1
|
Üzar-Özçetin YS, Connolly M, Frawley T, Drennan J, Timmins F, Barnard M, Blake C, Di Placido M, Donnelly S, Doyle G, Fealy G, Fitzgerald K, Gallagher P, Guerin S, Mangiarotti E, McNulty J, Mucheru D, O' Neill D, O' Donnell D, Ryder M, Segurado R, Stokes D, Wells J, Čartolovni A. From the ground up: stakeholders' representations of the Irish longitudinal study on ageing (TILDA). PSYCHOL HEALTH MED 2024; 29:1619-1634. [PMID: 39312721 DOI: 10.1080/13548506.2024.2402002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024]
Abstract
Healthy ageing, which is the target of life' s later developmental stage, can be achieved through building a wise perspective towards life and existence. However, it may not be achievable for older people when the societal sources are limited. The TILDA project aimed to evaluate the associated factors with healthy ageing and to transfer that knowledge into practice. Hence, determining the perspectives of older people support and advocacy organisations on the enablers and facilitators of the healthy ageing strategies of TILDA is essential to gain a better understanding of the project and plan future strategies. This study aimed to investigate how the TILDA project has influenced or impacted upon these organisations from education, policy, or practice perspectives. The participants (n = 15) included in the study's sample were reached through representative organisations acting to support older people in the Republic of Ireland. Semi-structured interviews were conducted online via Zoom. A systematic thematic data analysis procedure was followed, and three themes emerged from the qualitative data, revealing the perceptions of participants about the TILDA project: (1) Limitations of TILDA, (2) Contributions of TILDA, and (3) Future recommendations for TILDA. In conclusion, among the disadvantages of TILDA, the most significant is not being representative and visible enough; it is evident that it is pivotal to develop a more inclusive culture of TILDA with close cooperation and effective marketing strategies. It is also apparent that TILDA has several advantages that include providing insights into ageing and rich data to plan future support for older people.
Collapse
Affiliation(s)
- Yeter Sinem Üzar-Özçetin
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
- Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Timmy Frawley
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Fiona Timmins
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Marlize Barnard
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
| | - Matteo Di Placido
- Department of Culture, Politics and Society, University of Turin, Turin, Italy
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin (UCD), Dublin, Ireland
| | - Gerardine Doyle
- College of Business, University College Dublin (UCD), Dublin, Ireland
| | - Gerard Fealy
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Kelly Fitzgerald
- School of Irish, Celtic Studies and Folklore, University College Dublin (UCD), Dublin, Ireland
| | - Paul Gallagher
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - Emanuela Mangiarotti
- School of Nursing, Midwifery and Health Systems, University of Pavia, Pavia, Italy
| | - Jonathan McNulty
- School of Medicine, University College Dublin (UCD), Dublin, Ireland
| | - Doreen Mucheru
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Desmond O' Neill
- Trinity College Dublin (TCD), Dublin, Ireland
- Tallaght University Hospital, Dublin, Ireland
| | - Deirdre O' Donnell
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Mary Ryder
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre (SNMHS), University College Dublin (UCD), Dublin, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
- UCD Library, University College Dublin (UCD), Dublin, Ireland
| | - Diarmuid Stokes
- UCD Library, University College Dublin (UCD), Dublin, Ireland
| | - John Wells
- School of Health Sciences, South East Technological University (SETU), Waterford, Ireland
| | - Anto Čartolovni
- School of Medicine, Digital healthcare ethics laboratory (Digit-HeaL), Catholic University of Croatia, Zagreb, Croatia
| |
Collapse
|
2
|
Huang L, Zhuang J, Lin Z, Min J, Wang C, Hu J, Wu W. Establishment and validation of a nomogram for predicting the risk of syncope after craniomaxillofacial surgery. J Plast Reconstr Aesthet Surg 2024; 98:37-43. [PMID: 39232370 DOI: 10.1016/j.bjps.2024.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/04/2024] [Accepted: 07/22/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE To explore the influencing factors of syncope in patients after plastic surgery, establish a syncope risk prediction model, and verify its accuracy. METHODS A total of 265 patients undergoing craniomaxillofacial surgery were included and divided into a syncope group and non-syncope group. Multivariate logistic regression analysis was used to screen for risk factors of syncope, and R language was used to establish a risk prediction nomogram of syncope in craniomaxillofacial surgery patients. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fit of the model, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of the model. RESULTS Syncope occurred in 87 of 265 patients (32.8%), and no syncope occurred in 178 patients (67.8%). Multivariate logistic regression analysis revealed statistical differences in age, orthostatic heart rate, orthostatic diastolic blood pressure, syncope history, weight loss history, and medication history between the 2 groups (P < 0.05). A nomogram was constructed for predicting the risk of syncope after craniomaxillofacial surgery, and the Hosmer-Lemeshow goodness-of-fit test proved that the nomogram fitted well (P = 0.431). The results of ROC curve analysis showed that the alignment graph model had high prediction accuracy; the area under the curve was 0.886 (95% confidence interval, 0.8381-0.9332). CONCLUSION Evaluating the risk of syncope after craniomaxillofacial surgery is helpful and provides guidance for the formulation of preventive strategies.
