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Yang S, Wang S, Liu G, Li R, Li X, Chen S, Zhao Y, Liu M, Liu Y, He Y. The relationship between sleep status and activity of daily living: based on China Hainan centenarians cohort study. BMC Geriatr 2023; 23:796. [PMID: 38049752 PMCID: PMC10694970 DOI: 10.1186/s12877-023-04480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE This study, based on the China Hainan Centenarians Cohort Study (CHCCS), aims to comprehensively describe the characteristic of daytime, night and total sleep duration, sleep quality and different sleep mode of Hainan centenarians and their associations with activity of daily living (ADL) functions. METHOD The baseline data of CHCCS was used. ADL function was evaluated the Bathel index, sleep quality was evaluated by Pittsburgh sleep quality index (PSQI), sleep status including daytime, night and total sleep duration as well as sleep quality and sleep mode. Multivariate logistic regression model was used to explore the association between sleep status and ADL disability and ADL moderate & severe disability. RESULTS A total of 994 centenarians were included in this study with the age range 100-116 years old. Compared with the centenarians who sleep 6-9 h at night and < 2 h in the daytime, the adjusted OR between sleep > 9 h at night and sleep ≥ 2 h in the daytime and ADL disability was 2.93 (95% CI: 1.02-8.44), and adjusted OR of ADL moderate & severe disability was 2.75 (95% CI: 1.56-4.83). Compared with centenarians who sleep for 7-9 h and have good sleep quality, centenarians who sleep for > 9 h and have poor sleep quality have an increased risk of ADL moderate & severe disability (OR = 3.72, 95% CI: 1.54-9.00). CONCLUSION Relation between sleep duration and ADL disability was more significant compared with sleep quality in Hainan centenarians. Poor sleep quality can aggravate the relationship between sleep duration and ADL moderate & severe disability.
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Affiliation(s)
- Shanshan Yang
- Department of Disease Prevention and Control, First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Guangdong Liu
- Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Rongrong Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Xuehang Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Shimin Chen
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Yali Zhao
- Central Laboratory of Hainan Hospital, Chinese People's Liberation Army General Hospital, Sanya, 572013, China
| | - Miao Liu
- Department of Statistics and Epidemiology, Graduate School, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Yunxi Liu
- Department of Disease Prevention and Control, First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
- State Key Laboratory of Kidney Diseases, Beijing, 100853, China.
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Wang H, Pan L, Li B, Ning T, Liang G, Cao Y. Obese elderly patients with hip fractures may have better survival outcomes after surgery. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04787-0. [PMID: 36757466 PMCID: PMC10374744 DOI: 10.1007/s00402-023-04787-0] [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: 11/05/2022] [Accepted: 01/22/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND In recent years, there has been an increasing amount of research on the "obesity paradox". So our primary objective was to explore whether this phenomenon exists in our study, and secondary objective was to determine the effect of body mass index (BMI) on major complications, and the incidence of acute kidney injury (AKI) after hip fracture surgery after controlling for confounding factors. METHODS We included patients over 70 years old with hip fracture who were admitted to the Department of Orthopedics, Peking University First Hospital between 2015 and 2021. Patients were classified as underweight (UW, < 18.5 kg/m2), normal weight (NW, 18.5-24.9 kg/m2), overweight (OW, 25.0-29.9 kg/m2) and obese (OB, ≥ 30.0 kg/m2). We analyzed demographic characteristics, operation information and postoperative outcomes. Using multivariate regression with normal-weight patients as the reference, we determined the odds of 1-year mortality, major complications, and AKI by BMI category. RESULTS A total of 644 patients were included. Nine percent of patients died after 1 year, 18% had major postoperative complications, and 12% had AKI. There was a U-shaped relationship between BMI and the rates of major complications or AKI. However, there was a linear decreasing relationship between 1-year mortality and BMI. After controlling for confounding factors, multivariate regression analysis showed that the risk of 1-year mortality after surgery was 2.24 times higher in underweight patients than in normal-weight patients (P < 0.05, OR: 2.24, 95% CI 1.14-4.42). Compared with normal-weight patients, underweight patients had a 2.07 times increased risk of major complications (P < 0.05, OR 2.07, 95% CI 1.21-3.55), and the risk of major complications in obese patients was 2.57 times higher than that in normal-weight patients (P < 0.05, OR 2.57, 95% CI 1.09-6.09). Compared with normal-weight, underweight patients had a 2.18 times increased risk of AKI (P < 0.05, OR 2.18, 95% CI 1.17-4.05). CONCLUSIONS The 1-year mortality risk of patients with higher BMI was significantly reduced. Besides, compared with normal-weight patients, underweight patients and obese patients have a higher risk of major complications; low-weight and obese patients are at higher risk for AKI.
