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Brika M, Mourey F, Kubicki A. Sensory reweighting in frail aged adults: Are the balance deficiencies mainly compensated by visual or podal dependences? Neurosci Lett 2021; 747:135670. [PMID: 33516799 DOI: 10.1016/j.neulet.2021.135670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/21/2020] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postural control is based on the integration of different sensory inputs. The process of scaling the relative importance of these sensory cues (visual, vestibular and proprioceptive) depends on individuals and creates sensory preferences, leading to sensory dependences when one particular source is preponderant. In this context, the literature showed a frequent visual dependence (visual inputs weighting) in aged adults. However, the somaesthetic inputs can also be prioritised in a podal-dependent profile. In the frail aged adults, none study has shown the distribution of these two dependences. RESEARCH QUESTION Which sensory orientation profile is preferentially adopted by frail aged males and females? METHODS In this cross-sectional study, we compared 33 frail aged adults to 16 non frail aged adults during a static postural control task in three conditions on a force platform: i) a standard condition, ii) a no-vision condition and iii) a foam condition. An analysis with the factor sex was also performed in each group of participants. RESULTS The analysis of stabilometric parameters (mean velocity and mean velocity variance) highlighted a significant difference in no-vision or foam conditions when compared to the standard condition in frail aged males and only in the foam condition when compared to the standard condition for females in the frail group. No significant difference was observed between conditions in the control group. SIGNIFICANCE Our study showed the predominance of both visual and podal information in frail aged adults when controlling their posture. Considering the sex factor, frail males were more dependents to their visual cues than frail females. This result should be used when designing the rehabilitation programs in this population.
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Affiliation(s)
- Marine Brika
- Hôpital Nord Franche-Comté, Institut de Formation des Métiers de la Santé, Filière Kinésithérapie - Physiothérapie, 25200, Montbéliard, France; Laboratoire de Neurosciences intégratives et cliniques (EA 482), Université de Bourgogne Franche-Comté, 25000 Besançon, France.
| | - France Mourey
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Espace d'Étude du Mouvement - Étienne Jules MAREY, F-21000, Dijon, France.
| | - Alexandre Kubicki
- Hôpital Nord Franche-Comté, Institut de Formation des Métiers de la Santé, Filière Kinésithérapie - Physiothérapie, 25200, Montbéliard, France; Laboratoire de Neurosciences intégratives et cliniques (EA 482), Université de Bourgogne Franche-Comté, 25000 Besançon, France.
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McCombe G, Fogarty F, Swan D, Hannigan A, Fealy GM, Kyne L, Meagher D, Cullen W. Identified mental disorders in older adults in primary care: A cross-sectional database study. Eur J Gen Pract 2018; 24:84-91. [PMID: 29353511 PMCID: PMC5795746 DOI: 10.1080/13814788.2017.1402884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Identifying and managing mental disorders among older adults is an important challenge for primary care in Europe. Electronic medical records (EMRs) offer considerable potential in this regard, although there is a paucity of data on their use for this purpose. OBJECTIVES To examine the prevalence/treatment of identified mental disorders among older adults (over 55 years) by using data derived from EMRs in general practice. METHODS We utilized data from a cross-sectional study of mental disorders in primary care, which identified patients with mental disorders based on diagnostic coding and prescribed medicines. We collected anonymized data from 35 practices nationally from June 2014 to March 2015, and secondary analysis of this dataset examined the prevalence of mental disorders in adults aged over 55 years. RESULTS 74,261 patients aged over 55 years were identified, of whom 14,143 had a mental health disorder (prevalence rate of 19.1%). There was considerable variation between practices (range: 3.7-38.9%), with a median prevalence of 23.1%. Prevalence increased with age, from 14.8% at 55-59 years to 28.9% at 80-84 years. Most common disorders were depression (17.1%), panic/anxiety (11.3%), cognitive (5.6%), alcohol (3.8%) and substance use (3.8%). CONCLUSIONS Examining mental disorders among older adults using data derived from EMRs is feasible. Mental disorders are common among older adults attending primary care and this study demonstrates the utility of electronic medical records in epidemiological studies of large populations in primary care.
