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Nakanishi M, Martins Pereira S, Van den Block L, Parker D, Harrison-Dening K, Di Giulio P, In der Schmitten J, Larkin PJ, Mimica N, Sudore RL, Holmerová I, Korfage IJ, van der Steen JT. Future policy and research for advance care planning in dementia: consensus recommendations from an international Delphi panel of the European Association for Palliative Care. Lancet Healthy Longev 2024; 5:e370-e378. [PMID: 38608695 DOI: 10.1016/s2666-7568(24)00043-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/14/2024] Open
Abstract
Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.
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Affiliation(s)
- Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands; Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan; Mental Health Promotion Unit, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics - Ethics and Sustainability Research Area, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Lieve Van den Block
- Vrije Universiteit Brussel-UGent End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Deborah Parker
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Karen Harrison-Dening
- Department of Research and Publications, Dementia UK, London, UK; Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Jürgen In der Schmitten
- Institute of General Practice/Family Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Philip J Larkin
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ninoslav Mimica
- School of Medicine, University of Zagreb, Zagreb, Croatia; Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands; Radboudumc Alzheimer Center and Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands; Cicely Saunders Institute, Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Coll-Planas L, Carbó-Cardeña A, Jansson A, Dostálová V, Bartova A, Rautiainen L, Kolster A, Masó-Aguado M, Briones-Buixassa L, Blancafort-Alias S, Roqué-Figuls M, Sachs AL, Casajuana C, Siebert U, Rochau U, Puntscher S, Holmerová I, Pitkala KH, Litt JS. Nature-based social interventions to address loneliness among vulnerable populations: a common study protocol for three related randomized controlled trials in Barcelona, Helsinki, and Prague within the RECETAS European project. BMC Public Health 2024; 24:172. [PMID: 38218784 PMCID: PMC10787456 DOI: 10.1186/s12889-023-17547-x] [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: 07/17/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The negative effects of loneliness on population health and wellbeing requires interventions that transcend the medical system and leverage social, cultural, and public health system resources. Group-based social interventions are a potential method to alleviate loneliness. Moreover, nature, as part of our social and health infrastructure, may be an important part of the solutions that are needed to address loneliness. The RECETAS European project H2020 (Re-imagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces) is an international research project aiming to develop and test the effectiveness of nature-based social interventions to reduce loneliness and increase health-related quality of life. METHODS This article describes the three related randomized controlled trials (RCTs) that will be implemented: the RECETAS-BCN Trial in Barcelona (Spain) is targeting people 18+ from low socio-economic urban areas; the RECETAS-PRG Trial in Prague (Czech Republic) is addressing community-dwelling older adults over 60 years of age, and the RECETAS-HLSNK trial is reaching older people in assisted living facilities. Each trial will recruit 316 adults suffering from loneliness at least sometimes and randomize them to nature-based social interventions called "Friends in Nature" or to the control group. "Friends in Nature" uses modifications of the "Circle of Friends" methodology based on group processes of peer support and empowerment but including activities in nature. Participants will be assessed at baseline, at post-intervention (3 months), and at 6- and 12-month follow-up after baseline. Primary outcomes are the health-related quality-of-life according to 15D measure and The De Jong Gierveld 11-item loneliness scale. Secondary outcomes are health and psychosocial variables tailored to the specific target population. Nature exposure will be collected throughout the intervention period. Process evaluation will explore context, implementation, and mechanism of impact. Additionally, health economic evaluations will be performed. DISCUSSION The three RECETAS trials will explore the effectiveness of nature-based social interventions among lonely people from various ages, social, economic, and cultural backgrounds. RECETAS meets the growing need of solid evidence for programs addressing loneliness by harnessing the beneficial impact of nature on enhancing wellbeing and social connections. TRIAL REGISTRATION Barcelona (Spain) trial: ClinicalTrials.gov, ID: NCT05488496. Registered 29 July 2022. Prague (Czech Republic) trial: ClinicalTrials.gov, ID: NCT05522140. Registered August 25, 2022. Helsinki (Finland) trial: ClinicalTrials.gov, ID: NCT05507684. Registered August 12, 2022.
