematic map and synthesis review on interventions enriching meaningful activities of daily living; (4) qualitative analysis of 24 ‘good examples’ and, to support future implementation, (5) focus groups with staff ( n = 69). Results determined the components of the new approach which was (6) pilot-tested in one long-term care facility. Quantitative and qualitative data were gathered concerning benefits for the residents and feasibility for the staff. Results A client- and activity-oriented approach was developed, characterised by an active participatory attitude of residents and staff and a systematic iterative process. Significant positive effects were found for the number of activities, the satisfaction with the leisure offered, the social network, medication use, but not for quality of life. The approach appeared to be feasible. Conclusion This approach stimulates residents' meaningful activities of daily living and social life. Further investigation is needed to evaluate its outcome and implementation potentials.
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Affiliation(s)
- Patricia De Vriendt
- Professor, Research Group Innovation in Health Care and Department of Occupational Therapy, Artevelde University College, Gent, Belgium; Faculty of Medicine and Pharmacy, Department of Gerontology and Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy, Department of Occupational Therapy, Ghent University, Gent, Belgium
| | - Elise Cornelis
- Occupational Therapist, University Hospital Brussels, Belgium; PhD Candidate Gerontology, Faculty of Medicine and Pharmacy, Department of Gerontology and Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Lecturer and Researcher, Department of Occupational Therapy, Artevelde University College, Gent, Belgium
| | - Ruben Vanbosseghem
- Lecturer and Researcher, Department of Nursing, Artevelde University College, Research Group Innovation in Health Care, Gent, Belgium
| | - Valerie Desmet
- Occupational Therapist, Lecturer and Researcher, Department of Occupational Therapy, Artevelde University College, Gent, Belgium
| | - Dominique Van de Velde
- Professor Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy, Department of Occupational Therapy, Ghent University, Gent, Belgium; Department of Occupational Therapy, Artevelde University College, Gent, Belgium
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Jerez-Roig J, Souza DLB, Andrade FLJPD, Lima BFD, Medeiros RJD, Oliveira NPDD, Cabral SM, Lima KC. Self-perceived health in institutionalized elderly. CIENCIA & SAUDE COLETIVA 2018; 21:3367-3375. [PMID: 27828570 DOI: 10.1590/1413-812320152111.15562015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/19/2015] [Indexed: 11/22/2022] Open
Abstract
This study aimed to verify health self-perception, its prevalence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted in 10 Long-Term care Institutions for the Elderly (LTIE) in the city of Natal (Northeast Brazil), between October and December 2013. Sociodemographic variables were analyzed, along with institution-related and health state variables. Descriptive and bivariate analyses were carried out (Chi-squared test, Fisher's exact test or linear trend Chi-squared test), as well as multivariate analysis (logistic regression). The final sample consisted of 127 elderly. The prevalence of negative self-perceived health was 63.19% (CI 95%: 55.07-70.63), and was associated with weight loss (PR: 1.54; CI 95%: 1.19-1.99), rheumatic disease (PR: 1.46; CI 95%: 1.05-2.01) and not-for-profit LTIE (PR: 1.37; CI 95%: 1.03-1.83), adjusted by sex. More than half of the elderly reported negative self-perceived health, which was associated with weight loss, rheumatic disease and type of institution. Actions must be developed to promote better health conditions in LTIE, such as nutrition consulting and physical therapy, to improve quality of life.
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Affiliation(s)
- Javier Jerez-Roig
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte (UFRN). Av. Senador Salgado Filho 1787, Lagoa Nova. 59010-000 Natal RN Brasil.
| | - Dyego Leandro Bezerra Souza
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte (UFRN). Av. Senador Salgado Filho 1787, Lagoa Nova. 59010-000 Natal RN Brasil.
| | | | | | | | - Nayara Priscila Dantas de Oliveira
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte (UFRN). Av. Senador Salgado Filho 1787, Lagoa Nova. 59010-000 Natal RN Brasil.
| | | | - Kenio Costa Lima
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte (UFRN). Av. Senador Salgado Filho 1787, Lagoa Nova. 59010-000 Natal RN Brasil.
