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Wieczorek M, Isler M, Landau K, Becker MD, Dawson-Hughes B, Kressig RW, Vellas B, Orav EJ, Rizzoli R, Kanis JA, Armbrecht G, Da Silva JAP, Egli A, Freystätter G, Bischoff-Ferrari HA. Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study. J Am Med Dir Assoc 2024; 25:789-795.e2. [PMID: 38640962 DOI: 10.1016/j.jamda.2024.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Although aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults. DESIGN Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. SETTING AND PARTICIPANTS Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. METHODS The numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids. RESULTS Among the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007). CONCLUSIONS AND IMPLICATIONS Our findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.
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Affiliation(s)
- Maud Wieczorek
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Marlis Isler
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias D Becker
- Department of Ophthalmology, City Hospital Zurich, Zurich, Switzerland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany; Spross Ophthalmology Research Institute, City Hospital Zurich, Zurich, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Centre on Aging, Tufts University, Boston, MA, USA
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, and University of Basel, Basel, Switzerland
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Endel John Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, United Kingdom; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Gabriele Armbrecht
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - José António P Da Silva
- Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra and Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreas Egli
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland
| | - Gregor Freystätter
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland; University Hospital Toulouse, IHU HealthAge Toulouse, France.
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Gagesch M, Rösler W, Bauernschmitt R, Wilhelm MJ, Freystätter G. [Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies]. Praxis (Bern 1994) 2023; 112:340-347. [PMID: 37042406 DOI: 10.1024/1661-8157/a004050] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies Abstract: Older patients face an increased risk of complications and adverse outcomes during and after operations, interventions, and intense oncological therapies. At the same time, this patient group should not be excluded per se from potentially beneficial medical procedures based on chronological age alone. The timely identification of geriatric syndromes and increased vulnerability by means of comprehensive geriatric assessment is becoming increasingly important and is already recommended in the guidelines of professional societies of several medical disciplines. Nonetheless, the geriatric assessment should ideally be followed by proactive co-management in the sense of integrated care. The establishment of interdisciplinary and integrated care pathways for older hospital patients can contribute to significantly improved treatment outcomes. In addition to better patient-related outcomes and rising quality indicators, this approach may also offer positive health economic effects.
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Affiliation(s)
- Michael Gagesch
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
- Zentrum Alter und Mobilität, Universitätsspital Zürich, Zürich, Schweiz
| | - Wiebke Rösler
- Klinik für Medizinische Onkologie und Hämatologie, Universitätsspital Zürich, Zürich, Schweiz
| | | | - Markus J Wilhelm
- Klinik für Herzchirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Gregor Freystätter
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
- Zentrum Alter und Mobilität, Universitätsspital Zürich, Zürich, Schweiz
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3
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Huberty S, Freystätter G, Wieczorek M, Dawson-Hughes B, Kanis JA, Rizzoli R, Kressig RW, Vellas B, Da Silva JAP, Armbrecht G, Theiler R, Egli A, Orav EJ, Bischoff-Ferrari HA. Association Between Multimorbidity and Rate of Falls: A 3-Year 5-Country Prospective Study in Generally Healthy and Active Community-Dwelling Adults Aged ≥70 Years. J Am Med Dir Assoc 2023:S1525-8610(22)00971-9. [PMID: 36657487 DOI: 10.1016/j.jamda.2022.12.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine the association between the baseline number of chronic diseases and multimorbidity with regard to the incidence of all and injurious falls over 3 years among European community-dwelling older adults. DESIGN Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. SETTING AND PARTICIPANTS Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. METHODS The main outcomes were the number of all falls and injurious falls experienced over 3 years. The number of chronic diseases and multimorbidity, defined as the presence of 3 or more chronic diseases at baseline, were assessed with the Self-Administered Comorbidity Questionnaire by Sangha et al. RESULTS Among the 2155 participants included in the analyses (mean age: 74.9 years, 62% were women, 52% were physically active more than 3 times a week), 569 (26.4%) had multimorbidity at baseline. Overall, each 1-unit increase in the baseline number of chronic diseases was linearly associated with a 7% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) 1.07, 95% CI 1.03-1.12, P < .001] and a 6% increased incidence rate of injurious falls (aIRR 1.06, 95% CI 1.02-1.11, P = .003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (aIRR 1.21, 95% CI 1.07-1.37, P = .002) and a 17% increased incidence rate of injurious falls (aIRR 1.17, 95% CI 1.03-1.32, P = .02). CONCLUSIONS AND IMPLICATIONS Baseline number of prevalent chronic diseases and multimorbidity in generally healthy and active community-dwelling older adults were associated with increased incidence rates of all and injurious falls over 3 years. These findings support that multimorbidity may need consideration as a risk factor for falls, even in generally healthy and active older adults.