Collapse
Affiliation(s)
- Lan Huang
- Anesthesia Intensive Care Unit, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhuang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyao Lin
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia Min
- Department of Plastic Surgery and Beauty, Nanchang People's Hospital, Jiangxi, China
| | - Cheng Wang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jintian Hu
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Wenhong Wu
- Anesthesia Intensive Care Unit, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
3
|
Archontakis S, Oikonomou E, Sideris K, Dourvas P, Milaras N, Kostakis P, Klogkeri T, Triantafyllou E, Theofilis P, Ntalakouras I, Arsenos P, Gkika A, Gatzoulis K, Sideris S, Tousoulis D. A More Targeted and Selective Use of Implantable Loop Recorders Improves the Effectiveness of Syncope Units: A Single-Center Experience. Life (Basel) 2024; 14:871. [PMID: 39063625 PMCID: PMC11277815 DOI: 10.3390/life14070871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE Syncope remains a common medical problem. Recently, the role of dedicated syncope units and implantable loop recorders has emerged in the investigation of unexplained syncope. This study aims to investigate the possibilities for a more rational and targeted use of various diagnostic tools. METHODS In this retrospective single-center study, 196 patients with unexplained syncope were included between March 2019 and February 2023. Various diagnostic tools were utilized during the investigation, according to clinical judgement. Patients were retrospectively allocated into Group A (including those who, among other tests, underwent loop recorder insertion) and Group B (including patients investigated without loop recorder implantation). Data were compared with Group C, including patients assessed prior to syncope unit establishment. RESULTS There was no difference between Group A (n = 133) and Group B (n = 63) in the diagnostic yield (74% vs. 76%, p = 0.22). There were significant differences between Groups A and B regarding age (67.3 ± 16.9 years vs. 48.3 ± 19.1 years, p < 0.001) and cause of syncope (cardiogenic in 69% of Group A, reflex syncope in 77% of Group B, p < 0.001). Electrocardiography-based diagnosis occurred in 55% and 19% of Groups A and B, respectively (p < 0.001). The time to diagnosis was 4.2 ± 2.7 months in Group A and 7.5 ± 5.6 months in Group B (p < 0.001). In Group C, the diagnostic yield was 57.9% and the electrocardiography-based diagnostic yield was 18.3%. CONCLUSIONS A selective use of loop recorders according to clinical and electrocardiographic characteristics increases the effectiveness of the structured syncope unit approach and further preserves financial resources.
Collapse
Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Evangelos Oikonomou
- Third Cardiology Division, Medical School, University of Athens, Sotiria Thoracic Diseases Hospital, 152 Mesogeion Ave., 11527 Athens, Greece;
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Panagiotis Dourvas
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Nikias Milaras
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Panagiotis Kostakis
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Tzonatan Klogkeri
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Epameinondas Triantafyllou
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Panagiotis Theofilis
- First Cardiology Division, Medical School, University of Athens, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (P.T.); (P.A.); (K.G.)
| | - Ioannis Ntalakouras
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Petros Arsenos
- First Cardiology Division, Medical School, University of Athens, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (P.T.); (P.A.); (K.G.)
| | - Athanasia Gkika
- Department of Cardiac Surgery, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, Medical School, University of Athens, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (P.T.); (P.A.); (K.G.)