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Almomani FM, Bani-issa W. The incidence of depression among residents of assisted living: prevalence and related risk factors. Clin Interv Aging 2017; 12:1645-1653. [PMID: 29070943 PMCID: PMC5640406 DOI: 10.2147/cia.s147436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study aims to recognize and estimate the prevalence of depression and its risk factors among residents of assisted living facilities (ALs) in Jordan. BACKGROUND Depression is commonly experienced by residents of ALs. The condition is, however, often misunderstood as a part of normal aging and may be overlooked by health care professionals. Little is known about the extent of depression and its risk factors among AL residents in Jordan. SUBJECTS AND METHODS A national representative sample of 221 residents selected from all AL units across Jordan was recruited to the study. Data on expected risk factors for depression were collected, including sociodemographics; smoking status; number of roommates; number of family members; assessments for cognitive functioning, for lower limb functioning, for hand, shoulder, and arm impairments; and oral health status. Levels of depression among the sample respondents were also assessed. RESULTS The study found that around 60% of the participants reported depressive manifestations, with 48.0% of AL residents exhibiting impaired cognitive functions, one-third (33.2%) having >50% upper limb disability, two-thirds (63.2%) being at moderate risk of falls, and 69.7% having fair to poor oral health status. Being female, and having a higher level of education, disability of the upper limbs, and impairment of cognitive functions were found to be independent risk factors for depression in participants. CONCLUSION Depression is relatively common among residents of AL units in Jordan. Health care professionals, nurses, physiotherapists, and dentists working in these facilities need to work cooperatively to identify the manifestations of depression in residents and collaboratively implement the best practice in the treatment of depression and circumvent its long-term impacts on the health of residents.
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Affiliation(s)
- Fidaa M Almomani
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Wegdan Bani-issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Hasan SS, Kow CS, Thiruchelvam K, Chong DWK, Ahmed SI. An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia. Neuroepidemiology 2017; 49:82-90. [PMID: 28892805 DOI: 10.1159/000480433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/AIMS Old age and institutionalization in care homes are associated with increased use of risk medications affecting the central nervous system (CNS). This study evaluated medication utilization and appropriateness; and assessed frailty among residents of Malaysian aged care homes. METHODS The subjects of this study included 202 elderly (≥65 years) residents of 17 aged care homes in suburban peninsular Malaysia. Frailty was measured using the Groningen Frailty Indicator (GFI) score and independence in daily living was measured as KATZ activity of daily living score. Medication appropriateness was assessed using the Medication Appropriateness Index (MAI) and 2015 Beers' criteria for Potentially Inappropriate Medication (PIM). RESULTS CNS medications constituted about 16% of the total, with an average of 0.8 ± 1.1 medications per resident, which reduced to 0.5 ± 0.8 medications after 3 months. Frailty (154/202) and polypharmacy (90/202) were highly prevalent in study subjects. Subjects on CNS medications had significantly higher GFI score (7.1 vs. 5.9; p = 0.031), polypharmacy (57.8 vs. 35.3%; p = 0.002), number of PIMs (0.9 vs. 0.2; p = 0.001), and mean summed MAI score (3.6 vs. 2.6; p = 0.015) than subjects not on CNS medications. Medication number was also significantly correlated with GFI (r = 0.194; p = 0.006) and KATZ (r = 0.141; p = 0.046) scores. CONCLUSION Frailty and polypharmacy were highly prevalent among aged care home subjects taking CNS medications. These findings support the notion that periodic regular medication review should improve the overall use of medications in elderly patients.
