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Lindh Mazya A, Axmon A, Sandberg M, Boström AM, W Ekdahl A. Discordance in Frailty Measures in Old Community Dwelling People with Multimorbidity - A Cross-Sectional Study. Clin Interv Aging 2023; 18:1607-1618. [PMID: 37790740 PMCID: PMC10543411 DOI: 10.2147/cia.s411470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Assessment of frailty is a key method to identify older people in need of holistic care. However, agreement between different frailty instrument varies. Thus, groups classified as frail by different instruments are not completely overlapping. This study evaluated differences in sociodemographic factors, cognition, functional status, and quality of life between older persons with multimorbidity who were discordantly classified by five different frailty instruments, with focus on the Clinical Frailty Scale (CFS) and Fried's Frailty Phenotype (FP). Participants and Methods This was a cross-sectional study in a community-dwelling setting. Inclusion criteria were as follows: ≥75 years old, ≥3 visits to the emergency department the past 18 months, and ≥3 diagnoses according to ICD-10. 450 participants were included. Frailty was assessed by CFS, FP, Short Physical Performance Battery (SPPB), Grip Strength and Walking Speed. Results 385 participants had data on all frailty instruments. Prevalence of frailty ranged from 34% (CFS) to 75% (SPPB). Nine percent of participants were non-frail by all instruments, 20% were frail by all instruments and 71% had discordant frailty classifications. Those who were frail according to CFS but not by the other instruments had lower cognition and functional status. Those who were frail according to FP but not CFS were, to a larger extent, women, lived alone, had higher cognitive ability and functional status. Conclusion The CFS might not identify physically frail women in older community-dwelling people with multimorbidity. They could thus be at risk of not be given the attention their frail condition need.
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Affiliation(s)
- Amelie Lindh Mazya
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Geriatric Medicine of Danderyd Hospital, Stockholm, Sweden
| | - Anna Axmon
- EPI@LUND (Epidemiology, Population Studies, and Infrastructures at Lund University), Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Huddinge, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- R&D unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Anne W Ekdahl
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences Helsingborg, Lund University, Helsingborg, Sweden
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Mazya AL, Boström AM, Bujacz A, Ekdahl AW, Kowalski L, Sandberg M, Gobbens RJJ. Translation and Validation of the Swedish Version of the Tilburg Frailty Indicator. Healthcare (Basel) 2023; 11:2309. [PMID: 37628509 PMCID: PMC10454910 DOI: 10.3390/healthcare11162309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The Tilburg Frailty Indicator (TFI) is a questionnaire with 15 questions designed for screening for frailty in community-dwelling older people. TFI has a multidimensional approach to frailty, including physical, psychological, and social dimensions. The aim of this study was to translate TFI into Swedish and study its psychometric properties in community-dwelling older people with multimorbidity. A cross-sectional study of individuals 75 years and older, with ≥3 diagnoses of the ICD-10 and ≥3 visits to the Emergency Department in the past 18 months. International guidelines for back-translation were followed. Psychometric properties of the TFI were examined by determining the reliability (inter-item correlations, internal consistency, test-retest) and validity (concurrent, construct, structural). A total of 315 participants (57.8% women) were included, and the mean age was 83.3 years. The reliability coefficient KR-20 was 0.69 for the total sum. A total of 39 individuals were re-tested, and the weighted kappa was 0.7. TFI correlated moderately with other frailty measures. The individual items correlated with alternative measures mostly as expected. In the confirmatory factor analysis (CFA), a three-factor model fitted the data better than a one-factor model. We found evidence for adequate reliability and validity of the Swedish TFI and potential for improvements.