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (S.A.); (K.S.); (P.K.); (T.K.); (E.T.); (I.N.); (S.S.)
| | - Dimitris Tousoulis
- First Cardiology Division, Medical School, University of Athens, Hippokration General Hospital, 114 Vasilisis Sofias Str., 11527 Athens, Greece; (P.T.); (P.A.); (K.G.)
| |
Collapse
|
4
|
Unes M, Tasar PT, Karasahin O, Birdal O, Sevinc C, Sahin S. Fear of falling and associated factors in older adults with heart failure. Psychogeriatrics 2024; 24:204-211. [PMID: 38151263 DOI: 10.1111/psyg.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND This study aimed to evaluate the prevalence of fear of falling and associated factors in older adults with heart failure. METHODS A prospective, cross-sectional study. The study included 100 geriatric patients who were hospitalised and treated in the cardiology department of our hospital with ventricular ejection fraction (LVEF) lower than 50% for at least 1 year. A series of geriatric assessments were performed by face-to-face interview on the day of admission. Electrocardiography (ECG) and transthoracic echocardiography (TTE) were also performed on the day of admission. RESULTS The median age of the patients was 72 years, and 72.0% were men. Falls Efficacy Scale scores indicated a fear of falling in 46 (46.0%) of the patients. Charlson Comorbidity Index (CCI) was significantly higher in patients with fear of falling (P < 0.001). Severe depression, severe clinical insomnia, daytime sleepiness, and malnutrition were significantly more frequent among patients with fear of falling. Fear of falling was associated with significantly lower LVEF (P = 0.001). The presence of severe depression increased the risk of fear of falling by 13.97 times (95% CI: 3.064-63.707; P = 0.001), and the presence of daytime sleepiness increased the risk by 3.49 times (95% CI: 1.012-12.037; P = 0.048). A one-unit increase in CCI increased the risk of fear of falling by 1.56 times (95% CI: 1.093-2.238; P = 0.014). CONCLUSIONS Heart failure patients with concomitant depression, sleep disorders, and high comorbidities have greater fear of falling.
Collapse
Affiliation(s)
- Mevlut Unes
- Department of Internal Medicine, Ataturk University Hospital, Erzurum, Turkey
| | - Pinar Tosun Tasar
- Department of Internal Medicine, Division of Geriatrics, Ataturk University Hospital, Erzurum, Turkey
| | - Omer Karasahin
- Erzurum Regional Training and Research Hospital, Infectious Diseases Clinic, Erzurum, Turkey
| | - Oguzhan Birdal
- Department of Cardiology, Ataturk University Hospital, Erzurum, Turkey
| | - Can Sevinc
- Department of Internal Medicine, Division of Nephrology, Ataturk University Hospital, Erzurum, Turkey
| | - Sevnaz Sahin
- Department of Internal Medicine, Division of Geriatrics, Ege University Hospital, Izmir, Turkey
| |
Collapse
|
5
|
Willy K, Ellermann C, Syring S, Rath B, Reinke F, Willy D, Wolfes J, Wegner FK, Eckardt L, Köbe J, Morina N. Psychological Aspects of Syncopes and Possible Association with Recurrency—The Role of Implantable Loop Recorders. J Pers Med 2022; 12:jpm12081219. [PMID: 35893313 PMCID: PMC9332765 DOI: 10.3390/jpm12081219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Syncopes are a very common phenomenon and have a high recurrence rate. The differentiation between the psychogenic and physical, especially of arrhythmic origin, remains difficult. In many cases, an implantable loop recorder is used for the detection of possible arrhythmias, leading to syncopes. Yet, the existing literature suggests that psychological factors may play a significant role in recurrent syncopes. We aimed at analyzing the potential role of several psychological factors on the recurrence of arrhythmic or non-arrhythmic syncopes. Methods and results: A total of 119 patients, who had received an implantable loop recorder for recurrent syncopes at our center between 01/2018 and 12/2021, participated in this retrospective cohort study. Anxiety, depression and quality of life were assessed using extensively validated questionnaires (GAD-7, PHQ-9 and SF-12). The mean follow-up after loop recorder implantation was 710 ± 430 days and 50% of patients were female. The mean patient age was 54.8 ± 18.6 years. Most patients had no evidence of structural heart disease (84%), and normal LV function (92%). A statistical analysis revealed that the presence of structural heart disease was the strongest predictor for arrhythmic syncope during follow-up. In patients with non-arrhythmic syncopes, we found significantly higher levels of anxiety (GAD-7 score: 2.5 ± 2.6 vs. 4.8 ± 4.3) and depression (PHQ-9 score: 3.9 ± 3.6 vs. 6.8 ± 5.1), and a lower quality of life (SF-12 score: 33.7 ± 6.4 vs. 29.6 ± 7.8). Discussion: We identified factors as contributors to a better identification of patients at risk for arrhythmic as well as non-arrhythmic syncopes. Especially anxious or depressive symptoms may hinted at non-arrhythmic causes of syncope. However, the study was limited by its retrospective design and low patient number. Further trials should likewise combine the diagnostic yield of loop recorders with psychometric evaluations before implantation and combine it with additional diagnostic measures, such as video monitoring, to further examine the role of psychological factors in the pathomechanism and treatment of syncope.
Collapse
Affiliation(s)
- Kevin Willy
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
- Department of Psychology, University of Münster, 48419 Münster, Germany;
- Correspondence: ; Tel.: +49-251-83-44949; Fax: +49-251-83-52980
| | - Christian Ellermann
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Sarah Syring
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Florian Reinke
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Daniela Willy
- Department of Obstetrics and Gynecology, University Hospital Münster, 48419 Münster, Germany;
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Felix K. Wegner
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Germany; (C.E.); (S.S.); (B.R.); (F.R.); (J.W.); (F.K.W.); (L.E.); (J.K.)
| | - Nexhmedin Morina
- Department of Psychology, University of Münster, 48419 Münster, Germany;
| |
Collapse
|
6
|
Fitzpatrick N, Romero-Ortuno R. The Syncope-Falls Index: a tool for predicting risk of syncope and complex falls in the older adult based on cumulative health deficits. QJM 2022; 115:367-373. [PMID: 34014303 PMCID: PMC9172838 DOI: 10.1093/qjmed/hcab141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Syncope is aetiologically diverse and associated with adverse outcomes; in older people, there is clinical overlap with complex falls presentations (i.e. recurrent, unexplained and/or injurious). AIM To formulate an index to predict future risk of syncope and falls in the Irish longitudinal study on ageing (TILDA). DESIGN/METHODS Using the frailty index methodology, we selected, from TILDA Wave 1 (2010), 40 deficits that might increase risk of syncope and falls. This syncope-falls index (SYFI) was applied to TILDA Wave 1 participants aged 65 and over, who were divided into three risk groups (low, intermediate and high) based on SYFI tertiles. Multivariate logistic regression models were used to investigate, controlling for age and sex, how SYFI groups predicted incident syncope, complex falls and simple falls occurring up to Wave 4 of the study (2016). RESULTS At Wave 1, there were 3499 participants (mean age 73, 53% women). By Wave 4, of the remaining 2907 participants, 185 (6.4%) had reported new syncope, 1077 (37.0%) complex falls and 218 (7.5%) simple falls. The risk of both syncope and complex falls increased along the SYFI groups (high risk group: odds ratio 1.88 [1.26-2.80], P = 0.002 for syncope; 2.22 [1.82-2.72], P < 0.001 for complex falls). No significant relationship was identified between SYFI and simple falls. CONCLUSION The 6-year incidences of falls and syncope were high in this cohort. SYFI could help identify older adults at risk of syncope and complex falls, and thus facilitate early referral to specialist clinics to improve outcomes.