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Affiliation(s)
- Hao Wang
- Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, XiCheng District, Beijing, 100034, China
| | - Liping Pan
- Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, XiCheng District, Beijing, 100034, China
| | - Baoqiang Li
- Department of Orthopedics, Beijing Chao-Yang Hospital, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Taiguo Ning
- Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, XiCheng District, Beijing, 100034, China
| | - Guanghua Liang
- Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, XiCheng District, Beijing, 100034, China
| | - Yongping Cao
- Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, XiCheng District, Beijing, 100034, China.
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Hordvik HB, Reed IH, Tenden S, Van den Bergh G. Physiotherapists´ experiences with older adults´ rehabilitation trajectory after hip fracture: A qualitative study in Western Norway. Physiother Theory Pract 2023; 39:328-342. [PMID: 34842493 DOI: 10.1080/09593985.2021.2007557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Norway reports the highest prevalence of hip fractures in the world. Physiotherapists play a key-role in rehabilitation. PURPOSE To explore physiotherapists' experiences with rehabilitation trajectories of older adults after hip fracture across levels of care in Norway. METHODS A case-study design combined interviews and group-discussions with 22 physiotherapists in four hospitals and 12 primary health care settings in urban and rural municipalities in 2016 and 2018. A thematic content analysis was applied. RESULTS The physiotherapists viewed the rehabilitation trajectory after hip fracture as fragmented and poorly suited for patients with complex needs. Early hospital discharge, multiple transfers and insufficient staffing, put patients at risk of not receiving adequate services. Most at risk were patients with cognitive impairment. The physiotherapists' role and influence during the patients' rehabilitation course varied, depending on the health-care level. They viewed that current reforms and structural conditions limited the quality of geriatric care and the prioritization of patients with dementia, who risked getting no rehabilitation at all. CONCLUSION An orthogeriatric, person-centered approach to rehabilitation after hip fracture seems beneficial. A focus on cognitive impairment is needed requiring investment and professional skills' development. Political, economic, and organizational interventions should secure that, geriatric patients receive necessary rehabilitation services.
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Affiliation(s)
- Heidi Borgund Hordvik
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingrid Hjohlman Reed
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Susanne Tenden
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Graziella Van den Bergh
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Chung HJ, Kim DS, Lee JW, Hong SI. Analyzing the Risk Factors of Mortality after Osteoporotic Hip Fractures Using the National Health Insurance Service Sample Cohort 2.0 Database. Hip Pelvis 2022; 34:150-160. [PMID: 36299469 PMCID: PMC9577307 DOI: 10.5371/hp.2022.34.3.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose The purpose of this study is to determine risk factors that affect mortality following osteoporotic hip fracture in patients 50 years or older using the National Health Insurance Service (NHIS) sample cohort 2.0 database. Materials and Methods Data from 2,533 patients who satisfied the inclusion criteria for the NHIS sample cohort 2.0 database were used in this study. Data from patients who suffered osteoporotic hip fractures between 2002-2015 were used. An analysis of correlations between the incidence of osteoporotic hip fractures and various factors (sex, age, underlying diseases, etc.) was performed. Analysis of the associations between the mortality of osteoporotic hip fracture and the various factors with hazard ratio (HR) was performed using Cox regression models. Results Patient observation continued for an average of 38.12±32.09 months. During the observation period, a higher incidence of hip fracture was observed in women; however, higher mortality following the fracture was observed in men (HR=0.728; 95% confidence interval [CI], 0.635-0.836). The incidence and mortality of fractures increased when there were increasing age, more than three underlying diseases (HR=1.945; 95% CI, 1.284-2.945), cerebrovascular diseases (HR=1.429; 95% CI, 1.232-1.657), and renal diseases (HR=1.248; 95% CI, 1.040-1.497). Also, higher mortality was observed in patients who were underweight (HR=1.342; 95% CI, 1.079-1.669), current smokers (HR=1.338; 95% CI, 1.104-1.621), and inactivity (HR=1.379; 95% CI, 1.189-1.601). Conclusion Male gender, the presence of cerebrovascular or kidney disease, a more than three underlying diseases, underweight, a current smoker, and inactivity were risk factors that increased mortality.
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Affiliation(s)
- Hoe Jeong Chung
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Doo Sup Kim
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok In Hong
- Internship of Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Lee YH, Kong D, Lee YTH, Lin CH, Liu CT, Chang YC. Functional disabilities and changes in sleep quality and duration among older adults: results from a longitudinal study in China, 2005-2014. Eur Geriatr Med 2022; 13:967-975. [PMID: 35191012 DOI: 10.1007/s41999-022-00619-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We examined the associations of activities of daily living (ADL) and instrumental activities of daily living (IADL) with changes in sleep-related measurements among Chinese older adults from 2005 to 2014. METHODS Four waves of longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS; 2005-2014; n = 42,417) were used. Two sleep-related measurements were included: sleep quality and meeting the recommended daily sleep duration (7-8 h). We used Cox two-state regression models to examine the different states of sleep quality and duration. RESULTS Approximately 43.6% of observations were between 81 and 95 years old, and 35.9% were between 65 and 80 years old. Around 54.8% of observations were female. Older adults with more ADL and IADL limitations had a higher risk of experiencing declines in sleep quality and the transition from meeting to not meeting the recommended sleep duration over time (all p < 0.01). CONCLUSION ADL and IADL limitations are significant risk factors for the development of sleep-related issues over time among Chinese older adults. Functional limitations need to be included in intervention strategies focused on sleep hygiene and studies examining changes in sleep patterns over time.