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Affiliation(s)
- Sarah Huberty
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland
| | - Gregor Freystätter
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland
| | - Maud Wieczorek
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Centre on Aging, Tufts University, Boston, MA, USA
| | - John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, United Kingdom; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine, Felix Platter and University of Basel, Basel, Switzerland
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - José A P Da Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Gabriele Armbrecht
- Klinik für Radiologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Theiler
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland
| | - Andreas Egli
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland
| | - Endel J Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Heike A Bischoff-Ferrari
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland.
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Bischoff-Ferrari HA, Freystätter G, Vellas B, Dawson-Hughes B, Kressig RW, Kanis JA, Willett WC, Manson JE, Rizzoli R, Theiler R, Hofbauer LC, Armbrecht G, da Silva JAP, Blauth M, de Godoi Rezende Costa Molino C, Lang W, Siebert U, Egli A, Orav EJ, Wieczorek M. Effects of vitamin D, omega-3 fatty acids, and a simple home strength exercise program on fall prevention: the DO-HEALTH randomized clinical trial. Am J Clin Nutr 2022; 115:1311-1321. [PMID: 35136915 DOI: 10.1093/ajcn/nqac022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 08/13/2021] [Accepted: 01/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The roles of vitamin D, omega-3 fatty acids, and home exercise on fall prevention among generally healthy and active older adults are unclear. OBJECTIVES We tested the effects of daily supplemental vitamin D, daily supplemental marine omega-3s fatty acids, and a simple home exercise program (SHEP), alone or in combination, on the incidences of total and injurious falls among generally healthy older adults. METHODS We performed a 2 × 2 × 2 factorial-design randomized controlled trial among 2157 community-dwelling adults aged 70 years and older, who had no major health events in the 5 years prior to enrolment, recruited from Switzerland, Germany, Austria, France, and Portugal between December 2012 and November 2014. Participants were randomly assigned to supplementation with 2000 international units/day of vitamin D3 and/or 1 g/day of marine omega-3s, and/or a SHEP compared with placebo and/or control exercise over 3 years. The primary endpoint for the present fall analysis was the incidence rate of total falls. Falls were recorded prospectively throughout the trial. Since there were no interactions between treatments, the main effects are reported based on a modified intent-to-treat analysis. RESULTS Of 2157 randomized participants, 1900 (88%) completed the study. The mean age was 74.9 years, 61.7% were women, 40.7% had a serum 25-hydroxyvitamin D concentration < 20 ng/ml, and 83% were at least moderately physically active. In total, 3333 falls were recorded over a median follow-up of 2.99 years. Overall, vitamin D and the SHEP had no benefit on total falls, whilst supplementation with omega-3s compared to no omega-3 supplementation reduced total falls by 10% (incidence rate ratio = 0.90; 95% CI, 0.81-1.00; P = 0.04). CONCLUSIONS Among generally healthy, active, and vitamin D-replete older adults, omega-3 supplementation may have a modest benefit on the incidence of total falls, whilst a daily high dose of vitamin D or a SHEP had no benefit.
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Affiliation(s)
- Heike A Bischoff-Ferrari
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.,Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland.,University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland
| | - Gregor Freystätter
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.,Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland.,University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Centre on Aging, Tufts University, Boston, MA, USA
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, and University of Basel, Basel, Switzerland
| | - John A Kanis
- Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, United Kingdom.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Walter C Willett
- Department of Epidemiology and Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Robert Theiler
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.,Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland
| | - Lorenz C Hofbauer
- Centre for Healthy Aging, Department of Medicine III Dresden University Medical Centre, Dresden, Germany.,Centre for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Armbrecht
- Klinik für Radiologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - José A P da Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Michael Blauth
- Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Caroline de Godoi Rezende Costa Molino
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.,Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland
| | - Wei Lang
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.,Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.,Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Program on Cardiovascular Research, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Egli
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.,Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland
| | - Endel J Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maud Wieczorek
- Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.,Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland
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Huberty S, Mattle M, Theiler R, Freystätter G. [Evidence of Physical Training Programs for Fall Prevention in Seniors]. Praxis (Bern 1994) 2022; 111:815-821. [PMID: 36285409 DOI: 10.1024/1661-8157/a003922] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Evidence of Physical Training Programs for Fall Prevention in Seniors Abstract. It has been shown that physical exercise reduced fall risk by 23-42% in community-dwelling adults aged 65+. This is particularly true for physical exercises with functional, balance and strength components. Growing evidence shows that functional training is particularly effective in reducing fall risk. Functional training is composed by exercises which reflect activities of daily life, supported by weights and other aids.