Collapse
Affiliation(s)
- N Fitzpatrick
- Address correspondence to Dr N. Fitzpatrick, MedEL Directorate, St. James’s Hospital, James St, Dublin 8, Ireland.
| | - R Romero-Ortuno
- From the MedEL Directorate, St. James’s Hospital, James St, Dublin 8, D08 NHY1, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, College Green, Dublin 2, D02 PN40, Ireland
- Global Brain Health Institute, Trinity College Dublin, College Green, Dublin, D02 PN40, Ireland
| |
Collapse
|
7
|
Canever JB, de Souza Moreira B, Danielewicz AL, de Avelar NCP. Are multimorbidity patterns associated with fear of falling in community-dwelling older adults? BMC Geriatr 2022; 22:192. [PMID: 35272634 PMCID: PMC8915478 DOI: 10.1186/s12877-022-02889-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/02/2022] [Indexed: 01/09/2023] Open
Abstract
Background Multimorbidity is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in the same individual and can be grouped into different patterns based on the type of disease. These patterns are associated with poorer quality of life and premature death. It is believed that these patterns entail functional limitations, which may contribute to the fear of falling; however, this association remains unknown. Identifying this possible association is fundamental for developing individual and collective care approaches aimed at preventing the different patterns of chronic diseases in older adults in order to decrease the fear of falling. The objective of this study was to investigate the association between multimorbidity patterns and fear of falling in older adults. Methods This was a cross-sectional study including 308 older adults. The exposure variables were the presence of three multimorbidity patterns (cardiopulmonary, musculoskeletal, and vascular-metabolic) and pattern association assessed by self-report of two or more similar coexisting chronic diseases. The outcome was fear of falling assessed by the Brazilian version of Falls Efficacy Scale-International (cut-off point ≥ 23 points). Multivariable logistic regression was used to analyze the association between variables. Results Older adults with cardiopulmonary, musculoskeletal, vascular-metabolic patterns and pattern association had 3.49 (95%CI 1.13; 10.78), 2.03 (95%CI 1.13; 3.64), 2.14 (95%CI 1.20; 3.82), and 4.84 (95%CI 2.19; 10.68), respectively, greater chances of presenting fear of falling when compared to older adults without the patterns. Conclusions The presence of multimorbidity patterns is associated with higher chances of reporting fear of falling. It is emphasized that the introduction of public health programs aimed at preventing multimorbidity patterns is essential to reduce possible adverse health outcomes, including fear of falling and its negative consequences for older adult health.
Collapse
Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | | | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil.
| |
Collapse
|
8
|
Johansson M, Rogmark C, Sutton R, Fedorowski A, Hamrefors V. Risk of incident fractures in individuals hospitalised due to unexplained syncope and orthostatic hypotension. BMC Med 2021; 19:188. [PMID: 34446019 PMCID: PMC8394111 DOI: 10.1186/s12916-021-02065-7] [Citation(s) in RCA: 9] [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: 04/23/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impaired orthostatic blood pressure response and syncope confer a high risk of falls and trauma. The relationship between a history of unexplained syncope and orthostatic hypotension (OH) with subsequent fractures, however, has not been thoroughly examined. In this study, we aimed to investigate the relationship between previous hospital admissions due to unexplained syncope and OH and incident fractures in a middle-aged population. METHODS We analysed a large population-based prospective cohort of 30,399 middle-aged individuals (age, 57.5 ± 7.6; women, 60.2%). We included individuals hospitalised due to unexplained syncope or OH as the main diagnosis. Multivariable-adjusted Cox regression analysis was applied to assess the impact of unexplained syncope and OH hospitalisations on subsequent incident fractures. RESULTS During a follow-up period of 17.8 + 6.5 years, 8201 (27%) subjects suffered incident fractures. The mean time from baseline and first admission for syncope (n = 493) or OH (n = 406) was 12.6 ± 4.2 years, and the mean age of the first hospitalisation was 74.6 ± 7.4 years. Individuals with incident fractures were older, more likely to be women, and had lower BMI, higher prevalence of prevalent fractures, and family history of fractures. Multivariable-adjusted Cox regression showed an increased risk of incident fractures following hospitalisations due to unexplained syncope (HR 1.20; 95% CI 1.02-1.40; p = 0.025) and OH (HR 1.42; 95% CI 1.21-1.66; p < 0.001) compared with unaffected individuals. CONCLUSIONS Individuals hospitalised due to unexplained syncope and orthostatic hypotension have an increased risk of subsequent fractures. Our findings suggest that such individuals should be clinically assessed for their syncope aetiology, with preventative measures aimed at fall and fracture risk assessment and management.