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Affiliation(s)
- Yen-Han Lee
- Department of Public Health and Sports Medicine, McQueary College of Health and Human Services, Missouri State University, Springfield, MO, USA.
| | - Dexia Kong
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yi-Ting Hana Lee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chia-Hung Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Ti Liu
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Yen-Chang Chang
- Center for General Education, National Tsing Hua University, Hsinchu City, Taiwan.
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Chaudhry YP, Rao SS, Puvanesarajah V, Amin RM, Khanuja HS, Oni JK, Hasenboehler EA, Sterling RS. Complications and 30-Day Mortality Rate After Hip Fracture Surgery in Superobese Patients. J Orthop Trauma 2021; 35:322-328. [PMID: 33165206 DOI: 10.1097/bot.0000000000001987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Paradoxically, overweight and obesity are associated with lower odds of complications and death after hip fracture surgery. Our objective was to determine whether this "obesity paradox" extends to patients with "superobesity." In this study, we compared rates of complications and death among superobese patients with those of patients in other body mass index (BMI) categories. METHODS Using the National Surgical Quality Improvement Program database, we identified >100,000 hip fracture surgeries performed from 2012 to 2018. Patients were categorized as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese (BMI 30-39.9), morbidly obese (BMI 40-49.9), or superobese (BMI ≥50). We analyzed patient characteristics, surgical characteristics, and 30-day outcomes. Using multivariate regression with normal-weight patients as the referent, we determined odds of major complications, minor complications, and death within 30 days by BMI category. RESULTS Of 440 superobese patients, 20% had major complications, 33% had minor complications, and 5.2% died within 30 days after surgery. When comparing patients in other BMI categories with normal-weight patients, superobese patients had the highest odds of major complications [odds ratio (OR): 1.6, 95% confidence interval (CI), 1.2-2.0] but did not have significantly different odds of death (OR: 0.91, 95% CI, 0.59-1.4) or minor complications (OR: 1.2, 95% CI, 0.94-1.4). CONCLUSION Superobese patients had significantly higher odds of major complications within 30 days after hip fracture surgery compared with all other patients. This "obesity paradox" did not apply to superobese patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a Complete Description of Levels of Evidence.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, the Johns Hopkins School of Medicine, Baltimore, MD
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Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients. Clin Nutr 2021; 40:1381-1387. [DOI: 10.1016/j.clnu.2020.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 01/01/2023]
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Li P, Lim ASP, Gao L, Hu C, Yu L, Bennett DA, Buchman AS, Hu K. More random motor activity fluctuations predict incident frailty, disability, and mortality. Sci Transl Med 2020; 11:11/516/eaax1977. [PMID: 31666398 DOI: 10.1126/scitranslmed.aax1977] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
Abstract
Mobile healthcare increasingly relies on analytical tools that can extract meaningful information from ambulatory physiological recordings. We tested whether a nonlinear tool of fractal physiology could predict long-term health consequences in a large, elderly cohort. Fractal physiology is an emerging field that aims to study how fractal temporal structures in physiological fluctuations generated by complex physiological networks can provide important information about system adaptability. We assessed fractal temporal correlations in the spontaneous fluctuations of ambulatory motor activity of 1275 older participants at baseline, with a follow-up period of up to 13 years. We found that people with reduced temporal correlations (more random activity fluctuations) at baseline had increased risk of frailty, disability, and all-cause death during follow-up. Specifically, for 1-SD decrease in the temporal activity correlations of this studied cohort, the risk of frailty increased by 31%, the risk of disability increased by 15 to 25%, and the risk of death increased by 26%. These incidences occurred on average 4.7 years (frailty), 3 to 4.2 years (disability), and 5.8 years (death) after baseline. These observations were independent of age, sex, education, chronic health conditions, depressive symptoms, cognition, motor function, and total daily activity. The temporal structures in daily motor activity fluctuations may contain unique prognostic information regarding wellness and health in the elderly population.