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Affiliation(s)
- Sarah Huberty
- Universitäre Altersmedizin, Felix Platter Spital, Basel, Schweiz
| | - Michèle Mattle
- Zentrum Alter und Mobilität, Universität Zürich und Stadtspital Zürich Waid, Zürich, Schweiz
| | - Robert Theiler
- Zentrum Alter und Mobilität, Universität Zürich und Stadtspital Zürich Waid, Zürich, Schweiz
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
| | - Gregor Freystätter
- Zentrum Alter und Mobilität, Universität Zürich und Stadtspital Zürich Waid, Zürich, Schweiz
- Klinik für Altersmedizin, Universitätsspital Zürich, Zürich, Schweiz
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Lanz P, Wieczorek M, Sadlon A, de Godoi Rezende Costa Molino C, Abderhalden LA, Schaer DJ, Spahn DR, Freystätter G, Orav EJ, Egli A, Bischoff-Ferrari HA. Iron Deficiency and Incident Infections among Community-Dwelling Adults Age 70 Years and Older: Results from the DO-HEALTH Study. J Nutr Health Aging 2022; 26:864-871. [PMID: 36156678 DOI: 10.1007/s12603-022-1836-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To assess if baseline iron deficiency, with or without anemia, is associated with incident infections over 3 years among community-dwelling older adults. DESIGN Prospective secondary analysis of DO-HEALTH, a 3-year randomized, double-blind controlled trial. SETTING AND PARTICIPANTS 2157 community-dwelling adults age 70+ from 5 European countries with good cognitive function and mobility and no major health events in the 5 years prior to enrollment Measurements: Incident infections, their severity and type were recorded every 3 months throughout the 3-year follow-up. Iron deficiency was defined as soluble transferrin receptor (sTfR) levels > 28.1 nmol/l and anemia as hemoglobin levels < 120 g/l for women and 130 g/l for men. We applied negative binomial mixed effects regression models with random effects for countries, and controlling for treatment allocation, age, sex, body mass index, polypharmacy, number of comorbidities, smoking status, living situation, alcohol intake, frailty status, and physical activity levels. A pre-defined stratified analysis was performed to explore if the associations between iron deficiency and infections were consistent by baseline anemia status. RESULTS In total, 2141 participants were included in the analyses (mean age 74.9 years, 61.5% of women, 26.8% with iron deficiency). Across all participants, baseline iron deficiency was not associated with incident overall infections, but was associated with a 63% greater rate of incident severe infections requiring hospitalization (incidence rate ratio [IRR] 1.63, 95% Confidence Interval [CI] 1.11-2.41, p=0.01). This association was more pronounced among the 2000 participants who did not have anemia at baseline (IRR=1.80, 95% CI 1.20-2.69, p=0.005). CONCLUSION Based on this prospective study among generally healthy European community-dwelling older adults, iron deficiency was not associated with the incidence rate of overall infections but may increase the incidence of severe infections. Intervention studies are needed to prove the causality of this observation.
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Affiliation(s)
- P Lanz
- Heike A. Bischoff-Ferrari, University Hospital Zurich, Department of Aging Medicine and Aging Research, Raemistrasse 101, 8091 Zurich, Switzerland, ORCID 0000-0002-4554-658X, Phone: +41-44-255-2757,
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Sadlon A, Ensslin A, Freystätter G, Gagesch M, Bischoff-Ferrari HA. Are patients with cognitive impairment fit to fly? Current evidence and practical recommendations. J Travel Med 2021; 28:5876266. [PMID: 32710619 DOI: 10.1093/jtm/taaa123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/05/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The worldwide prevalence of dementia is increasing and represents a major public health concern. In the last decades, air travel services have undergone an impressive expansion and one of ten passengers is aged 65 years and older. While air travel can be stressful at all ages and health conditions, older individuals with cognitive impairment carry a greater risk for air-travel-related complications. Consequently, demands to general practitioners for assessing their older patient's fitness to fly are increasing. METHODS We conducted a search of the literature in PubMed on the impact of in-flight environmental changes on passengers with cognitive impairment and possible resulting complications. This set the base for a discussion on pharmacological and non-pharmacological interventions aimed at preventing in-flight complications in this vulnerable population. RESULTS While our research strategy identified a total of 11 articles related to older age and air travel, only three focused on passengers with cognitive impairment. Our literature review showed that the airplane environment may lead to a large spectrum of symptoms in passengers of all age groups. However, passengers with cognitive impairment due to neurodegenerative diseases are at increased risk for experiencing the most extreme symptoms such as acute confusional state. Non-pharmacological and pharmacological interventions at different stages of the travel process (before, during and after) can help prevent complications in this vulnerable population. CONCLUSION The decision to let a patient with cognitive impairment fly requires a solid understanding of the in-flight environmental changes and their impact on older patients with cognitive impairment. Moreover, a sound weighing of the risks and benefits while considering different aspects of the patient's history is demanded. In this regard, the role of the treating physicians and caregivers is essential along with the support of the medical department of the airline.