Collapse
Affiliation(s)
- Madeleine Johansson
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20213, Malmö, Sweden. .,Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
| | - Cecilia Rogmark
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Orthopaedics, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Richard Sutton
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20213, Malmö, Sweden.,National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus, London, UK
| | - Artur Fedorowski
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20213, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20213, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
9
|
Jost ST, Visser-Vandewalle V, Rizos A, Loehrer PA, Silverdale M, Evans J, Samuel M, Petry-Schmelzer JN, Sauerbier A, Gronostay A, Barbe MT, Fink GR, Ashkan K, Antonini A, Martinez-Martin P, Chaudhuri KR, Timmermann L, Dafsari HS. Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease. NPJ PARKINSONS DISEASE 2021; 7:48. [PMID: 34103534 PMCID: PMC8187358 DOI: 10.1038/s41531-021-00174-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as ‘difficulties experiencing pleasure’ and ‘problems sustaining concentration’. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.
Collapse
Affiliation(s)
- Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Michael Samuel
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
| | | |
Collapse
|
10
|
Hall J, Bourne KM, Sheldon RS, Vernino S, Raj V, Ng J, Okamoto LE, Arnold AC, Bryarly M, Phillips L, Paranjape SY, Raj SR. A comparison of health-related quality of life in autonomic disorders: postural tachycardia syndrome versus vasovagal syncope. Clin Auton Res 2021; 31:433-441. [PMID: 33550497 PMCID: PMC8184624 DOI: 10.1007/s10286-021-00781-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Postural tachycardia syndrome (POTS) and vasovagal syncope (VVS) are two disorders of orthostatic intolerance which are often misdiagnosed as the other. In each case, patients experience a reduced health-related quality of life (HRQoL) compared to healthy populations. This study was conducted to test the hypothesis that HRQoL is worse in POTS. METHODS POTS patients were recruited from the Dysautonomia International Annual Patient and Caregiver Conference. VVS patient data came from those enrolled in the Second Prevention of Syncope Trial. Participants aged ≥ 18 years (177 POTS and 72 VVS) completed the RAND 36-Item Health Survey, a generic and coherent health-related quality of life survey. RESULTS POTS patients reported reduced HRQoL compared to VVS patients in physical functioning (42.5 ± 1.7 vs. 76.5 ± 2.9, p < 0.001), role limitations due to physical health (11.4 ± 1.9 vs. 33.0 ± 5.0, p < 0.001), energy and fatigue (27.2 ± 1.3 vs. 50.7 ± 2.6, p < 0.001), social functioning (45.2 ± 1.8 vs. 71.2 ± 2.9, p < 0.001), pain (48.8 ± 1.9 vs. 67.7 ± 2.9, p < 0.001), and general health (31.2 ± 1.5 vs. 60.5 ± 2.6, p < 0.001) domains. Scores did not differ significantly in the role limitations due to emotional health (p = 0.052) and emotional well-being (p = 0.271) domains. Physical and general health composite scores were lower in the POTS population, while mental health composite scores were not different. CONCLUSION Differences in HRQoL exist between these patient populations. POTS patients report lower scores in physical and general health domains than VVS patients, but emotional health domains do not differ significantly. Targeting physical functioning in these patients may help improve quality of life.
Collapse
Affiliation(s)
- Juliette Hall
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, HRIC GAC70, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kate M Bourne
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, HRIC GAC70, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Robert S Sheldon
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, HRIC GAC70, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Steven Vernino
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vidya Raj
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, HRIC GAC70, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jessica Ng
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, HRIC GAC70, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Luis E Okamoto
- Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy C Arnold
- Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Meredith Bryarly
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lauren Phillips
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sachin Y Paranjape
- Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Satish R Raj
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, HRIC GAC70, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|