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Affiliation(s)
- Laura Coll-Planas
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC). Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Aina Carbó-Cardeña
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC). Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Anu Jansson
- Department of General Practice, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland
| | - Vladimira Dostálová
- Charles University, Faculty of Humanities - Centre of Expertise in Longevity and Long-Term Care, Pátkova 2137/5, 182 00, Prague, Czech Republic
| | - Alzbeta Bartova
- Charles University, Faculty of Humanities - Centre of Expertise in Longevity and Long-Term Care, Pátkova 2137/5, 182 00, Prague, Czech Republic
| | - Laura Rautiainen
- Department of General Practice, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland
| | - Annika Kolster
- Department of General Practice, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland
- Western Uusimaa Wellbeing Services, Health Services, Espoo, Finland
| | - Montse Masó-Aguado
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC). Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Laia Briones-Buixassa
- Innovation in Mental Health and Social Wellbeing Research group (ISAMBES), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC). Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Sergi Blancafort-Alias
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB C/ Sant Antoni M. Claret, 171, 4a planta, Barcelona, Spain
| | - Marta Roqué-Figuls
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB C/ Sant Antoni M. Claret, 171, 4a planta, Barcelona, Spain
| | - Ashby Lavelle Sachs
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB) Doctor Aiguader, 88 08003, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Cristina Casajuana
- Subdirecció General d'Addiccions, VIH, ITS i Hepatitis Víriques. Agència de Salut Pública de Catalunya, Carrer de Roc Boronat, 81-95, 08005, Barcelona, Spain
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Institute for Technology Assessment, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Ursula Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Sibylle Puntscher
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Iva Holmerová
- Charles University, Faculty of Humanities - Centre of Expertise in Longevity and Long-Term Care, Pátkova 2137/5, 182 00, Prague, Czech Republic
| | - Kaisu H Pitkala
- Department of General Practice, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland
- Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Jill S Litt
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB C/ Sant Antoni M. Claret, 171, 4a planta, Barcelona, Spain.
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB) Doctor Aiguader, 88 08003, Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Dostálová V, Bártová A, Bláhová H, Holmerová I. The experiences and needs of frail older people receiving home health care: A qualitative study. Int J Older People Nurs 2021; 17:e12418. [PMID: 34418315 PMCID: PMC9285561 DOI: 10.1111/opn.12418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/06/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 01/26/2023]
Abstract
Background Due to the rapid ageing of the population, there is increasing demand for long‐term care in the people's home environment. Such care aims to allow the people to stay at home and avoid hospitalisation or other institutional care. In home health care, care must be provided at the highest possible quality, with the focus on the people's needs and experiences. Objectives This study explores the experiences and needs of frail older people receiving home health care. Design and methods An exploratory descriptive qualitative approach was chosen. Audio‐taped semi‐structured interviews were conducted with fifteen older people receiving home health care. A content analysis was used to analyse the data collected. Results The content analysis identified one main theme, three categories and seven subcategories related to frail older people's needs and experiences of home health care. The main theme was quality of care. The first category, Safe and Secure Care, consisted of three subcategories: Education and Experience of Nurses, Information, and Continuity of Care in terms of personnel continuity and regular care. The second category, Autonomy, contained two subcategories: Decision‐making and Self‐sufficiency. The last category, Relationship with Professionals, consisted of two subcategories: Personality of Nurse and Partnerships. Conclusion Older people are able to express their satisfaction or dissatisfaction with home health care. The results of this study revealed that the quality of care is crucial for frail older people. Implication for practice The provision of home health care is inherently highly specific; home care nurses should work to provide the highest possible quality of care. In particular, nurses should focus on ensuring that the care they provide is safe, effective, timely, efficient and person‐centred.