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Affiliation(s)
- Angélique Sadlon
- Department of Geriatrics, University Hospital Zürich, Switzerland.,Centre on Aging and Mobility, University of Zürich, Switzerland.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, UK
| | - Angela Ensslin
- Medical Services, Swiss International Air Lines Ltd., Zürich Airport, Kloten, Switzerland
| | - Gregor Freystätter
- Department of Geriatrics, University Hospital Zürich, Switzerland.,Centre on Aging and Mobility, University of Zürich, Switzerland
| | - Michael Gagesch
- Department of Geriatrics, University Hospital Zürich, Switzerland.,Centre on Aging and Mobility, University of Zürich, Switzerland
| | - Heike A Bischoff-Ferrari
- Department of Geriatrics, University Hospital Zürich, Switzerland.,Centre on Aging and Mobility, University of Zürich, Switzerland
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Palzer M, Meyer U, Abderhalden LA, Gazzotti A, Hierholzer C, Bischoff-Ferrari HA, Freystätter G. [Acute geriatric treatment of older trauma patients : Influence on mobility, autonomy and postdischarge destination]. Z Gerontol Geriatr 2020; 54:816-822. [PMID: 33201306 PMCID: PMC8636419 DOI: 10.1007/s00391-020-01812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/07/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Hintergrund Die geriatrische frührehabilitative Komplexbehandlung (GFK) wird bei hochbetagten hospitalisierten Patienten eingesetzt, um die Selbstversorgungsfähigkeit wiederherzustellen und eine Pflegebedürftigkeit zu vermeiden. Ziel der Arbeit Ziel der Arbeit war es, die Veränderungen von Mobilität und Selbsthilfefähigkeit bei alterstraumatologischen Patienten* im Rahmen der GFK zu beschreiben. Material und Methoden Mobilität, Ganggeschwindigkeit und Selbsthilfefähigkeit von 164 hospitalisierten Alterstraumatologiepatienten wurde zu Beginn und bei Abschluss der GFK erfasst. Wir analysierten die Veränderungen der Mobilität während GFK (t-Test), und welche Mobilitätsmerkmale mit einer Entlassung nach Hause vs. einer Entlassung in die Langzeitpflege assoziiert sind (alters- und geschlechtsadjustiertes Regressionsmodell). Ergebnisse Die Patienten verbesserten ihre Mobilität gemessen mittels Short Physical Performance Battery (SPPB) um 1,8 ± 2,1 Punkte, die Ganggeschwindigkeit um 0,10 ± 0,14 m/s und den Barthel-Index um 13 ± 16 Punkte (alle p < 0,001). Die Zahl nichtgehfähiger Patienten verringerte sich von 43 auf 14 % (p = 0,003). Die Mehrzahl (73 %) der vor der Hospitalisation zu Hause lebenden Patienten wurde direkt oder nach einer überbrückenden spitalexternen Rehabilitation nach Hause entlassen. Schlussfolgerung Die Datenanalyse zeigt signifikante und klinisch relevante Verbesserungen in den Bereichen Mobilität und Selbstständigkeit bei Alterstraumatologiepatienten. Die Mehrzahl der Patienten konnte wieder nach Hause austreten. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01812-4) enthalten.
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Affiliation(s)
- M Palzer
- Zentrum Alter und Mobilität, Universität Zürich, Zürich, Schweiz.,Klinik für Geriatrie, Universitätsspital Zürich, Rämistrasse 101, 8091, Zürich, Schweiz
| | - U Meyer
- Zentrum Alter und Mobilität, Universität Zürich, Zürich, Schweiz.,Klinik für Geriatrie, Universitätsspital Zürich, Rämistrasse 101, 8091, Zürich, Schweiz
| | - L A Abderhalden
- Zentrum Alter und Mobilität, Universität Zürich, Zürich, Schweiz.,Klinik für Geriatrie, Universitätsspital Zürich, Rämistrasse 101, 8091, Zürich, Schweiz
| | - A Gazzotti
- Zentrum Alter und Mobilität, Universität Zürich, Zürich, Schweiz.,Klinik für Geriatrie, Universitätsspital Zürich, Rämistrasse 101, 8091, Zürich, Schweiz
| | - C Hierholzer
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - H A Bischoff-Ferrari
- Zentrum Alter und Mobilität, Universität Zürich, Zürich, Schweiz.,Klinik für Geriatrie, Universitätsspital Zürich, Rämistrasse 101, 8091, Zürich, Schweiz.,Universitäre Klinik für Akutgeriatrie, Stadtspital Waid, Zürich, Schweiz
| | - G Freystätter
- Zentrum Alter und Mobilität, Universität Zürich, Zürich, Schweiz. .,Klinik für Geriatrie, Universitätsspital Zürich, Rämistrasse 101, 8091, Zürich, Schweiz.