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Affiliation(s)
- Amelie Lindh Mazya
- Division of Clinical Geriatrics, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Geriatric Medicine of Danderyd Hospital, 182 88 Danderyd, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, 141 86 Huddinge, Sweden
- Division of Nursing, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- R&D Unit, Stockholms Sjukhem, 112 19 Stockholm, Sweden
| | - Aleksandra Bujacz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anne W. Ekdahl
- Division of Clinical Geriatrics, Department NVS, Karolinska Institutet, 141 83 Huddinge, Sweden
- Department of Clinical Sciences Helsingborg, Lund University, 251 87 Helsingborg, Sweden
| | - Leo Kowalski
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, 1180 HV Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
- Tranzo, Tilburg University, 5037 AB Tilburg, The Netherlands
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Biegus KR, Frobell RB, Wallin ÅK, Ekdahl AW. The challenge of recruiting multimorbid older patients identified in a hospital database to a randomised controlled trial. Aging Clin Exp Res 2022; 34:3115-3121. [PMID: 36242723 DOI: 10.1007/s40520-022-02263-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research involving multimorbid older patients is gaining momentum. However, little is known about how to plan a randomised controlled trial (RCT) involving this group of patients. An evidence-based approach to the challenges of a recruitment process could guide researchers and help prevent underpowered trials. AIM To define the number of multimorbid older patients that need to be identified and the number of eligible patients that need to be invited to achieve the desired recruitment number to a RCT. METHOD We used recruitment data from the GerMoT trial, a RCT comparing proactive outpatient care based on Comprehensive Geriatric Assessment with usual care. Multimorbid older patients with high healthcare utilisation were recruited to the trial. RESULTS Of the 1212 patients identified in a database as meeting the inclusion criteria 838 (70%) could be invited to participate in the trial. The rest could not be invited for a variety of reasons; 162 had moved out of area or into nursing homes and 86 had died before they could be contacted. 113 could not be reached. 450 (54%) of the invited patients agreed to participate. CONCLUSIONS In our study, we have shown that it is possible to achieve a good consent rate despite older participants with multimorbidity. This can be used when planning an RCT for this patient group, who are often excluded from clinical trials. Our results are specific to a context that provides similar abilities to identify and recruit patients as can be seen in Sweden.
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Affiliation(s)
- Karol R Biegus
- Geriatric Medicine, Helsingborg Hospital, Charlotte Yhléns Gata 10, 251 87, Helsingborg, Sweden. .,Clinical Sciences, Lund University, Lund, Sweden.
| | - Richard B Frobell
- Orthopedics, Helsingborg Hospital, Helsingborg, Sweden.,Clinical Sciences, Lund University, Lund, Sweden
| | - Åsa K Wallin
- Geriatric Medicine, Helsingborg Hospital, Charlotte Yhléns Gata 10, 251 87, Helsingborg, Sweden.,Clinical Sciences, Lund University, Lund, Sweden
| | - Anne W Ekdahl
- Geriatric Medicine, Helsingborg Hospital, Charlotte Yhléns Gata 10, 251 87, Helsingborg, Sweden.,Clinical Sciences, Lund University, Lund, Sweden
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Mezera V, Ekdahl AW, Bertschi D, Bonnici M, Buzaco R, Rodeles SC, Eruslanova K, Matchekhina L, Bazan LMP, Epelde IM, Kotsani M, Femminella GD, Koca M, Dejaeger M. The experiences of early career geriatricians throughout Europe during the COVID-19 pandemic. Eur Geriatr Med 2022; 13:719-724. [PMID: 35091891 PMCID: PMC8799436 DOI: 10.1007/s41999-021-00605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Aim To assess the experiences of early career geriatricians during the COVID-19 pandemic. Findings The respondents reported moderate levels of anxiety, work overload, and strong disruption in their work routine and private lives. Message Many early career geriatricians throughout Europe were involved as frontline workers in the care of older adults with COVID-19, and experienced a major impact on their professional and private lives. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00605-1. The COVID-19 pandemic has severely affected older adults and brought about unprecedented challenges to geriatricians. We aimed to evaluate the experiences of early career geriatricians (residents or consultants with up to 10 years of experience) throughout Europe using an online survey. We obtained 721 responses. Most of the respondents were females (77.8%) and residents in geriatric medicine (54.6%). The majority (91.4%) were directly involved in the care of patients with COVID-19. The respondents reported moderate levels of anxiety and feelings of being overloaded with work. The anxiety levels were higher in women than in men. Most of the respondents experienced a feeling of a strong restriction on their private lives and a change in their work routine. The residents also reported a moderate disruption in their training and research activities. In conclusion, early career geriatricians experienced a major impact of COVID-19 on their professional and private lives.
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Affiliation(s)
- Vojtech Mezera
- Geriatric Center, Pardubice Hospital, Kyjevska 44, 532 03, Pardubice, Czech Republic.