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Affiliation(s)
- Geoff McCombe
- UCD School of Medicine, University College DublinDublinIreland
| | - Frank Fogarty
- UCD School of Medicine, University College DublinDublinIreland
| | - Davina Swan
- UCD School of Medicine, University College DublinDublinIreland
- Institute of Psychiatry, King’s College LondonLondonUK
| | - Ailish Hannigan
- Graduate-Entry Medical School, University of LimerickLimerickIreland
| | - Gerard M. Fealy
- UCD School of Nursing, Midwifery and Health Systems, University College DublinDublinIreland
| | - Lorraine Kyne
- UCD School of Medicine, University College DublinDublinIreland
| | - David Meagher
- Graduate-Entry Medical School, University of LimerickLimerickIreland
| | - Walter Cullen
- UCD School of Medicine, University College DublinDublinIreland
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Koivula R, Tigerstedt C, Vilkko A, Kuussaari K, Pajala S. How does Older People's Drinking Appear in the Daily Work of Home Care Professionals? NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2016-0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims In this article the authors ask how the alcohol use of elderly home care clients affects the daily work of home care professionals and how the professionals act to support the drinking client. Methods Semi-structured interviews with 10 home care professionals were conducted from December 2014 to February 2015 in the Helsinki metropolitan area of Finland. Everyday situations during home visits related to the clients' alcohol use were analysed according to modalities of agency of the home care professionals. Results The results focus on three themes raised in the interviews: supporting life management of the client, the lack of qualifications in tackling clients' drinking and the need for multi-professional collaboration. Intoxicated clients complicated the home care nurses' work and obstructed the implementation of recommendations set out to guide the professionals' operations. Care work with alcohol-using clients was particularly demanding, and the professionals were concerned about not having enough training in how to encounter elderly clients' drinking. Multi-professional collaboration with substance abuse services and emergency department personnel was called for to remedy this problem. Conclusions More extensive and detailed research is needed for a better picture of how clients' drinking influences home care nurses' working conditions and what kind of skills nurses need in different alcohol-related situations. Such research would have the potential to benefit clients and improve the well-being of the employees.
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DiBartolo MC, Jarosinski JM. Alcohol Use Disorder in Older Adults: Challenges in Assessment and Treatment. Issues Ment Health Nurs 2017; 38:25-32. [PMID: 27936333 DOI: 10.1080/01612840.2016.1257076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol use disorder (AUD) is a common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the U.S. population ages; consequently, it is poised to place a significant burden on the healthcare system. Given the growing body of evidence regarding the patterns of use in this age group and the serious consequences of its misuse, it is critical that nurses and other healthcare providers assess for AUD in order to identify older adults in need of treatment. Yet, differences in symptom presentation, problems in isolating the symptoms of AUD from other healthcare complaints associated with aging, as well as the denial and fear of stigma that is especially pervasive in this age group, are major barriers to its identification and subsequent treatment. Furthermore, the lack of consistent use of evidence-based, age-specific screening instruments to identify those at risk is another significant obstacle to successful treatment. Healthcare providers in primary care are especially well-positioned to perform a systematic assessment utilizing appropriate instruments to identify AUD and initiate age-specific interventions, including the use of alcohol screening and brief interventions (ASBIs). The use of ASBIs, along with other targeted interventions such as mutual help groups (MHGs), such as Alcoholics Anonymous, can be key in encouraging insight, dismantling denial, and supporting treatment success, lifelong recovery, and overall quality of life in this vulnerable group.
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Affiliation(s)
- Mary C DiBartolo
- a Salisbury University , Department of Nursing , Salisbury , Maryland , USA
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Haighton C, Wilson G, Ling J, McCabe K, Crosland A, Kaner E. A Qualitative Study of Service Provision for Alcohol Related Health Issues in Mid to Later Life. PLoS One 2016; 11:e0148601. [PMID: 26848583 PMCID: PMC4744048 DOI: 10.1371/journal.pone.0148601] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/21/2016] [Indexed: 11/18/2022] Open
Abstract
Aims Epidemiological surveys over the last 20 years show a steady increase in the amount of alcohol consumed by older age groups. Physiological changes and an increased likelihood of health problems and medication use make older people more likely than younger age groups to suffer negative consequences of alcohol consumption, often at lower levels. However, health services targeting excessive drinking tend to be aimed at younger age groups. The aim of this study was to gain an in-depth understanding of experiences of, and attitudes towards, support for alcohol related health issues in people aged 50 and over. Methods Qualitative interviews (n = 24, 12 male/12 female, ages 51–90 years) and focus groups (n = 27, 6 male/21 female, ages 50–95 years) were carried out with a purposive sample of participants who consumed alcohol or had been dependent. Findings Participants’ alcohol misuse was often covert, isolated and carefully regulated. Participants tended to look first to their General Practitioner for help with alcohol. Detoxification courses had been found effective for dependent participants but only in the short term; rehabilitation facilities were appreciated but seen as difficult to access. Activities, informal groups and drop-in centres were endorsed. It was seen as difficult to secure treatment for alcohol and mental health problems together. Barriers to seeking help included functioning at a high level, concern about losing positive aspects of drinking, perceived stigma, service orientation to younger people, and fatalistic attitudes to help-seeking. Facilitators included concern about risk of fatal illness or pressure from significant people. Conclusion Primary care professionals need training on improving the detection and treatment of alcohol problems among older people. There is also a compelling need to ensure that aftercare is in place to prevent relapse. Strong preferences were expressed for support to be provided by those who had experienced alcohol problems themselves.