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9
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Mansky R, Marzel A, Orav EJ, Chocano-Bedoya PO, Grünheid P, Mattle M, Freystätter G, Stähelin HB, Egli A, Bischoff-Ferrari HA. Playing a musical instrument is associated with slower cognitive decline in community-dwelling older adults. Aging Clin Exp Res 2020; 32:1577-1584. [PMID: 32144734 DOI: 10.1007/s40520-020-01472-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elucidating behavioral protective factors for cognitive decline and dementia can have a far-reaching impact. AIMS To describe the association of present and past musical instrument playing with cognitive function in cognitively intact older adults. METHOD A post hoc observational analysis of the Zurich Disability Prevention Trial. Past and present musical instrument playing was correlated with Mini-Mental State Examination (MMSE) and EuroQol-Visual Analogue Scale (EQ-VAS) using linear regression at baseline and mixed-model linear regression over 1 year. RESULTS Two hundred community dwelling adults age 70 and older (mean age 77.7) were included. There were 48.5% (97/200) participants, who ever played a musical instrument; 35% (70/200) played in the past and 13.5% (27/200) played at present. At baseline, present players had a suggestively higher adjusted-MMSE than never players (28.9 vs. 28.5, p value 0.059). Over 12 months, compared to never players, ever players showed a significantly better improvement from baseline in adjusted-MMSE (0.29 vs. - 0.12, p value 0.007). The association remained significant even after restricting to participants without higher education (p value 0.03). Over time, no differences were observed for EQ-VAS (p value 0.45). However, past players had the largest decline in health-related quality of life at 12 months. DISCUSSION The support for a protective association in our observational study suggests the need for clinical trials to examine the effect of playing a musical instrument on cognitive function and decline. Both returning to play after an interruption and learning to play from the beginning should be examined. CONCLUSIONS Present and past musical instrument playing may assist in preserving cognitive function in community-dwelling older adults.
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Affiliation(s)
- Richard Mansky
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland
| | - Alex Marzel
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
- Department of Teaching, Research and Development, Schulthess Clinic, Zurich, Switzerland
| | - E John Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Patricia O Chocano-Bedoya
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland
| | - Patricia Grünheid
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland
| | - Michèle Mattle
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland
| | - Gregor Freystätter
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland
| | - H B Stähelin
- Department of Geriatrics, University of Basel, Basel, Switzerland
| | - Andreas Egli
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland.
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland.
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10
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Wiegand A, Zieger A, Staiger RD, Egli A, Freystätter G, Bischoff-Ferrari HA, Chocano-Bedoya PO. Corrigendum to "Association of Depression with Malnutrition, Grip Strength and Impaired Cognitive Function among Senior Trauma Patients" [J Affect Disord 2019 Mar 15;247:175-182]. J Affect Disord 2020; 265:695. [PMID: 32090787 DOI: 10.1016/j.jad.2020.01.071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Wiegand
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - A Zieger
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - R D Staiger
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A Egli
- Centre on Aging and Mobility, University Zurich, Switzerland; Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
| | - G Freystätter
- Centre on Aging and Mobility, University Zurich, Switzerland; Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
| | - H A Bischoff-Ferrari
- Centre on Aging and Mobility, University Zurich, Switzerland; Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland; University Clinic for Acute Geriatric Care, City Hospital Waid, Switzerland
| | - P O Chocano-Bedoya
- Centre on Aging and Mobility, University Zurich, Switzerland; Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland.