- 3rd Department of Internal Medicine-Metabolism and Gerontology, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic.
| | - Anne W Ekdahl
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Dominic Bertschi
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Maria Bonnici
- Department of Geriatric Medicine, University of Malta, Msida, Malta
- Karin Grech Hospital, Pietà, Malta
- St Vincent De Paul Residence, Luqa, Malta
| | - Rui Buzaco
- Unidade de Saúde Familiar Novo Mirante, ACES Loures Odivelas, Lisbon, Portugal
| | | | - Kseniia Eruslanova
- Russian Gerontology Research Centre, Pirogov Russian National Research University, Moscow, Russia
| | - Lubov Matchekhina
- Russian Gerontology Research Centre, Pirogov Russian National Research University, Moscow, Russia
| | - Laura Monica Perez Bazan
- RE-FIT Barcelona Research Group, Parc Sanitari Pere Virgili, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | | | - Marina Kotsani
- Department of Geriatrics, CHRU de Nancy, 54500, Vandœuvre-lès-Nanc, France
| | | | - Meltem Koca
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Marian Dejaeger
- Laboratory of Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
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Soulis G, Kotovskaya Y, Bahat G, Duque S, Gouiaa R, Ekdahl AW, Sieber C, Petrovic M, Benetos A. Geriatric care in European countries where geriatric medicine is still emerging. Eur Geriatr Med 2020; 12:205-211. [PMID: 33237564 PMCID: PMC7685957 DOI: 10.1007/s41999-020-00419-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
Aim To describe several aspects that affect practicing geriatric medicine in five different countries: Greece, Portugal, Russia, Turkey, and Tunisia Findings Discrepancies exist between countries concerning all aspects of geriatric medicine (recognition, training, educational and professional standards, academic representation, working context). Message Specificities of each country that set the frame should be taken into consideration in promoting geriatric medicine in different settings. Purpose Practicing geriatric medicine is a challenging task since it involves working together with other medical doctors while coordinating a multidisciplinary team. Global Europe Initiative (GEI) group within the European Geriatric Medicine Society gathers geriatricians from different regions where geriatrics is underrepresented or still developing to promote initiatives for the advancement of geriatric medicine within these countries. Methods Here we present a first effort to describe several aspects that affect practicing geriatric medicine in five different countries: Greece, Portugal, Russia, Turkey, and Tunisia. Results We can notice discrepancies between countries concerning all dimensions of geriatrics (recognition, training, educational and professional standards, academic representation, working context). Conclusions These differences correspond to the specificities of each country and set the frame where geriatric medicine is going to be developed across Europe. EuGMS with GEI group can provide useful support.
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Affiliation(s)
- George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece.
| | - Yulia Kotovskaya
- Russian Clinical and Research Center of Gerontology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Gülistan Bahat
- Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Sofia Duque
- Lisboa Ocidental Hospital Center, Lisbon, Portugal
| | | | - Anne W Ekdahl
- Section of Geriatric Medicine, Department of Emergency Medicine Helsingborg Hospital and Department of Clinical Sciences, Lunds University, Helsingborg, Sweden
| | - Cornel Sieber
- Institut Für Biomedizin Des Alterns, FAU Erlangen-Nürnberg, Nürnberg, Germany
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Athanase Benetos
- Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France
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W Ekdahl A, Ekerstad N, Alfredsson J, Johanzon M, Metzner C, Wilhelmson K, Strandberg T, Cederholm T. [Frailty]. Lakartidningen 2020; 117:F3HE. [PMID: 32396209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Frailty is a concept that is better than multimorbidity at identifying older people in need of special multidimensional care. Frailty denotes a state of accelerated biological aging in which the body gradually loses the ability to handle physical, mental and social stress. It is a dynamic condition which can be partly prevented and treated with physical exercise, nutrition and appropriate medication. They are many validated and simple screening tools for frailty. Some of these screening tools can assess the degree of frailty and thereby provide a risk stratification in for example a medical emergency. This can be used to support decisions to offer relevant medical intervention to chronologically old but biologically young people as well as to refrain from treatment in chronologically young but biologically older people.