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Affiliation(s)
- Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew S P Lim
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Lei Gao
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Chelsea Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
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Córcoles-Jiménez MP, Candel-Parra E, Del Egido-Fernández MÁ, Villada-Munera A, Moreno-Moreno M, Piña-Martínez AJ, Jiménez-Sánchez MD, Azor-García RJ. Preventing Functional Urinary Incontinence in Hip-Fractured Older Adults Through Patient Education: A Randomized Controlled Trial. J Appl Gerontol 2020; 40:890-901. [PMID: 32865102 DOI: 10.1177/0733464820952608] [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] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate whether an educational intervention would reduce the incidence of functional urinary incontinence (UI) in older adults with a fall-related hip fracture. The project was conducted as a multicenter randomized controlled trial (RCT). A total of 109 patients that had been admitted to six hospitals in Castilla-La Mancha (Spain) for acute treatment of hip fracture, previously continent and without cognitive impairment, were enrolled and randomly assigned to the experimental group (EG) or the control group (CG). Intervention (on EG): urinary habit training (Nursing Interventions Classifications taxonomy) was performed during hospital stay (second to fourth postoperative day), with a telephonic reinforcement 10 days after discharge. The CG received routine care. Primary outcome measure: incidence of UI. Follow-up: telephone assessment 3 and 6 months after discharge (blinded evaluation). The incidence of UI at 6 months was 49% (CG) versus 25.5% (EG) (relative risk = 0.52, 95% confidence interval [0.3, 0.9]; number necessary to treat = 4). The mean of UI episodes was 0.54 (EG) versus 1.8 (CG), p = .007. The educational intervention prevents the development of UI and decreases the number of episodes in case of appearance, in a statistically significant way.
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Affiliation(s)
| | - Eduardo Candel-Parra
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | | | | | - Mónica Moreno-Moreno
- Gerencia de Atención Integrada de Albacete, Hospital General de Albacete, Albacete, Spain
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Ko Y, Lee J, Kim SY, Baek SH. Identification of Factors Related to Functional Decline of Korean Older Adults After Hip Fracture Surgery: A Cross-Sectional Study. Res Gerontol Nurs 2019; 12:312-320. [PMID: 31283829 DOI: 10.3928/19404921-20190702-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/01/2019] [Indexed: 11/20/2022]
Abstract
Reducing functional decline is an essential treatment goal in older adults after hip fracture surgery. The current study examined different effects of functional decline-related factors according to activities of daily living (ADL) and instrumental ADL (IADL) in older adults after hip fracture surgery. A total of 120 participants were included. In quantile regression, preoperative walking and fear of falling were significantly associated with ADLs in the 25th percentile ADL group. Fear of falling was the only significant factor in the poorest IADL group (25th percentile). Efforts should be made to reduce fear of falling after hip fracture surgery. Preoperative walking status was significant in patients with poor ADL after hip fracture surgery; therefore, walking status should be taken into consideration when planning rehabilitation care in this group, so that the best possible ADL outcomes can be attained. [Research in Gerontological Nursing, 12(6),312-320.].
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Associations among hearing loss, hospitalization, readmission and mortality in older adults: A systematic review. Geriatr Nurs 2019; 40:367-379. [DOI: 10.1016/j.gerinurse.2018.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022]
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Mayoral AP, Ibarz E, Gracia L, Mateo J, Herrera A. The use of Barthel index for the assessment of the functional recovery after osteoporotic hip fracture: One year follow-up. PLoS One 2019; 14:e0212000. [PMID: 30730973 PMCID: PMC6366714 DOI: 10.1371/journal.pone.0212000] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
Abstract
The Barthel index evolution was analyzed in a sample of older people with osteoporotic hip fracture in order to verify the influence of comorbidities and cognitive impairment on the physical recovery of those patients, during the first year following the fracture. A prospective observational study was carried out between October 1, 2012 and March 31, 2013. A sample of 247 individuals was initially selected. After a primary revision, 39 participants were excluded (clearly not meeting inclusion criteria, lack of data, or not agree to participate in the study), and finally a total of 208 participants were included in the analysis, 166 women, with an average age of 84.59 years, and 42 men, with an average age of 82.05. 54.80% of all cases were older than 85 years. The mean Barthel index value prior to fracture was 76.63, decreasing to 64.91 at one-year follow-up. Only 22.12% of patients achieved a full recovery for activities of daily living. A statistical analysis was performed by comparing Barthel index recovery depending on the values of Charlson and Pfeiffer indexes, respectively. The mean differences in Barthel index drop between the one-year follow-up and the hospital admission values were found statistical significant (p<0.01). These findings indicate that Charlson and Pfeiffer indexes clearly influence the Barthel index recovery. Low values of Charlson and Pfeiffer indexes resulted in better Barthel index recovery. In conclusion, the Barthel index is a good tool to evaluate the physical recovery after osteoporotic hip fracture.