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Affiliation(s)
- Vladimíra Dostálová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Alžběta Bártová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Hana Bláhová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Iva Holmerová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
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Ottoboni G, Chirico I, Povolná P, Dostálová V, Holmerová I, Janssen N, Dassen F, de Vugt M, Sánchez-Gómez MC, García-Peñalvo F, Franco-Martin MA, Chattat R. Psychosocial care in dementia in European higher education: Evidence from the SiDECar ("Skills in DEmentia Care") project. Nurse Educ Today 2021; 103:104977. [PMID: 34051541 DOI: 10.1016/j.nedt.2021.104977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 05/25/2023]
Abstract
In dementia care, psychosocial interventions can increase people's quality of life with dementia and their caregivers. Despite their effectiveness, their translation into practice lacks the desirable systematicity. Systematic educational programs on psychosocial interventions in dementia will improve this translation, as it prepares professionals to face the complexity of dementia care. This study aimed to systematically map out the extent to which higher education programs in Europe include teaching activities about psychosocial care of dementia. We collected quantitative and qualitative data about 303 higher education teaching activities on psychosocial care in dementia across Europe. The analysis revealed that the number of teaching activities focusing on psychosocial care in dementia was relative. Although the results reflected UNESCO indications, the teaching activities on psychosocial care in dementia appeared less systematized than optimal. As world health agencies recommend, international higher education systems should consider more psychosocial care topics because they can prepare professionals to respond timely and effectively to dementia patients and caregivers' needs.
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Affiliation(s)
- G Ottoboni
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - I Chirico
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - P Povolná
- Charles University, Faculty of Humanities, Czech Republic; Institute for Postgraduate Medical Education, Prague, Czech Republic.
| | - V Dostálová
- Charles University, Faculty of Humanities, Czech Republic; Institute for Postgraduate Medical Education, Prague, Czech Republic.
| | - I Holmerová
- Charles University, Faculty of Humanities, Czech Republic; Institute for Postgraduate Medical Education, Prague, Czech Republic.
| | - N Janssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - F Dassen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - M de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands.
| | | | | | | | - R Chattat
- Department of Psychology, University of Bologna, Bologna, Italy.
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5
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Bláhová H, Bártová A, Dostálová V, Holmerová I. The needs of older patients in hospital care: a scoping review. Aging Clin Exp Res 2021; 33:2113-2122. [PMID: 33083972 DOI: 10.1007/s40520-020-01734-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research into care for older patients in the hospital environment has become an increasingly valuable source of information, as it gives feedback on the quality of hospital care provided. The aim of this study is to provide a comprehensive overview of the self-reported needs of older people in hospital care. METHODS The scoping review was conducted by searching the following databases: Medline, Web of Science, ProQuest Central, Scopus, Cinahl, PsycINFO and Summon. RESULTS The search identified articles focusing on older people in hospital care. The majority of these articles address the system and quality of care for seniors at a somewhat general and theoretical level. Met and unmet needs were assessed by a variety of test methods focusing mainly on medical issues (e.g., Mini-Nutritional Assessment, ADLs-activities of daily living, Abbey Pain Scale) and mostly from the perspective of hospital staff, carers and relatives. Only 15 articles used assessments based on information and opinions obtained from the seniors themseAbstract_Paralves (self-reported needs). A thematic analysis revealed seven main themes: conduct and care in emergency departments, dignity, nutritional care, satisfaction of patients' needs, pain, caring with respect, decision-making and spiritual needs. CONCLUSION/DISCUSSION The results of this scoping review suggest that more attention should be focused on information acquired from the patients themselves, as it is only the patient, however, old or frail, who can offer an accurate perspective on met or unmet needs and the quality of care provided.