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Affiliation(s)
- Catherine Haighton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Graeme Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jonathan Ling
- Department of Pharmacy, Health and Well-being, Sunderland University, Sunderland, United Kingdom
| | - Karen McCabe
- Department of Pharmacy, Health and Well-being, Sunderland University, Sunderland, United Kingdom
| | - Ann Crosland
- Department of Pharmacy, Health and Well-being, Sunderland University, Sunderland, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Barnes AJ, Xu H, Tseng CH, Ang A, Tallen L, Moore AA, Marshall DC, Mirkin M, Ransohoff K, Duru OK, Ettner SL. The Effect of a Patient-Provider Educational Intervention to Reduce At-Risk Drinking on Changes in Health and Health-Related Quality of Life Among Older Adults: The Project SHARE Study. J Subst Abuse Treat 2015; 60:14-20. [PMID: 26254687 DOI: 10.1016/j.jsat.2015.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/10/2015] [Accepted: 06/23/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND At-risk drinking, defined as alcohol use that is excessive or potentially harmful in combination with select comorbidities or medications, affects about 10% of older adults in the United States and is associated with higher mortality. The Project SHARE intervention, which uses patient and provider educational materials, physician counseling, and health educator support, was designed to reduce at-risk drinking among this vulnerable population. Although an earlier study showed that this intervention was successful in reducing rates of at-risk drinking, it is unknown whether these reductions translate into improved health and health-related quality of life (HRQL). OBJECTIVE The aim of this study was to examine changes in health and HRQL of older adult at-risk drinkers resulting from a patient-provider educational intervention. RESEARCH DESIGN A randomized controlled trial to compare the health and HRQL outcomes of patients assigned to the Project SHARE intervention vs. care as usual at baseline, 6- and 12-months post assignment. Control patients received usual care, which may or may not have included alcohol counseling. Intervention group patients received a personalized patient report, educational materials on alcohol and aging, a brief provider intervention, and a telephone health educator intervention. SUBJECTS Current drinkers 60years and older accessing primary care clinics around Santa Barbara, California (N=1049). MEASUREMENTS Data were collected from patients using baseline, 6- and 12-month mail surveys. Health and HRQL measures included mental and physical component scores (MCS and PCS) based on the Short Form-12v2 (SF-12v2), the SF-6D, which is also based on the SF-12, and the Geriatric Depression Scale (GDS). Adjusted associations of treatment assignment with these outcomes were estimated using generalized least squares regressions with random provider effects. Regressions controlled for age group, sex, race/ethnicity, marital status, education, household income, home ownership and the baseline value of the dependent variable. RESULTS After regression adjustment, the intervention was associated with a 0.58 point (95% CI: -0.06, 1.21) increase in 6-month MCS and a 0.14 point (95% CI: 0.01, 0.26) improvement in 12-month GDS score, compared to the control group. The intervention also increased adjusted SF-6D scores by 0.01 points at both 6 and 12months (6-month 95% CI: 0.01, 0.02; 12-month 95% CI: 0.01, 0.01). CONCLUSIONS Despite the previously shown effectiveness of the Project SHARE intervention to reduce at-risk drinking among older adults, this effect translated into effects on health and HRQL that were statistically but not necessarily clinically significant. Effects were most prominent for patients who received physician discussions, suggesting that provider counseling may be a critical component of primary care-based interventions targeting at-risk alcohol use.
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Affiliation(s)
- Andrew J Barnes
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alfonso Ang
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Louise Tallen
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alison A Moore
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Deborah C Marshall
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA; Department of Radiation Medicine and Applied Science, University of California, San Diego, CA, USA
| | - Michelle Mirkin
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - O Kenrik Duru
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan L Ettner
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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