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Affiliation(s)
- Ana P. Mayoral
- Health Sciences School, University of Zaragoza, Zaragoza, Spain
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragon Institute of Engineering Research, Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragon Institute of Engineering Research, Zaragoza, Spain
| | - Jesús Mateo
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
| | - Antonio Herrera
- Aragon Institute of Engineering Research, Zaragoza, Spain
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- * E-mail:
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Morbidity and Mortality following Surgery for Hip Fractures in Elderly Patients. J Aging Res 2019; 2019:7084657. [PMID: 30867965 PMCID: PMC6379848 DOI: 10.1155/2019/7084657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/24/2018] [Accepted: 12/30/2018] [Indexed: 11/17/2022] Open
Abstract
Aim To determine morbidity and mortality in elderly patients following hip fracture surgery in Egypt and its correlates and to determine the utility of the POSSUM scale to predict morbidity and mortality among our population. Methodology We assessed postoperative morbidity and mortality following hip fracture surgery in a 6-month prospective observational study of 100 elderly patients who were undergoing surgical repair at the beginning of the study. The exclusion criteria included surgically unfit patients and patients refusing to participate in the study. The study was conducted in Ain Shams University Hospital, Ain Shams Specialized Hospital, and El-helal Hospital. Results The subjects were categorized as survivors and nonsurvivors according to the 6-month mortality, and the groups were compared statistically according to this classification. The observed 6-month mortality was 19.56%. POSSUM had high specificity for predicting 6-month survival (97.3%). A multivariate regression analysis revealed that postoperative admission to the intensive care unit and lack of ambulation were major risk factors associated with the 6-month mortality. Conclusions The POSSUM system had high specificity for predicting survivors (97.3%) but failed to predict mortality (sensitivity = 5.6%). The major risks for 6-month mortality are intensive care unit admission and lack of ambulation.
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Moerman S, Mathijssen NM, Tuinebreijer WE, Nelissen RG, Vochteloo AJ. Less than one-third of hip fracture patients return to their prefracture level of instrumental activities of daily living in a prospective cohort study of 480 patients. Geriatr Gerontol Int 2018; 18:1244-1248. [PMID: 30004174 DOI: 10.1111/ggi.13471] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/01/2018] [Accepted: 05/27/2018] [Indexed: 12/26/2022]
Abstract
AIM A significant loss of instrumental activities of daily living (IADL) after a hip fracture has been reported. The aim of the present study was to identify specific predictors for low IADL after a hip fracture, in order to target better postoperative care for these patients. METHODS A prospective observational cohort study of 480 hip fracture patients was carried out. IADL was measured at baseline, and after 3 and 12 months using the Groningen Activity Restriction Scale. Multivariable logistic regression analysis was carried out using age, sex, American Society of Anesthesiologists classification, prefracture living with a partner, prefracture living situation, prefracture use of walking aids, type of fracture, type of anesthesia, length of hospital stay, postoperative complications and prefracture IADL as potential predictors for low IADL after a hip fracture. The correlation between IADL, mobility and living situation, both at admission, and 3 and 12 months postoperatively, were measured. RESULTS Three months after hip fracture treatment, 24% of patients returned to their baseline IADL level, at 12 months postoperative this was 29%. Factors associated with a larger loss in IADL after a hip fracture were older age, prefracture living with a partner, prefracture living at home, prefracture use of walking aids and longer length of hospital stay. The correlation between IADL and living situation was 0.69, and between IADL and use of walking aids was 0.80. CONCLUSIONS A return to prefracture IADL level was low. Healthier patients have a steeper decline in postoperative IADL. Geriatr Gerontol Int 2018; 18: 1244-1248.
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Affiliation(s)
- Sophie Moerman
- Department of Orthopedics, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Nina Mc Mathijssen
- Department of Orthopedics, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Wim E Tuinebreijer
- Department of Surgery/Traumatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rob Ghh Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne Jh Vochteloo
- Department of Orthopedics, Center for Orthopedic Surgery OCON, Hengelo, the Netherlands
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15
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O'Súilleabháin PS, Hughes BM. Neuroticism predicts all-cause mortality over 19-years: The moderating effects on functional status, and the angiotensin-converting enzyme. J Psychosom Res 2018; 110:32-37. [PMID: 29764603 DOI: 10.1016/j.jpsychores.2018.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine if the personality traits neuroticism, extraversion, and openness to experience are related to all-cause mortality in older adults over a follow-up period of 19 years. METHODS Participants were a locally representative sample of 417 older adults (M ± SD = 84.55 ± 8.62 years). Statistical significance levels for hazard ratios were estimated having adjusted for age, sex, education, income, depressive illness, and personality traits. RESULTS A significant effect was observed for neuroticism with each 1 SD increase in neuroticism associated with a 14% increased risk in all-cause mortality (p = 0.031: 95% CI, 1.01-1.28). Following the trichotomization of neuroticism, the hazard for those >1 SD above the mean was significantly greater than the average range (HR = 1.59; p = 0.001; 95% CI, 1.19-2.11). Examination of potential mechanisms revealed that neuroticism significantly moderated the effects of functional status (HRinteration = 1.09; p = 0.018; 95% CI = 1.02-1.17), and the angiotensin-converting enzyme (ACE; HRinteration = 0.88; p = 0.031; 95% CI = 0.79-0.99) on mortality. As such, for each 1 SD increase in neuroticism, the effect rate on all-cause mortality increased by 9% for functional status, and decreased by 12% for ACE. CONCLUSIONS Findings suggest that neuroticism is associated with all-cause mortality in older age. Specifically, persons higher in neuroticism are at a distinctly greater risk of all-cause mortality. Both functional status, and the angiotensin-converting enzyme provide two potential mechanisms of effect in the association between neuroticism and mortality.