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Affiliation(s)
| | | | - Joakim Alfredsson
- docent, kardiologiska kliniken, Universitetssjukhuset i Linköping; institutionen för medi-cin och hälsa, Linköpings universitet
| | - Madelene Johanzon
- Silvialäkare, ordförande Nationella programområdet äldres hälsa; medicinkliniken, Centralsjukhuset Karlstad
| | - Carina Metzner
- verksamhetschef multisjuka äldre, ordförande Svensk geriatrisk förening, Karolinska universitetssjukhuset
| | | | - Timo Strandberg
- professor, institutionen för folkhälso- och vårdvetenskap, Uppsala universitet; Tema åldrande, Karolinska universitetssjukhuset
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Klompstra L, Ekdahl AW, Krevers B, Milberg A, Eckerblad J. Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period. BMC Geriatr 2019; 19:187. [PMID: 31277674 PMCID: PMC6612189 DOI: 10.1186/s12877-019-1194-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of multimorbidity is increasing worldwide, and older people with multimorbidity are frequent users of health care services. Since multimorbidity has a significant negative impact on Health-related Quality of Life (HrQoL) and is more common in older age it would be expected that factors related to HrQoL in this group might have been thoroughly researched, but this is not the case. Furthermore, it is important to look at old people living at home, considering the shift from residential to home-based care. Therefore, we aim to investigate factors that are related to HrQoL in older people with multimorbidity and high health care consumption, living at home. METHODS This is a secondary analysis of a RCT study conducted in a municipality in south-eastern Sweden. The study had a longitudinal design with a two-year follow-up period assessing HrQoL, symptom burden, activities of daily living, physical activity and depression. RESULTS In total, 238 older people with multimorbidity and high health care consumption, living at home were included (mean age 82, 52% female). A multiple linear regression model including symptom burden, activities of daily living and depression as independent variables explained 64% of the HrQoL. Higher symptom burden, lower ability in activities of daily living and a higher degree of depression were negatively related to HrQoL. Depression at baseline and a change in symptom burden over a two-year period explained 28% of the change in HrQoL over a two-year period variability. A higher degree of depression at baseline and negative change in higher symptom burden were related to a decrease in HrQoL over a two-year period. CONCLUSION In order to facilitate better delivery of appropriate health care to older people with high health care consumption living at home it is important to assess HrQoL, and HrQoL over time. Symptom burden, activities of daily living, depression and change in symptom burden over time are important indicators for HrQoL. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01446757 , the trial was registered prospectively with the date of trial registration October 5th, 2011.
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Affiliation(s)
- Leonie Klompstra
- Department of Social and Welfare Studies, Division of Nursing, Linköping University, Linköping, Sweden. .,Department of Social and Welfare Studies, Linköping University, SE 601 74, Norrköping, Sweden.
| | - Anne W Ekdahl
- Section of Geriatric Medicine and Institution of Clinical Research, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Barbro Krevers
- Department of Medicine and Health Sciences, Division of Health Care Analysis, Linköping University, Linkoping, Sweden
| | - Anna Milberg
- Department of Advanced Home Care, Linköping University, Norrköping, Sweden.,Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Jeanette Eckerblad
- Department on Neurobiology and Care Science and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Mazya AL, Garvin P, Ekdahl AW. Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization. Aging Clin Exp Res 2019; 31:519-525. [PMID: 30039453 PMCID: PMC6439176 DOI: 10.1007/s40520-018-1004-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/06/2018] [Indexed: 10/31/2022]
Abstract
BACKGROUND Multimorbidity and frailty are often associated and Comprehensive Geriatric Assessment (CGA) is considered the gold standard of care for these patients. AIMS This study aimed to evaluate the effect of outpatient Comprehensive Geriatric Assessment (CGA) on frailty in community-dwelling older people with multimorbidity and high health care utilization. METHODS The Ambulatory Geriatric Assessment-Frailty Intervention Trial (AGe-FIT) was a randomized controlled trial (intervention group, n = 208, control group n = 174) with a follow-up period of 24 months. Frailty was a secondary outcome. Inclusion criteria were: age ≥ 75 years, ≥ 3 current diagnoses per ICD-10, and ≥ 3 inpatient admissions during 12 months prior to study inclusion. The intervention group received CGA-based care and tailored interventions by a multidisciplinary team in an Ambulatory Geriatric Unit, in addition to usual care. The control group received usual care. Frailty was measured with the Cardiovascular Health Study (CHS) criteria. At 24 months, frail and deceased participants were combined in the analysis. RESULTS Ninety percent of the population were frail or pre-frail at baseline. After 24 months, there was a significant smaller proportion of frail and deceased (p = 0.002) and a significant higher proportion of pre-frail patients in the intervention group (p = 0.004). Mortality was high, 18% in the intervention group and 26% in the control group. CONCLUSION Outpatient CGA may delay the progression of frailty and may contribute to the improvement of frail patients in older persons with multimorbidity.