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11
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Gratza SK, Chocano-Bedoya PO, Orav EJ, Fischbacher M, Freystätter G, Theiler R, Egli A, Kressig RW, Kanis JA, Bischoff-Ferrari HA. Influence of fall environment and fall direction on risk of injury among pre-frail and frail adults. Osteoporos Int 2019; 30:2205-2215. [PMID: 31377914 DOI: 10.1007/s00198-019-05110-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/24/2019] [Indexed: 12/29/2022]
Abstract
UNLABELLED In this prospective study, half of all falls resulted in injury. Pre-frail adults sustained more injuries, while more frail adults had injuries requiring hospitalization or fractures. Pre-frail adults fell more often when in movement compared with frail adults who fell more often when standing and in indoor public spaces. PURPOSE To assess prospectively how fall environment and direction are related to injury among pre-frail and frail adults. METHODS We included 200 community-dwelling adults with a prior fall (pre-frail, mean age 77 years) and 173 adults with acute hip fracture (frail, mean age 84 years; 77% community-dwelling). Falls were prospectively recorded using standardized protocols in monthly intervals, including date, time, fall direction and environment, and injury. We used logistic regression to assess the odds of injury adjusting for age, body mass index (BMI), and gender. RESULTS We recorded 513 falls and 331 fall-related injuries (64.5%) among the 373 participants. While the fall rate was similar between groups, pre-frail adults had more injuries (71% among pre-frail vs. 56% among frail, p = 0.0004) but a lower incidence of major injuries (9% among pre-frail vs. 27% among frail, p = 0.003). Pre-frail adults fell more often while in movement (84% among pre-frail vs. 55% among frail, p < 0.0001), and frail adults fell more often while standing (26% vs. 15% respectively, p = 0.01). The odds of injury among frail adults was increased 3.3-fold when falling sideways (OR = 3.29, 95% CI = 1.68-6.45) and 2.4-fold when falling in an indoor public space (OR = 2.35, 95% CI = 1.00-5.53), and was reduced when falling at home (OR = 0.55, 95% CI = 0.31-0.98). The odds of injury among pre-frail adults was not influenced by environment and was 53% lower when falling backwards (OR = 0.47, 95% CI = 0.26-0.82). CONCLUSION While pre-frail adults sustain more fall-related injuries, frail adults were more likely to sustain major injuries, especially when falling sideways or outside their home.
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Affiliation(s)
- S K Gratza
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- Basel University Medicine of Aging, Felix-Platter Spital, Basel, Switzerland
| | - P O Chocano-Bedoya
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - E J Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - M Fischbacher
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - G Freystätter
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - R Theiler
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - A Egli
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland
| | - R W Kressig
- Basel University Medicine of Aging, Felix-Platter Spital, Basel, Switzerland
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre of Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - H A Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich, Waid City Hospital, and University of Zurich, Zurich, Switzerland.
- Department of Geriatrics and Aging Research, University Hospital Zurich, Raemistrasse 101, 8091, Zurich, Switzerland.
- University Clinic for Acute Geriatric Care, City Hospital Waid, Zurich, Switzerland.
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12
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Ernst R, Fischer K, de Godoi Rezende Costa Molino C, Orav EJ, Theiler R, Meyer U, Fischler M, Gagesch M, Ambühl PM, Freystätter G, Egli A, Bischoff-Ferrari HA. Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study. J Am Med Dir Assoc 2019; 21:254-259.e1. [PMID: 31501003 DOI: 10.1016/j.jamda.2019.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/22/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Information on the impact of polypharmacy on kidney function in older adults is limited. We prospectively investigated the association between intake of total number of drugs or nonsteroidal anti-inflammatory drugs (NSAIDs) and kidney function. DESIGN Our study is a prospective observational analysis of the 2-year Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis Patients. SETTING AND PARTICIPANTS Of the 273 participants of the original trial, 270 participants (mean age 70.3 ± 6.4 years, 53% women) were included in this observational analysis. METHODS The associations between (1) total number of drugs (or NSAIDs) at baseline or (2) cumulative number of drugs (or NASAIDs) repeatedly measured over 24 months and kidney function repeatedly measured over 24 months as estimated glomerular filtration rate (eGFR) were investigated using multivariable-adjusted repeated-measures analysis. RESULTS Per drug at baseline, kidney function decreased by 0.64 mL/min/1.73 m2 eGFR (Beta = -0.64; 95% CI -1.19 to -0.08; P = .024) over 24 months. With every additional drug taken cumulatively over 24 months, kidney function decreased by 0.39 mL/min/1.73 m2 eGFR (Beta = -0.39; 95% CI -0.63 to -0.15; P = .002). In a high-risk subgroup, per NSAID taken cumulatively over 24 months, kidney function declined by 1.21 mL/min/1.73 m2 eGFR (Beta = -1.21; 95% CI -2.35 to -0.07; P = .021). CONCLUSIONS AND IMPLICATIONS For every additional drug prescribed among older adults, our study supports an independent and immediate harmful impact on kidney function. This negative impact seems to be about 3 times greater for NSAIDs compared with an additional average drug.