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Affiliation(s)
| | - Brian M Hughes
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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16
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A method of decision analysis quantifying the effects of age and comorbidities on the probability of deriving significant benefit from medical treatments. JOURNAL OF COMORBIDITY 2017; 7:50-63. [PMID: 29090189 PMCID: PMC5556438 DOI: 10.15256/joc.2017.7.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 03/08/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The external validity, or generalizability, of trials and guidelines has been considered poor in the context of multiple morbidity. How multiple morbidity might affect the magnitude of benefit of a given treatment, and thereby external validity, has had little study. OBJECTIVE To provide a method of decision analysis to quantify the effects of age and comorbidity on the probability of deriving a given magnitude of treatment benefit. DESIGN We developed a method to calculate probabilistically the effect of all of a patient's comorbidities on their underlying utility, or well-being, at a future time point. From this, we derived a distribution of possible magnitudes of treatment benefit at that future time point. We then expressed this distribution as the probability of deriving at least a given magnitude of treatment benefit. To demonstrate the applicability of this method of decision analysis, we applied it to the treatment of hypercholesterolaemia in a geriatric population of 50 individuals. We highlighted the results of four of these individuals. RESULTS This method of analysis provided individualized quantifications of the effect of age and comorbidity on the probability of treatment benefit. The average probability of deriving a benefit, of at least 50% of the magnitude of benefit available to an individual without comorbidity, was only 0.8%. CONCLUSION The effects of age and comorbidity on the probability of deriving significant treatment benefits can be quantified for any individual. Even without consideration of other factors affecting external validity, these effects may be sufficient to guide decision-making.
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17
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Müller M, Ricklin ME, Weiler S, Exadaktylos AK, Arampatzis S. Emergency medicine in the extreme geriatric era: A retrospective analysis of patients aged in their mid 90s and older in the emergency department. Geriatr Gerontol Int 2017; 18:415-420. [DOI: 10.1111/ggi.13192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/21/2017] [Accepted: 08/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - Meret E Ricklin
- Department of Emergency Medicine, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - Stefan Weiler
- Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - Spyridon Arampatzis
- Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
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18
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Yoshizawa T, Nishino T, Mishima H, Ainoya T, Yamazaki M. Rehabilitation in a convalescent rehabilitation ward following an acute ward improves functional recovery and mortality for hip fracture patients: a sequence in a single hospital. J Phys Ther Sci 2017. [PMID: 28626336 PMCID: PMC5468211 DOI: 10.1589/jpts.29.1102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
[Purpose] The convalescent rehabilitation ward (CRW) plays an important role for hip fracture patients in Japanese super-aged society. The purpose of this study is to clarify the usefulness of the CRW concomitant with acute wards in a single hospital. [Subjects and Methods] 110 hip fracture patients were evaluated; 63 patients were moved from acute wards to the CRW in the same hospital (Group C) and 47 patients were treated in acute wards only (Group A). Patient selection was determined by each attending doctor. The outcomes were examined from medical records. [Results] 90.5% of patients in the group C were discharged to home and 57.4% in the group A. 92.9% of patients in the group C had regained their ambulatory ability at discharge and 88.9% in the group A. The average total functional independence measure scores at discharge were 96.4 in the group C and 85.0 in the group A. The one-year mortality was 2.4% in the group C and 8.3% in the group A. [Conclusion] Using a CRW concomitant with acute wards in a single hospital could achieve a high home-discharge rate, good functional recovery, and low mortality in hip fracture patients.
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Affiliation(s)
- Tomohiro Yoshizawa
- Department of Orthopaedic Surgery, Tsukuba Memorial Hospital, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Tomofumi Nishino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Takeshi Ainoya
- Department of Orthopaedic Surgery, Tsukuba Memorial Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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19
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Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend. Sci Rep 2017; 7:1233. [PMID: 28450739 PMCID: PMC5430676 DOI: 10.1038/s41598-017-01308-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/27/2017] [Indexed: 11/09/2022] Open
Abstract
Proximal femoral fractures are a major public health concern with estimated annual direct and social costs amounting to £2 billion and average 30-day mortality risk of 7.5%. In response to the recent debate over out-of-hours hospital provision we investigated the ‘weekend effect’ at a major trauma centre, caring for acute injuries. A single centre, multi-surgeon review of 2060 patients performed. The distribution of patient and treatment variables compared in patients admitted on a weekday or the weekend. Fewer patients met performance indicators during weekend admission, time to surgery (63 vs. 71%) and time to geriatric review (86 vs. 91%). Weekend admission 30-day mortality was marginally lower than weekday (9.7% vs. 10.2%, OR 0.94, 95% CI 0.67 to 1.32, p = 0.7383). Increasing age, female gender, co-morbidities and confusion increased mortality risk. Binary regression analysis including these variables found no significant ‘weekend effect’. Despite the unit observing an increasing workload in the last five years, with meticulous workforce planning, senior doctor provisions and careful use of resources, it is possible to provide a seven-day fracture neck of femur service with no variation in thirty-day mortality by the day of admission.