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Affiliation(s)
- Syed Shahzad Hasan
- International Medical University, Jalan Jalil Perkasa, Bukit Jalil, Kuala Lumpur, Malaysia
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Sánchez-García S, Gallegos-Carrillo K, Espinel-Bermudez MC, Doubova SV, Sánchez-Arenas R, García-Peña C, Salvà A, Briseño-Fabian SC. Comparison of quality of life among community-dwelling older adults with the frailty phenotype. Qual Life Res 2017; 26:2693-2703. [PMID: 28667436 DOI: 10.1007/s11136-017-1630-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the perception of the quality of life (QOL) of community-dwelling older adults with the phenotype of frailty. METHODS Cross-sectional analysis of baseline data of the "Cohort of Obesity, Sarcopenia and Frailty of Mexican Older Adults" (COSFOMA). Operationalization of frailty was carried out using the phenotype as follows: weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness. QOL was measured using two scales: World Health Organization Quality of Life of Older Adults (WHOQOL-OLD), which is a specific instrument for the elderly population, and Short Form-36 Health Survey (SF-36), a generic instrument to evaluate the QOL related to health. One-way analyses of variance were conducted to assess the differences among the three phenotypes of frailty and QOL perception. RESULTS There were 1252 older adult participants who were analyzed; 11.2% (n = 140) had frailty, 50.3% (n = 630) pre-frailty and 38.5% (n = 482) were not frail. The mean (±SD) total score of the WHOQOL-OLD according to the phenotype of frailty was 60.3 (13.9) for those with frailty, 67.4 (12.7) pre-frailty and 72.4 (11.2) not frail (ANOVA, p < 0.001). The mean (±SD) of the SF-36 of the physical and mental component measures the sum, 38.9 (9.9) and 41.9 (11.3) with frailty, 45.7 (9.1) and 46.6 (9.8) pre-frailty, and 49.6 (7.3) and 49.4 (7.9) not frail, respectively (ANOVA, p < 0.001). CONCLUSIONS Frailty is observed in 1/10 community-dwelling older adults. Those with frailty and pre-frailty had a lower perception of QOL compared with those who were not frail.
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Affiliation(s)
- Sergio Sánchez-García
- Epidemiological Research Unit and Health Services, Aging AreaXXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico. .,Unidad de Investigación en Epidemiología y Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI. IMSS, Avenida Cuauhtémoc No. 330., Edificio CORCE, Tercer piso. Col. Doctores, Delegación Cuauhtémoc, 06725, México, D.F., Mexico.
| | - Katia Gallegos-Carrillo
- Epidemiological Research Unit and Health Services, Mexican Social Security Institute, Mexico City, Morelos, Mexico
| | - María Claudia Espinel-Bermudez
- Medical Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialty Hospital, National Medical Center West, Mexican Social Security Institute, Guadalajara, Mexico
| | - Svetlana V Doubova
- Epidemiological Research Unit and Health Services, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Rosalinda Sánchez-Arenas
- Epidemiological Research Unit and Health Services, Aging AreaXXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Carmen García-Peña
- National Institute of Geriatrics, National Institutes of Health of Mexico, Ministry of Health, Mexico City, Mexico
| | - Antoni Salvà
- Fundació Salut i Envelliment, Autonomous University of Barcelona, Barcelona, Spain
| | - Silvia C Briseño-Fabian
- Family Medicine Unit No. 14, North Delegation, Mexican Social Security Institute, Mexico City, Mexico
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Serrano MD, Garrido M, Fuentes RM, Simón MJ, Díaz MJ. The impact of biological frailty syndrome on quality of life of nursing home residents. Appl Nurs Res 2017; 35:112-117. [DOI: 10.1016/j.apnr.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022]
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Korall AMB, Godin J, Feldman F, Cameron ID, Leung PM, Sims-Gould J, Robinovitch SN. Validation and psychometric properties of the commitment to hip protectors (C-HiP) index in long-term care providers of British Columbia, Canada: a cross-sectional survey. BMC Geriatr 2017; 17:103. [PMID: 28468679 PMCID: PMC5415742 DOI: 10.1186/s12877-017-0493-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND If worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool. METHODS We conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, "Do you think of yourself as a champion of hip protectors", rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn't. RESULTS Hierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach's alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p < 0.01) increase in C-HiP Index score. Median C-HiP Index scores were 4.3-points lower (p < 0.01) among respondents aware of a protected fall causing hip fracture, and 7.0-points higher (p < 0.01) among respondents who agreed in the existence of a champion of hip protectors within their home. CONCLUSIONS We offer evidence of the psychometric properties of the C-HiP Index. The development of a valid and reliable assessment tool is crucial to understanding the factors that govern adherence to hip protectors in long-term care.