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Roller-Wirnsberger R, Masud T, Vassallo M, Zöbl M, Reiter R, Van Den Noortgate N, Petermans J, Petrov I, Topinkova E, Andersen-Ranberg K, Saks K, Nuotio M, Bonin-Guillaume S, Lüttje D, Mestheneos E, Szekacs B, Jonsdottir AB, O’Neill D, Cherubini A, Macijauskiene J, Leners JC, Fiorini A, van Iersel M, Ranhoff AH, Kostka T, Duque S, Prada GI, Davidovic M, Krajcik S, Kolsek M, del Nozal JM, Ekdahl AW, Münzer T, Savas S, Knight P, Gordon A, Singler K. European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing 2019; 48:291-299. [PMID: 30423032 PMCID: PMC6424375 DOI: 10.1093/ageing/afy173] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. METHODS under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. RESULTS the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). CONCLUSION the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.
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Affiliation(s)
| | - Tahir Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK
| | - Michael Vassallo
- Royal Bournemouth and Christchurch NHS Hospitals Foundation Trust, Castle Lane East, Bournemouth, UK
| | - Martina Zöbl
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Raphael Reiter
- Department of Geriatric Medicine, Paracelsus Medical University Strubergasse 22, Salzburg, Austria
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital Corneel Heymanslaan 10, Gent, Belgium
| | - Jean Petermans
- Geriatric Department, CHU Rue de Gaillarmont 600, Liège, Belgium
| | - Ignat Petrov
- Clinical Centre of Endocrinology and Gerontology, Medical University of SofiaBoulevard “Akademik Ivan Evstratiev Geshov” 15, Sofia Center, Sofia, Bulgaria
| | - Eva Topinkova
- Department of Gerontology and Geriatrics, 1st Faculty of Medicine, Charles University and General Faculty HospitalOvocný trh 3-5, Staré Město, Czechia
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, Odense, Denmark
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Ülikooli 18, Tartu, Estonia
| | - Maria Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, Finland
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Sylvie Bonin-Guillaume
- Department of Geriatric Medicine, Hopital de la Timone, 264 Rue Saint Pierre, 13005 Marseille 05, Provence-Alpes-Côte d'Azur, France
| | - Dieter Lüttje
- Medizinische Klinik IV, Geriatrie und Palliativmedizin, Klinikum Osnabrück, Germany
| | - Elizabeth Mestheneos
- Hellenic Association of Gerontology and Geriatrics, Past President Age Platform Europe, Greece
| | - Bela Szekacs
- Hungarian Association of Gerontology and Geriatrics (HAGG)
| | - Anna Björg Jonsdottir
- Department of Geriatric Medicine, The National University Hospital of Iceland Landakoti, 101, Reykjavík Iceland
| | - Desmond O’Neill
- Department of Clinical Gerontology, College Green, Dublin 2, Ireland
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italia
| | - Jurate Macijauskiene
- Department of Geriatrics, The Faculty of Nursing, Medical Academy Lithuanian, University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania
| | - Jean-Claude Leners
- House Omega & LTCF Alzheimer, University of Luxembourg, 2, avenue de l'Université, Esch-sur-Alzette, Luxembourg
| | - Anthony Fiorini
- The Geriatric Medicine Society of Malta, Karin Grech Hospital, Telghat Gwardamangia, Pieta' Malta PTA, Malta
| | - Marianne van Iersel
- Department of Geriatric Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, Netherlands
| | | | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, plac Hallera 1, Łódź, Poland
| | - Sofia Duque
- Internal Medicine Specialist with Geriatrics Competence, Orthogeriatric Unit Coordinator, Internal Medicine Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa, Ocidental, Invited Lecturer of Geriatrics, Faculdade de Medicina, Universidade de Lisboa, Estr. Forte do Alto Duque, Lisboa, Portugal
| | - Gabriel Ioan Prada
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Ana Aslan National Institute of Gerontology and Geriatrics, Romania
| | - Mladen Davidovic
- Serbian Association of Geriatricians and Gerontologist, Udruženje gerijatara i gerontologa Srbije, Preševska 31, Beograd, Serbia
| | - Stefan Krajcik
- Geriatric Department, Slovak Medical University, 831 01 Bratislava, Slovakia
| | - Marko Kolsek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana Korytkova ulica 2, Ljubljana, Slovenia
| | | | - Anne W Ekdahl
- Department of Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Svartbrödragränden 3-5, Helsingborg, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics, Solnavägen 1, Solna, Sweden
| | - Thomas Münzer
- Department of Geriatrics, Geriatrische Klinik St. Gallen and University of Zürich, Zürich, Switzerland
| | - Sumru Savas
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Ege University Erzene Mahallesi, Bornova/İzmir, Turkey
| | - Paul Knight
- Department Geriatric Medicine, Royal Infirmary, Glasgow, UK
| | - Adam Gordon
- CLAHRC-East Midlands ‘Caring for Older People and Stroke Survivors’ (COPSS), Nottingham Biomedical Research Centre (BRC)
| | - Katrin Singler
- Institute of Biomedicine of Ageing, Friedrich Alexander University Erlangen, Schloßplatz 4, Erlangen, Germany
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private Medical University, Prof.-Ernst-Nathan-Straße 1, Nürnberg, Germany
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Westgård T, Ottenvall Hammar I, Holmgren E, Ehrenberg A, Wisten A, Ekdahl AW, Dahlin-Ivanoff S, Wilhelmson K. Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study. Pilot Feasibility Stud 2018; 4:41. [PMID: 29423259 PMCID: PMC5789623 DOI: 10.1186/s40814-018-0228-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/03/2018] [Indexed: 11/14/2022] Open