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20
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Ritchie CS, Kelley AS, Stijacic Cenzer I, Smith AK, Wallhagen ML, Covinsky KE. High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. J Pain Symptom Manage 2016; 52:533-538. [PMID: 27521282 PMCID: PMC5357076 DOI: 10.1016/j.jpainsymman.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 06/27/2016] [Accepted: 07/29/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care. OBJECTIVES Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture. METHODS Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression. RESULTS Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls. CONCLUSIONS A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.
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Affiliation(s)
- Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Jewish Home of San Francisco Center for Research on Aging, San Francisco, California, USA.
| | - Amy S Kelley
- Icahn School of Medicine at Mount Sinai, New York, New York and the James J Peters VA Medical Center, Bronx, New York, USA
| | - Irena Stijacic Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA
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21
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Seitz DP, Gill SS, Austin PC, Bell CM, Anderson GM, Gruneir A, Rochon PA. Rehabilitation of Older Adults with Dementia After Hip Fracture. J Am Geriatr Soc 2016; 64:47-54. [PMID: 26782851 DOI: 10.1111/jgs.13881] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effects of postoperative rehabilitation on the outcomes of older adults with dementia who experienced hip fracture. DESIGN Retrospective cohort study. SETTING Ontario, Canada. PARTICIPANTS Community-dwelling adults with dementia who underwent hip fracture surgery between 2003 and 2011. Participants were categorized as no rehabilitation, complex continuing care (CCC), home-care based rehabilitation (HCR), and inpatient rehabilitation (IPR). MEASUREMENTS Time to long-term care (LTC) placement, mortality, and risk of repeat hip fracture and falls. RESULTS Of 11,200 individuals with dementia who experienced a hip fracture during the study period, 4,494 (40.1%) received no rehabilitation, 2,474 (22.1%) were admitted to CCC, 1,157 (10.3%) received HCR, and 3,075 (27.4%) received IPR. HCR and IPR were associated with less risk of LTC admission after discharge from hospital than no rehabilitation. All three forms of rehabilitation were associated with lower risk of mortality than no rehabilitation, with the greatest effect observed with IPR. HCR was associated with a higher risk of falls than no rehabilitation (P=.03); there were no other significant between-group differences in risk of falls or repeat fractures (P>.05). CONCLUSION Postfracture rehabilitation for older adults with dementia is associated with lower risk of LTC placement and mortality. Improving access to rehabilitation services for this vulnerable population may improve postfracture outcomes.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Chaim M Bell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, Mt. Sinai Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paula A Rochon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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22
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Zhou Y, Putter H, Doblhammer G. Years of life lost due to lower extremity injury in association with dementia, and care need: a 6-year follow-up population-based study using a multi-state approach among German elderly. BMC Geriatr 2016; 16:9. [PMID: 26758623 PMCID: PMC4710990 DOI: 10.1186/s12877-016-0184-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 01/04/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dementia and care need are challenging aging populations worldwide. Lower extremity injury (LEI) in the elderly makes matters worse. Using a multi-state approach, we express the effect of LEI on dementia, care need, and mortality in terms of remaining life expectancy at age 75 (rLE) and years of life lost (YLL). METHODS A population-based random sample of beneficiaries aged 75-95 years was drawn from the largest public health insurer in Germany in 2004 and followed until 2010 (N 62,103; Mean Age ± SD 81.5 ± 4.8 years; Female 71.2%). We defined a five-state model (Healthy, Dementia, Care, Dementia & Care, Dead), and calculated transition-specific hazard ratios of LEI using Cox regression. The transition probabilities as well as the YLL due to LEI were estimated. RESULTS LEI significantly increased the risk for each transition, with a maximum risk for the transition from Healthy to Care (HR: 1.70, 95% CI: 1.63-1.77) and a minimum risk for the transition from Care to Dead (HR: 1.16, 95% CI: 1.10-1.22). If the elderly had LEI-history, their age-specific mortality was generally higher and their probabilities of transient states peaked at younger ages. At age 75, initially dementia-free and care-independent elderly experiencing LEI lost about 2 years of life, of which more than 90% were life years free of dementia or care need. Dementia patients lost about one and a half year, more than 60% were free of long-term care need. CONCLUSIONS LEI not only casts a large health burden on care need, but is also associated with cognitive decline and shortened rLE. LEI plus dementia extend the relative life time in need of care, despite generally shortening rLE. Using the composite measure YLL may help to better convey these results to the elderly, families, and health professionals. This may strengthen preventive measures as well as improve timely and rehabilitative treatment of LEI, not only in cognitive and physically intact elderly.