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Affiliation(s)
- Alexandra M B Korall
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada.
| | - Judith Godin
- Geriatric Medicine Research Unit, Nova Scotia Health Authority, 5955 Veteran's Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Fabio Feldman
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Patient Safety and Injury Prevention, Fraser Health Authority, Suite 400, 13450 102nd Avenue, Surry, BC, V3T 5X3, Canada
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, 2065, Australia
| | - Pet-Ming Leung
- Patient Safety and Injury Prevention, Fraser Health Authority, Suite 400, 13450 102nd Avenue, Surry, BC, V3T 5X3, Canada.,New Vista Care Home, 7550 Rosewood Street, Burnaby, BC, V5E 3Z3, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada.,Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Stephen N Robinovitch
- Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada
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Mazimba S, Holland E, Nagarajan V, Mihalek AD, Kennedy JLW, Bilchick KC. Obesity paradox in group 1 pulmonary hypertension: analysis of the NIH-Pulmonary Hypertension registry. Int J Obes (Lond) 2017; 41:1164-1168. [PMID: 28209971 DOI: 10.1038/ijo.2017.45] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The 'obesity paradox' refers to the fact that obese patients have better outcomes than normal weight patients. This has been observed in multiple cardiovascular conditions, but evidence for obesity paradox in pulmonary hypertension (PH) remains sparse. METHODS We categorized 267 patients from the National Institute of Health-PH registry into five groups based on body mass index (BMI): underweight, normal weight, overweight, obese and morbidly obese. Mortality was compared in BMI groups using the χ2 statistic. Five-year probability of death using the PH connection (PHC) risk equation was calculated, and the model was compared with BMI groups using Cox proportional hazards regression and Kaplan-Meier (KM) survival curves. RESULTS Patients had a median age of 39 years (interquartile range 30-50 years), a median BMI of 23.4 kg m-2 (21.0-26.8 kg m-2) and an overall mortality at 5 years of 50.2%. We found a U-shaped relationship between survival and 1-year mortality with the best 1-year survival in overweight patients. KM curves showed the best survival in the overweight, followed by obese and morbidly obese patients, and the worst survival in normal weight and underweight patients (log-rank P=0.0008). In a Cox proportional hazards analysis, increasing BMI was a highly significant predictor of improved survival even after adjustment for the PHC risk equation with a hazard ratio for death of 0.921 per kg m-2 (95% confidence interval: 0.886-0.954) (P<0.0001). CONCLUSION We observed that the best survival was in the overweight patients, making this more of an 'overweight paradox' than an 'obesity paradox'. This has implications for risk stratification and prognosis in group 1 PH patients.
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Affiliation(s)
- S Mazimba
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - E Holland
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - V Nagarajan
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - A D Mihalek
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J L W Kennedy
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - K C Bilchick
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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Lee IC, Chiu YH, Lee CY. Exploration of the importance of geriatric frailty on health-related quality of life. Psychogeriatrics 2016; 16:368-375. [PMID: 26756915 DOI: 10.1111/psyg.12179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The ageing of the population is a demographic trend globally. Promoting the health of elderly persons has become a crucial priority. However, knowledge about the relationship between frailty and quality of life (QoL) remains limited. This research aimed to investigate the association between elderly frailty and QoL, and to identify whether frailty or current health status more significantly affects the QoL of elderly persons. METHODS This research began in 2012, and by the end of the study in April 2013, 375 samples had been collected. Structured questionnaires and the face-to-face questionnaire interviews were used. Multiple linear regression, t-test, and one-way anova were administered. RESULTS Elderly individuals who were hospitalized performed worse in the physical health QoL domain, whereas those who regularly attended outpatient follow-ups performed worse in the mental health QoL domain. QoL was only partially affected in both groups. All QoL domains were affected in elderly individuals with symptoms of frailty. Age, marital status, and financial status significantly affect health-related QoL. CONCLUSION Geriatric frailty significantly affects general QoL. Early screening of frailty-related conditions among the elderly can prompt early and proper intervention for this population.