Abstract
Background Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety. Methods The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status. Result Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment − 0.80 [95% CI 1.06, − 0.57], occupational therapy assistive devices − 0.73 [95% CI 1.00, − 0.47], discharge planning −0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, −0.02]. Controlling for documented risk assessments, the intervention had for falls − 0.94 [95% CI 1.08, − 0.08], nutrition − 0.87 [95% CI 1.06, − 0.67], decubitus ulcers − 0.94 [95% CI 1.08, − 0.80], and ADL status − 0.80 [95% CI 1.04, − 0.57]. Conclusion The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study. Trial registration Clinical Trials ID: NCT02773914. Registered 16 May 2016.
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Affiliation(s)
- Theresa Westgård
- 1Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 2, Box 455, 405 30 Gothenburg, Sweden.,3Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Isabelle Ottenvall Hammar
- 1Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 2, Box 455, 405 30 Gothenburg, Sweden.,2Department of Occupational Therapy and Physiotherapy, The Sahlgrenska University Hospital, Gothenburg, Sweden.,3Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Eva Holmgren
- 1Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 2, Box 455, 405 30 Gothenburg, Sweden.,3Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Anna Ehrenberg
- 4School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Aase Wisten
- 5Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Anne W Ekdahl
- 6Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics, Karolinska Institute (KI), Solna, Sweden.,7Department of Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Synneve Dahlin-Ivanoff
- 1Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 2, Box 455, 405 30 Gothenburg, Sweden.,3Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Wilhelmson
- 1Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 2, Box 455, 405 30 Gothenburg, Sweden.,3Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden.,8Department of Geriatrics, The Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Lundqvist M, Alwin J, Henriksson M, Husberg M, Carlsson P, Ekdahl AW. Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial. BMC Geriatr 2018; 18:32. [PMID: 29386007 PMCID: PMC5793378 DOI: 10.1186/s12877-017-0703-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/29/2017] [Indexed: 11/19/2022] Open
Abstract
Background Older people with multi-morbidity are increasingly challenging for today’s healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity. Method The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros. Results Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer. Conclusion CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population. Trial registration The trial was retrospectively registered in clinicaltrial.gov, NCT01446757. September, 2011. Electronic supplementary material The online version of this article (10.1186/s12877-017-0703-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martina Lundqvist
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Jenny Alwin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Martin Henriksson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Magnus Husberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per Carlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anne W Ekdahl
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics, Karolinska Institute (KI), Stockholm, Sweden.,Institution of Clinical Sciences, Lund University, Helsingborg, Sweden
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Eckerblad J, Theander K, Ekdahl AW, Jaarsma T. Symptom trajectory and symptom burden in older people with multimorbidity, secondary outcome from the RCT AGe-FIT study. J Adv Nurs 2016; 72:2773-2783. [PMID: 27222059 DOI: 10.1111/jan.13032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to follow the symptom trajectory of community-dwelling older people with multimorbidity and to explore the effect on symptom burden from an ambulatory geriatric care unit, based on comprehensive geriatric assessment. BACKGROUND Older community-dwelling people with multimorbidity suffer from a high symptom burden with a wide range of co-occurring symptoms often resulting to decreased health-related quality of life. There is a need to move from a single-disease model and address the complexity of older people living with multimorbidity. DESIGN Secondary outcome data from the randomized controlled Ambulatory Geriatric Assessment Frailty Intervention Trial (AGe-FIT). METHODS Symptom trajectory of 31 symptoms was assessed with the Memorial Symptom Assessment Scale. Data from 247 participants were assessments at baseline, 12 and 24 months, 2011-2013. Participants in the intervention group received care from an ambulatory geriatric care unit based on comprehensive geriatric assessment in addition to usual care. RESULTS Symptom prevalence and symptom burden were high and stayed high over time. Pain was the symptom with the highest prevalence and burden. Over the 2-year period 68-81% of the participants reported pain. Other highly prevalent and persistent symptoms were dry mouth, lack of energy and numbness/tingling in the hands/feet, affecting 38-59% of participants. No differences were found between the intervention and control group regarding prevalence, burden or trajectory of symptoms. CONCLUSIONS Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms.