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Affiliation(s)
- Rahel Ernst
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland; Internal Medicine Clinic, City Hospital Waid, Zurich, Switzerland
| | - Karina Fischer
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland
| | - Caroline de Godoi Rezende Costa Molino
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland
| | - Endel J Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Robert Theiler
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland
| | - Ursina Meyer
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland
| | - Manuel Fischler
- Internal Medicine Clinic, City Hospital Waid, Zurich, Switzerland
| | - Michael Gagesch
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland
| | - Patrice M Ambühl
- Institute of Nephrology, City Hospital Waid, Zurich, Switzerland
| | - Gregor Freystätter
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland
| | - Andreas Egli
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Center on Aging and Mobility, University Hospital Zurich, City Hospital Waid Zurich, Zurich, Switzerland; University Clinic for Acute Geriatric Care, City Hospital Waid, Zurich, Switzerland.
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13
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Fischer K, Trombik M, Freystätter G, Egli A, Theiler R, Bischoff-Ferrari HA. Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis. Osteoporos Int 2019; 30:1371-1381. [PMID: 30941485 DOI: 10.1007/s00198-019-04944-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED We investigated the timeline of functional recovery after hip fracture over 12 months in adults age ≥ 65 years using objective lower extremity function tests and subjective physical functioning. Objective functional recovery was largely complete in the first 6 months, whereas subjective recovery improved up to 9 months after hip fracture. INTRODUCTION Hip fractures are a major cause of loss of function among seniors. We assessed the timeline of objective and subjective functional recovery after hip fracture. METHODS We conducted a prospective observational secondary analysis of a 1-year clinical trial on vitamin D and home exercise treatment and complications after hip fracture among 173 patients age ≥ 65 years (mean age 84 years; 79.2% women; 77.4% community-dwelling) conducted from January 2005 through December 2007. Lower extremity function (Timed Up and Go test (TUG), knee extensor and flexor strength) and grip strength was assessed at baseline and at 6 and 12 months follow-up. Subjective physical functioning was assessed using the SF-36 questionnaire also at 3 and 9 months follow-up. Multivariable-adjusted repeated-measures models were used to assess the timeline of functional recovery in the total population and in subgroups of patients. RESULTS Lower extremity function including TUG (- 61.1%), knee extensor (+ 17.6%), and knee flexor (+ 11.6%) strength improved significantly in the first 6 months (P < 0.001). However, between 6 and 12 months, there was no further significant improvement for any of the functional tests. Grip strength decreased from baseline to 6 months (- 7.9%; P < 0.001) and from 6 to 12 months (- 10.8%; P < 0.001). Subjective physical functioning improved from 3 to 9 months (+ 15.2%, P < 0.001), but no longer thereafter. CONCLUSIONS Functional recovery after hip fracture may be largely complete in the first 6 months for objective functional tests, whereas may extend up to 9 months for subjective recovery, with oldest-old, female, institutionalized, and cognitively impaired patients recovering most poorly. CLINICAL TRIALS REGISTRY (ORIGINAL TRIAL) NCT00133640.
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Affiliation(s)
- K Fischer
- Department of Geriatrics and Aging Research, Geriatric Clinic, University Hospital Zurich and University of Zurich, RAE B1, Rämistrasse 100, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
| | - M Trombik
- Department of Geriatrics and Aging Research, Geriatric Clinic, University Hospital Zurich and University of Zurich, RAE B1, Rämistrasse 100, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
| | - G Freystätter
- Department of Geriatrics and Aging Research, Geriatric Clinic, University Hospital Zurich and University of Zurich, RAE B1, Rämistrasse 100, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Centre for Senior Trauma Care, University Hospital Zurich, Zurich, Switzerland
| | - A Egli
- Department of Geriatrics and Aging Research, Geriatric Clinic, University Hospital Zurich and University of Zurich, RAE B1, Rämistrasse 100, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
| | - R Theiler
- Department of Geriatrics and Aging Research, Geriatric Clinic, University Hospital Zurich and University of Zurich, RAE B1, Rämistrasse 100, 8091, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Centre for Senior Trauma Care, University Hospital Zurich, Zurich, Switzerland
| | - H A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, Geriatric Clinic, University Hospital Zurich and University of Zurich, RAE B1, Rämistrasse 100, 8091, Zurich, Switzerland.
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland.
- Centre for Senior Trauma Care, University Hospital Zurich, Zurich, Switzerland.
- City Hospital Waid, University Clinic for Acute Geriatric Care, Zurich, Switzerland.