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Affiliation(s)
- I-Chen Lee
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Hsien Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ying Lee
- Department of Family Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
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Juma S, Taabazuing MM, Montero-Odasso M. Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay. Can Geriatr J 2016; 19:34-9. [PMID: 27403211 PMCID: PMC4922366 DOI: 10.5770/cgj.19.196] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Frailty is characterized by increased vulnerability to external stressors. When frail older adults are admitted to hospital, they are at increased risk of adverse events including falls, delirium, and disability. The Clinical Frailty Scale (CFS) is a practical and efficient tool for assessing frailty; however, its ability to predict outcomes has not been well studied within the acute medical service. Objective To examine the CFS in elderly patients admitted to the acute medical ward and its association with length of stay. Design Prospective cohort study in an acute care university hospital in London, Ontario, Canada, involving 75 patients over age 65, admitted to the general internal medicine clinical teaching units (CTU). Measurements Patient demographics were collected through chart review, and CFS score was assigned to each patient after brief clinician assessment. The CFS ranges from 1 (very fit) to 9 (terminally ill) based on descriptors and pictographs of activity and functional status. The CFS was collapsed into three categories: non-frail (CFS 1–4), mild-to-moderately frail (CFS 5–6), and severely frail (CFS 7–8). Outcomes of length of stay and 90-day readmission were gathered through the LHSC electronic patient record. Results Severe frailty was associated with longer lengths of stay (Mean = 12.6 ± 12.7 days) compared to mild-to-moderate frailty (mean = 11.2 ± 10.8 days), and non-frailty (mean = 4.1 ± 2.1 days, p = .014). This finding was significant after adjusting for age, sex, and number of medications. Participants with higher frailty scores showed higher readmission rates when compared with those with no frailty (31.2% for severely frail, vs. 34.2% for mild-to-moderately frail vs. 19% for non-frail) although there was no significant difference in the adjusted analysis. Conclusion The CFS helped identify patients that are more likely to have prolonged hospital stays on the acute medical ward. The CFS is an easy to use tool which can detect older adults at high risk of complicated course and longer stay. Objective early identification of seniors with frailty in acute care units can help to target interventions to prevent complications and to implement effective discharge planning in high risk older adults.
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Affiliation(s)
- Salina Juma
- Department of Medicine, Internal Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON
| | - Mary-Margaret Taabazuing
- Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON
| | - Manuel Montero-Odasso
- Department of Medicine, Internal Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON;; Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON;; Gait and Brain Lab, Lawson Health Research Institute, Parkwood Hospital, London, ON
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Abstract
As Canada's population ages, frailty - with its increased risk of functional decline, deterioration in health status, and death - will become increasingly common. The physiology of frailty reflects its multisystem, multi-organ origins. About a quarter of Canadians over age 65 are frail, increasing to over half in those older than 85. Our health care system is organized around single-organ systems, impairing our ability to effectively treat people having multiple disorders and functional limitations. To address frailty, we must recognize when it occurs, increase awareness of its significance, develop holistic models of care, and generate better evidence for its treatment. Recognizing how frailty impacts lifespan will allow for integration of care goals into treatment options. Different settings in the Canadian health care system will require different strategies and tools to assess frailty. Given the magnitude of challenges frailty poses for the health care system as currently organized, policy changes will be essential.