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Affiliation(s)
- Jeanette Eckerblad
- Department of Social and Welfare Studies, Faculty of Medicine and Health Sciences, Linkoping University, Sweden.
| | - Kersti Theander
- Faculty of Health, Science and Technology, Department of Health Sciences, Nursing, Karlstad University, Sweden
| | - Anne W Ekdahl
- Department of Research and Education, Helsingborg Hospital, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Medicine and Health Sciences, Linkoping University, Sweden
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Abstract
OBJECTIVES To investigate the correlation between MMSE ≤ 23 and the presence of a diagnosis of dementia in the medical record in a population with multimorbidity. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was part of the Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT; N = 382). Participants were community dwelling, aged ≥ 75 years, had received inpatient hospital care at least three times during the past 12 months, and had three or more concomitant diagnoses according to the International Classification of Diseases, 10th revision. MEASUREMENTS The Mini Mental State Examination (MMSE) was administered at baseline. Medical records of participants with MMSE scores < 24 were examined for the presence of dementia diagnoses and two years ahead. RESULTS Fifty-three (16%) of 337 participants with a measure of MMSE had a MMSE scores < 24. Six of these 53 (11%) participants had diagnoses of dementia (vascular dementia, n = 4; unspecified dementia, n = 1; Alzheimers disease, n = 1) according to medical records; 89% did not. CONCLUSIONS A MMSE-score < 24 is not well correlated to a diagnosis of dementia in the medical record in a population of elderly with multimorbidity. This could imply that cognitive decline and the diagnosis of dementia remain undetected in older people with multimorbidity. Proactive care of older people with multimorbidity should focus on cognitive decline to detect cognitive impairment and to provide necessary help and support to this very vulnerable group.
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Affiliation(s)
- A W Ekdahl
- Anne W. Ekdahl, Department of Geriatric Medicine, Norrköping and Karolinska Institutet, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Sweden. E-mail:
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14
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Ekdahl AW, Alwin J, Eckerblad J, Husberg M, Jaarsma T, Mazya AL, Milberg A, Krevers B, Unosson M, Wiklund R, Carlsson P. Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months. J Am Med Dir Assoc 2016; 17:263-8. [PMID: 26805750 DOI: 10.1016/j.jamda.2015.12.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. DESIGN Randomized, controlled, assessor-blinded, single-center trial. SETTING A geriatric ambulatory unit in a municipality in the southeast of Sweden. PARTICIPANTS Community-dwelling individuals aged ≥ 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). INTERVENTION Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. OUTCOME MEASURES Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. RESULTS Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P = .026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P = .01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P = .43). CONCLUSIONS CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGA's superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs.
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Affiliation(s)
- Anne W Ekdahl
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Research and Education, Helsingborg Hospital, Helsingborg, Skåne Region, Sweden.