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Affiliation(s)
- Ying Zhou
- Institute for Sociology and Demography, University of Rostock, Ulmenstrasse 69, 18057, Rostock, Germany.,Rostock Center for the Study of Demographic Change, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Einthovenweg 20, 2333 ZC, Leiden, Netherlands
| | - Gabriele Doblhammer
- Institute for Sociology and Demography, University of Rostock, Ulmenstrasse 69, 18057, Rostock, Germany. .,Rostock Center for the Study of Demographic Change, Konrad-Zuse-Str. 1, 18057, Rostock, Germany. .,German Center for Neurodegenerative Disease, Ludwig-Erhard-Allee 2, 53175, Bonn, Germany.
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23
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Seitz DP, Gill SS, Bell CM, Austin PC, Gruneir A, Anderson GM, Rochon PA. Response to Xue and Colleagues. J Am Geriatr Soc 2015; 63:1974-5. [PMID: 26390006 DOI: 10.1111/jgs.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sudeep S Gill
- Department of Medicine, Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
| | - Chaim M Bell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Paula A Rochon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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24
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González-Zabaleta J, Pita-Fernandez S, Seoane-Pillado T, López-Calviño B, Gonzalez-Zabaleta JL. Comorbidity as a predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int 2015; 16:561-9. [PMID: 25981487 DOI: 10.1111/ggi.12510] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/14/2022]
Abstract
AIM To determine mortality and mobility rates after hip fracture. METHODS A prospective study (n = 199 patients) was carried out in the Health Care Center of A Coruña (Spain) during the period between January 2009 and December 2011. A descriptive study, and Cox and logistic regression analysis were carried out. Informed consent and ethical review board approval were obtained (code 2010/120 CEIC Galicia). RESULTS The patients' mean age was 82.5 ± 8.4 years and 76% were female. The average Charlson Comorbidity Index score was 6.1 ± 2.1. Creatinine clearance <60 mL/min/1.73 m(2) was 44%. The probability of survival 6 months after hip fracture was 89.2% and the survival rate at 12 months was 81.4%. Cox regression analysis showed that the indicator that most influenced mortality rate was comorbidity (HR = 1.133; P = 0.020) and age approaching borderline statistical significance (HR = 1.034; P = 0.064). The Parker Mobility Score decreased significantly (P < 0.001) after hip fracture. Before fracture, 19% of the patients were able to get about the house, 26% were able to get out of the house and 55% were able to go shopping. After hip fracture (90 days), the percentages changed to 56.2%, 19.1% and 24.7%, respectively (P < 0.001). After taking into account age, sex, type of fracture, surgical delay, previous fracture and comorbidity, the only indicator capable of predicting incapacity to walk was comorbidity. CONCLUSIONS Comorbidity is the best predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int 2016; 16: 561-569.
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Affiliation(s)
| | - Salvador Pita-Fernandez
- Clinical Epidemiology and Biostatistics Research Group, Biomedical Research Institute of A Coruña (INIBIC), A Coruña Hospital (CHUAC), SERGAS, University of A Coruña, A Coruña, Spain
| | - Teresa Seoane-Pillado
- Clinical Epidemiology and Biostatistics Research Group, Biomedical Research Institute of A Coruña (INIBIC), A Coruña Hospital (CHUAC), SERGAS, University of A Coruña, A Coruña, Spain
| | - Beatriz López-Calviño
- Clinical Epidemiology and Biostatistics Research Group, Biomedical Research Institute of A Coruña (INIBIC), A Coruña Hospital (CHUAC), SERGAS, University of A Coruña, A Coruña, Spain
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25
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Dependence for basic and instrumental activities of daily living after hip fractures. Arch Gerontol Geriatr 2014; 60:66-70. [PMID: 25465506 DOI: 10.1016/j.archger.2014.10.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/03/2014] [Accepted: 10/30/2014] [Indexed: 11/23/2022]
Abstract
The objective of the study is to determine basic activities of daily living (Barthel Index) and instrumental activities of daily living (Lawton-Brody Index) before and after hip fracture. Follow-up study of patients (n=100) with hip fracture, operated at Complejo Hospitalario Universitario de A Coruña (Spain). Period January/2009-December/2011. Demographic characteristic of the patients, Charlson Index, Glomerular filtration rate, Barthel index, Lawton index, type of proximal femur fracture and surgical treatment delay were recorded. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained. Before fracture were independent for activities of daily living (ADL) a 38.0%, at 90 days were 15.4%. The Barthel index score decreased from 75.2±28.2 to 56.5±31.8) (p<0.0001). If we consider the age, gender, comorbidity (Charlson index), renal function, fracture type and surgical delay objectify the only independent variable to predict dependency effect is age. If we also consider the Barthel score objectify the variable that significantly modifies that score at 90 days is the baseline value of the index. The prevalence of independence for instrumental activities of daily living (IADL) at the baseline moment is 11% and at 90 days is decreased to 2.2%. There is a decrease in the independence effect in all activities. The variable predictor of independence for all activities after taking into consideration age, sex, comorbidity, fracture type, surgical delay and renal function is the baseline score of the Barthel and Lawton index.
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