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Chang SF, Wen GM. Association of frail index and quality of life among community-dwelling older adults. J Clin Nurs 2016; 25:2305-16. [PMID: 27161863 DOI: 10.1111/jocn.13248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the independent effect of frailty on quality of life. BACKGROUND The World Health Organisation has proposed that frailty be used to indicate a lack of successful ageing. However, studies investigating the relationship between frail phenotypes and quality of life are lacking. DESIGN This research employed a cross-sectional design. METHODS The Study of Osteoporotic Fractures index was used based on the following three criteria: unexpected weight loss, inability to rise from a chair without using the armrests five times, and feeling a lack of energy. Participants who fulfilled more than two, one or zero criteria were considered as frail, prefrail or robust respectively. Moreover, this study used the Taiwanese version of the World Health Organisation Quality of Life-BREF to assess the quality of life of older people. A multiple linear regression was performed to investigate the independent effect of frail status on each quality of life subscale. RESULTS A total of 239 older people [average age = 74·77 years; standard deviation = 7·02 years; 104 males (43·5%) and 135 females (56·5%)] participated in this study. The multiple linear regression analysis showed that the older people who were more advanced in age and had been diagnosed with a greater number of chronic diseases had a lower comprehensive quality of life. The Study of Osteoporotic Fractures index was associated only with the environmental domain of the World Health Organisation Quality of Life-BREF. CONCLUSIONS Compared with robust and prefrail older people, frail older people have worse biomarkers, health statuses, and quality of life. The Study of Osteoporotic Fractures index was correlated only with the quality of life environmental domain. RELEVANCE TO CLINICAL PRACTICE Professional nurses must understand the differences among frail, prefrail and robust older people with regard to their biomarkers, health status, and quality of life. In addition, a comprehensive nursing intervention programme must be developed to improve the quality of life of older people.
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Affiliation(s)
- Shu-Fang Chang
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Gi-Mi Wen
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
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Abstract
Cardiovascular disease (CVD) is a common problem in the elderly. In particular, the morbidity and mortality of patients with heart failure (HF) increase with age. The poor outcomes of elderly patients with HF can be explained partly by cardiac aging at the cellular and organ levels. Moreover, recent evidence has demonstrated that functional evaluation, which may reflect the status of individual aging, predicts mortality in patients with HF. Age-related changes occur throughout the body and in virtually all organ systems. Thus, we should pay more attention to geriatric conditions when treating patients with HF. Frailty represents a complex clinical syndrome that results from multiple impairments across different organs and is characterized by decreased physiological reserves and increased vulnerability to stressors. Frail patients with CVD have a worse prognosis than non-frail patients. Evidence demonstrates that frailty is an independent risk factor for incident HF among older people. The ways in which cellular senescence promotes age-related CVD and frailty remain an important issue in the biology of aging and clinical geriatrics. Senescent cells that have acquired a senescence-associated secretory phenotype (SASP) can cause local and potentially systemic inflammation. SASP might be a key phenomenon in the association between cellular senescence and the development of age-related CVD and frailty. Frailty is a dynamic and potentially reversible state; therefore, translational research efforts are focused on obtaining mechanistic insights into the pathobiology of frailty, the development of novel therapeutics, and the identification of biomarkers for frailty. This is particularly important in developed countries that are confronted with an aging society.
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Lisiak M, Uchmanowicz I, Wontor R. Frailty and quality of life in elderly patients with acute coronary syndrome. Clin Interv Aging 2016; 11:553-62. [PMID: 27217737 PMCID: PMC4862345 DOI: 10.2147/cia.s99842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Frail elderly people are at risk of developing adverse health outcomes such as disability, hospitalization, and mortality. In recent years, the literature has drawn attention to the role of frailty syndrome (FS) in acute coronary syndrome (ACS). There are few studies regarding the relationship between two multidimensional variables such as FS and quality of life (QoL). Objective The aim of the study was to investigate the relationship between FS and early QoL of elderly patients with ACS (≥65 years old). Methods The study was conducted among 91 patients aged 65 years and over with ACS. The MacNew questionnaire was used to evaluate QoL and the Tilburg frailty indicator to evaluate frailty. Results FS was present in 82.4% of patients. The average Tilburg frailty indicator score was 7.43±2.57. A negative correlation between the global values of FS and QoL was shown (r=−0.549, P<0.05). The vulnerability factors that negatively affected early QoL were: FS, marital status, conservative therapy, and hypertension. In multivariate analysis, FS was found to be the independent predictor of worse QoL (β ± standard error −0.277±0.122, P=0.026). Conclusion The presence of FS has a negative impact on early QoL in patients with ACS. The study suggests that in elderly patients with ACS, there is a need to identify frailty in order to implement additional therapeutic and nursing strategies in ACS.