| | - Jenny Alwin
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Jeanette Eckerblad
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Magnus Husberg
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Amelie Lindh Mazya
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Geriatric Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Anna Milberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Advanced Home Care and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Barbro Krevers
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Rolf Wiklund
- Department of Analysis of Health Care, Östergötland Region, Linköping, Sweden
| | - Per Carlsson
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
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Ekdahl AW. The importance of studying personality traits and pain in the oldest adults. Scand J Pain 2015; 7:1-2. [DOI: 10.1016/j.sjpain.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anne W. Ekdahl
- Department of Geriatric Medicine , Vrinnevihospital and Karolinska Institutet, Division of clinical Geriatrics, Department of Neurobiology, Care Sciences and Society , Karlskrona , Sweden
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Ekdahl AW, Ivanoff SD, Ehrenberg A, Oredsson S, Sjöstrand F, Stavenow L, Wisten A. [Care of frail elderly patients--evidence-based approach exists]. Lakartidningen 2014; 111:256-257. [PMID: 24669484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ekdahl AW, Andersson L, Wiréhn AB, Friedrichsen M. Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey. BMC Geriatr 2011; 11:46. [PMID: 21851611 PMCID: PMC3170190 DOI: 10.1186/1471-2318-11-46] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 08/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the role elderly people with co-morbidities wish to assume and actually had with regard to information and participation in medical decision making during their last stay in hospital.This study was a cross-sectional survey including three Swedish hospitals with acute admittance. The participants were patients aged 75 years and above with three or more diagnoses according to the International Classification of Diseases (ICD-10) and three or more hospitalisations during the last year. METHODS We used a questionnaire combined with a telephone interview, using the Control Preference Scale to measure each participant's preferred and actual role in medical decision making during their last stay in hospital. Additional questions were asked about barriers to participation in decision making and preferred information seeking role. The results are presented with descriptive statistics with kappa weights. RESULTS Of the 297 elderly patients identified, 52.5% responded (n = 156, 46.5% male). Mean age was 83.1 years. Of the respondents, 42 of 153 patients said that they were not asked for their opinion (i.e. no shared decision making). Among the other 111 patients, 49 had their exact preferred level of participation, 37 had less participation than they would have preferred, and 23 had more responsibility than they would have preferred. Kappa statistics showed a moderate agreement between preferred and actual role (κw = 0.57; 95% CI: 0.45-0.69). Most patients wanted to be given more information without having to ask. There was no correlation between age, gender, or education and preferred role. 35% of the patients agreed that they experienced some of the various barriers to decision making that they were asked about: 1) the severity of their illness, 2) doctors with different treatment strategies, 3) difficulty understanding the medical information, and 4) difficulty understanding doctors who did not speak the patient's own language. CONCLUSIONS Physicians are not fully responsive to patient preferences regarding either the degree of communication or the patient's participation in decision making. Barriers to participation can be a problem, and should be taken into account more often when dealing with hospitalised elderly people.
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Affiliation(s)
- Anne W Ekdahl
- Geriatric Department, Vrinnevi Hospital, Gamla Ö vägen 25, 601 82 Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
| | - Lars Andersson
- National Institute for the Study of Ageing and Later Life, NISAL, Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
| | - Ann-Britt Wiréhn
- Local Health Care Research and Development Unit, County Council in Östergötland, Linköping University, St. Larsgatan 9 D, 581 85 Linköping, Sweden
| | - Maria Friedrichsen
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
- Palliative Education and Research Center, Vrinnevi Hospital, Gamla Ö vägen 25, 601 82 Norrköping, Sweden
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Ekdahl AW, Andersson L, Friedrichsen M. "They do what they think is the best for me." Frail elderly patients' preferences for participation in their care during hospitalization. Patient Educ Couns 2010; 80:233-240. [PMID: 19945814 DOI: 10.1016/j.pec.2009.10.026] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 10/20/2009] [Accepted: 10/28/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To deepen the knowledge of frail elderly patients' preferences for participation in medical decision making during hospitalization. METHODS Qualitative study using content analysis of semi-structured interviews. RESULTS Patient participation to frail elderly means information, not the wish to take part in decisions about their medical treatments. They view the hospital care system as an institution of power with which they cannot argue. Participation is complicated by barriers such as the numerous persons involved in their care who do not know them and their preferences, differing treatment strategies among doctors, fast patient turnover in hospitals, stressed personnel and linguistic problems due to doctors not always speaking the patient's own language. CONCLUSION The results of the study show that, to frail elderly patients, participation in medical decision making is primarily a question of good communication and information, not participation in decisions about medical treatments. PRACTICE IMPLICATIONS More time should be given to thorough information and as few people as possible should be involved in the care of frail elderly. Linguistic problems should be identified to make it possible to take the necessary precautions to prevent negative impact on patient participation.
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Affiliation(s)
- Anne W Ekdahl
- Geriatric Department, Vrinnevi Hospital, Norrköping, Sweden; Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.
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