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14
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Gugger A, Marzel A, Orav EJ, Willett WC, Dawson-Hughes B, Theiler R, Freystätter G, Egli A, Bischoff-Ferrari HA. Effect of Monthly High-Dose Vitamin D on Mental Health in Older Adults: Secondary Analysis of a RCT. J Am Geriatr Soc 2019; 67:1211-1217. [PMID: 30707771 DOI: 10.1111/jgs.15808] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To test the effect of monthly high-dose vitamin D supplementation on mental health in pre-frail older adults. DESIGN Ancillary study of a 1-year double-blind randomized clinical trial conducted in Zurich, Switzerland. SETTING AND PARTICIPANTS A total of 200 community-dwelling adults 70 years and older with a prior fall event in the last year. Participants were randomized to receive 24 000 IU vitamin D3 (considered standard of care), 60 000 IU vitamin D3 , or 24 000 IU vitamin D3 plus 300 μg calcifediol per month. MEASURES The primary end point was the Mental Component Summary (MCS) of the SF-36. Secondary end points were the SF-36 Mental Health (MH) subscale and the Geriatric Depression Scale (GDS-15). RESULTS Participants' mean age was 78 years (67% women), and 58% were vitamin D deficient (<20 ng/mL). Over time, primary and secondary end points did not differ significantly among the three treatment groups or in subgroups by vitamin D status at baseline. Given the lack of a true placebo group, we explored in a predefined observational analysis the change in mental health scales by achieved 25(OH)D levels at 12 months. After adjusting for confounders, participants achieving the highest 25(OH)D quartile (Q) at 12 months (44.7-98.9 ng/mL) had the greatest improvements in MCS (Q4 = 0.79 vs Q1 = -2.9; p = .03) and MH scales (Q4 = 2.54 vs Q1 = -3.07; p = .03); these associations were strongest among participants who were vitamin D deficient at baseline. No association was found for GDS (p = .89). CONCLUSIONS For mental health, our study suggests no benefit of higher monthly doses of vitamin D3 compared with the standard monthly dose of 24 000 IU. However, irrespective of vitamin D treatment dose, achieving higher 25(OH)D levels at 12-month follow-up was associated with a small, clinically uncertain but statistically significant improvement in mental health scores.
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Affiliation(s)
- Alenka Gugger
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Switzerland
| | - Alex Marzel
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Switzerland
| | - E John Orav
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Walter C Willett
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Robert Theiler
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Switzerland
| | - Gregor Freystätter
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Switzerland
| | - Andreas Egli
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Switzerland.,University Clinic for Acute Geriatric Care, City Hospital Waid, Zurich, Switzerland
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Bischoff-Ferrari HA, Fischer K, Orav EJ, Dawson-Hughes B, Meyer U, Chocano-Bedoya PO, Meyer OW, Ernst R, Schietzel S, Eberli F, Staehelin HB, Freystätter G, Roas S, Theiler R, Egli A, Wilson NM. Statin Use and 25-Hydroxyvitamin D Blood Level Response to Vitamin D Treatment of Older Adults. J Am Geriatr Soc 2017; 65:1267-1273. [PMID: 28240766 DOI: 10.1111/jgs.14784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 08/24/2016] [Revised: 11/05/2016] [Accepted: 11/16/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To determine whether statin use alters response of 25-hydroxyvitamin D (25(OH)D) level to vitamin D treatment. DESIGN Pooled analysis. SETTING Three double-blind randomized controlled trials that tested different doses of vitamin D. PARTICIPANTS Participants of three trials (N = 646; mean age 76.3 ± 8.4, 65% female). MEASUREMENTS In all three trials, 25(OH)D status and statin use were assessed repeatedly over time (baseline, 6 and 12 months). Repeated-measures analysis was used to compare 25(OH)D response to vitamin D treatment at baseline and 6 and 12 months of statin users and nonusers, controlling for age, sex, body mass index, Charlson Comorbidity Index, vitamin D dose, trial, and season. RESULTS At baseline, 17.5% were statin users, and 65% were vitamin D deficient (25(OH)D < 20 ng/mL). Baseline 25(OH)D levels did not differ significantly between groups at baseline (18.8 for statin users, 17.2 ng/mL for nonusers, P = .07), but according to the longitudinal analyses, the total increase over 12 months in 25(OH)D concentration was significantly lower in statin users (13.1 ng/L) than nonusers (15.9 ng/mL; 21.4% difference; P = .009). CONCLUSION Of persons aged 60 and older at high risk of vitamin D deficiency, statin users had a 21.4% smaller increase in 25(OH)D serum concentrations over time than nonusers, independent of vitamin D dose and other covariates.
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Affiliation(s)
- Heike A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Karina Fischer
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Endel J Orav
- Department of Biostatistics, School of Public Health, Harvard University, Boston, Massachusetts
| | - Bess Dawson-Hughes
- U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Ursina Meyer
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Patricia O Chocano-Bedoya
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Otto W Meyer
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Rahel Ernst
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Simeon Schietzel
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Franz Eberli
- Department of Cardiology, Triemli City Hospital, Zurich, Switzerland
| | | | - Gregor Freystätter
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Susanne Roas
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland
| | - Robert Theiler
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Andreas Egli
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
| | - Nicholas M Wilson
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland
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