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Affiliation(s)
- Magdalena Lisiak
- Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland
| | | | - Radosław Wontor
- Department of Cardiology, T. Marciniak Lower Silesian Specialist Hospital, Wroclaw, Poland
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Papaioannou A, Kennedy CC, Ioannidis G, Cameron C, Croxford R, Adachi JD, Mursleen S, Jaglal S. Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012. Osteoporos Int 2016; 27:887-897. [PMID: 26801930 PMCID: PMC5096943 DOI: 10.1007/s00198-015-3477-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/29/2015] [Indexed: 01/25/2023]
Abstract
SUMMARY In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. INTRODUCTION This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. METHODS This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). RESULTS Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. CONCLUSION Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.
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Affiliation(s)
- A Papaioannou
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
| | - C C Kennedy
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - G Ioannidis
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - C Cameron
- International Centre for Disability and Rehabilitation, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - R Croxford
- Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada
| | - J D Adachi
- Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - S Mursleen
- GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - S Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Abstract
BACKGROUND/OBJECTIVES To investigate the predictive validity of the short, simple FRAIL-NH frailty screening tool in the long term care population and to then compare the predictive validity with the frailty index (FI) for 6-month adverse health outcomes. DESIGN Retrospective study using the Minimum Data Set (MDS) 3.0 and chart review from June-December 2014. SETTING Two Long Term Care Facilities in Saint Louis, MO. PARTICIPANTS 270 patients ages ≥ 65 years old residing in long term care. MEASUREMENTS Frailty was measured using the FRAIL-NH and Frailty Index (FI) criteria. Adverse outcomes measured at 6-month follow-up included falls, hospitalizations, and hospice enrollment/mortality. RESULTS Based on screening tool used frailty prevalence was 48.7% for FRAIL-NH and 30.3% for FI. The FRAIL-NH pre-frail (Adjusted Odds Ratio [AOR]=2.62; 95% Confidence Interval [CI]=1.25-5.54; p=0.11) classification was associated with 6 month risk of falling and mortality/hospice enrollment was associated with the frail classification, AOR=3.96 (1.44-10.87, p=0.007). Combining the pre-frail and frail categories both measures predicted 6 month mortality with the FRAIL-NH being the strongest predictor (AOR=3.36; 95%CI=1.26-8.98; p=0.016) and the FI was a more modest predictor with an AOR of 2.28; 95%CI=1.01-5.15; p=0.047. When directly comparing the FRAIL-NH to the FI, the FRAIL-NH pre-frail were at increased risk of falling, AOR=2.42 (1.11-5.92, p=0.027) and the FRAIL-NH frail were at increased risk of hospice enrollment/death, OR=3.25 (1.04- 10.86) p=0.044. CONCLUSION In comparison to the FI, the FRAIL-NH preformed just as well at screening for frailty and was a slightly better predictor of adverse outcomes. The FRAIL-NH is a brief, easy-to-administer frailty screening tool appropriate for long term care patients and predicts increased risk of falls in the pre-frail and mortality/hospice enrollment in the frail.
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Affiliation(s)
- E W Kaehr
- Ellen W. Kaehr, M.D. Division of Geriatrics, Department of Internal Medicine, 1402 South Grad Boulevard, St. Louis, MO 63104, email , telephone 314-977-8462, fax 314-771-8575
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Naylor MD, Hirschman KB, Hanlon AL, Abbott KM, Bowles KH, Foust J, Shah S, Zubritsky C. Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports. J Am Med Dir Assoc 2015; 17:44-52. [PMID: 26412018 DOI: 10.1016/j.jamda.2015.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. DESIGN A prospective, observational, longitudinal cohort design. SETTING Nursing homes (NHs), assisted living facilities (ALFs), community. PARTICIPANTS A total of 470 older adults who were first-time recipients of LTSS. MEASUREMENT Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. RESULTS Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001). CONCLUSIONS Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.
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Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Alexandra L Hanlon
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Katherine M Abbott
- Miami University, Department of Sociology and Gerontology, Scripps Research Center, Oxford, OH
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Janice Foust
- College of Nursing and Health Sciences, University of Massachusetts - Boston, Boston, MA
| | - Shivani Shah
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
| | - Cynthia Zubritsky
- University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA
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Kennedy CC, Ioannidis G, Thabane L, Adachi JD, O’Donnell D, Giangregorio LM, Pickard LE, Papaioannou A. Osteoporosis prescribing in long-term care: impact of a provincial knowledge translation strategy. Can J Aging 2015; 34:137-48. [PMID: 25850439 PMCID: PMC5104546 DOI: 10.1017/s0714980815000057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: -3.9, 12.0; p = .318), and 0.2 per cent (95% CI: -3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.
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Affiliation(s)
- Courtney C. Kennedy
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - George Ioannidis
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University
- St Joseph’s Healthcare – Hamilton
| | - Jonathan D. Adachi
- Department of Medicine, McMaster University
- St Joseph’s Healthcare – Hamilton
- Alliance for Better Bone Health Chair in Rheumatology
| | | | | | - Laura E. Pickard
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University
- St. Peter’s Hospital, GERAS Centre
- Eli Lilly Canada Chair in Osteoporosis
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Chen IH, Brown R, Bowers BJ, Chang WY. Job Demand and Job Satisfaction in Latent Groups of Turnover Intention Among Licensed Nurses in Taiwan Nursing Homes. Res Nurs Health 2015; 38:342-56. [DOI: 10.1002/nur.21667] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/10/2022]
Affiliation(s)
- I-Hui Chen
- Assistant Professor, Department of Nursing; Asia University; 500 Lioufeng Rd., Wufeng District, Taichung 41354 Taiwan
| | - Roger Brown
- Professor, School of Nursing; University of Wisconsin; Madison Wisconsin
| | - Barbara J. Bowers
- Professor, School of Nursing; University of Wisconsin; Madison Wisconsin
| | - Wen-Yin Chang
- Professor, Graduate Institute of Nursing, College of Nursing; Taipei Medical University; Taipei Taiwan
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Abstract
RÉSUMÉLa qualité de vie (QV) dont bénéficient les résidents des centres d'hébergement de soins de longue durée (SLD) est un résultat important des soins. Cette étude descriptive transversale a examiné la qualité de vie auto-declarée de résidents des établissements de SLD au Canada, tout en utilisant l'auto-évaluation interRAI Nursing Home Quality of Life Survey. Un objectif secondaire était de tester les propriétés pschométriques de l'instrument. Les tests psychométriques de l'instrument ont soutenu sa fiabilité et la validité de sa convergence et de son contenu pour l'évaluation de QV des résidents. Les résultats ont montré que les résidents ont évalués positivement plusieurs aspects de leur vie, comme d'avoir la vie privée lors des visites (76,9%) et l'honnêteté du personnel en traitant avec eux (73,6%). Les résidents ont accordé des taux inférieures à d'autres aspects, comme l'autonomie, la liaison entre le personnel et les résidents, et les relations personnelles. Les résultats suggèrent des lacunes importantes entre les philosophies de soins dans les établissements et leur traduction dans un environnement de soins ou les soins sont vraiment dirigés aux résidents. En outre, les résultats ont des implications potentielles pour la planification de soins aux résidents, la programmation de l'installation, le développement de la politique sociale et de la recherche future.
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Mulasso A, Roppolo M, Rabaglietti E. The role of individual characteristics and physical frailty on health related quality of life (HRQOL): A cross sectional study of Italian community-dwelling older adults. Arch Gerontol Geriatr 2014; 59:542-8. [DOI: 10.1016/j.archger.2014.08.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 11/24/2022]
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