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Affiliation(s)
- Hana Bláhová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic.
| | - Alžběta Bártová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Vladimíra Dostálová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Iva Holmerová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
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Chirico I, Chattat R, Dostálová V, Povolná P, Holmerová I, de Vugt ME, Janssen N, Dassen F, Sánchez-Gómez MC, García-Peñalvo FJ, Franco-Martín MA, Ottoboni G. The Integration of Psychosocial Care into National Dementia Strategies across Europe: Evidence from the Skills in DEmentia Care (SiDECar) Project. Int J Environ Res Public Health 2021; 18:ijerph18073422. [PMID: 33806158 PMCID: PMC8036745 DOI: 10.3390/ijerph18073422] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
There is evidence supporting the use of psychosocial interventions in dementia care. Due to the role of policy in clinical practice, the present study investigates whether and how the issue of psychosocial care and interventions has been addressed in the national dementia plans and strategies across Europe. A total of 26 national documents were found. They were analyzed by content analysis to identify the main pillars associated with the topic of psychosocial care and interventions. Specifically, three categories emerged: (1) Treatment, (2) Education, and (3) Research. The first one was further divided into three subcategories: (1) Person-centred conceptual framework, (2) Psychosocial interventions, and (3) Health and social services networks. Overall, the topic of psychosocial care and interventions has been addressed in all the country policies. However, the amount of information provided differs across the documents, with only the category of ‘Treatment’ covering all of them. Furthermore, on the basis of the existing policies, how the provision of psychosocial care and interventions would be enabled, and how it would be assessed are not fully apparent yet. Findings highlight the importance of policies based on a comprehensive and well-integrated system of care, where the issue of psychosocial care and interventions is fully embedded.
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Affiliation(s)
- Ilaria Chirico
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
- Correspondence:
| | - Rabih Chattat
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
| | - Vladimíra Dostálová
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Pavla Povolná
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Iva Holmerová
- Faculty of Humanities, Charles University, 182 00 Prague, Czech Republic; (V.D.); (P.P.); (I.H.)
- Institute for Postgraduate Medical Education, Charles University, 100 00 Prague, Czech Republic
| | - Marjolein E. de Vugt
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - Niels Janssen
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - Fania Dassen
- Alzheimer Centrum Limburg, Maastricht University, 6229 MD Maastricht, The Netherlands; (M.E.d.V.); (N.J.); (F.D.)
| | - María Cruz Sánchez-Gómez
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Francisco José García-Peñalvo
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Manuel A. Franco-Martín
- Psycho-Sciences Research Group of IBSAL, Salamanca University, 37007 Salamanca, Spain; (M.C.S.-G.); (F.J.G.-P.); (M.A.F.-M.)
| | - Giovanni Ottoboni
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (R.C.); (G.O.)
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Vacinova G, Vejražkova D, Rusina R, Holmerová I, Vaňková H, Jarolímová E, Včelák J, Bendlová B, Vaňková M. Regulated upon activation, normal T cell expressed and secreted (RANTES) levels in the peripheral blood of patients with Alzheimer's disease. Neural Regen Res 2021; 16:796-800. [PMID: 33063745 PMCID: PMC8067920 DOI: 10.4103/1673-5374.295340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 12/27/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common type of dementia, but it is very difficult to diagnose with certainty, so many AD studies have attempted to find early and relevant diagnostic markers. Regulated upon activation, normal T cell expressed and secreted (RANTES, also known as C-C chemokine ligand) is a chemokine involved in the migration of T cells and other lymphoid cells. Changes in RANTES levels and its expression in blood or in cerebrospinal fluid have been reported in some neurodegenerative diseases, such as Parkinson’s disease and multiple sclerosis, but also in metabolic diseases in which inflammation plays a role. The aim of this observational study was to assess RANTES levels in peripheral blood as clinical indicators of AD. Plasma levels of RANTES were investigated in 85 AD patients in a relatively early phase of AD (median 8.5 months after diagnosis; 39 men and 46 women; average age 75.7 years), and in 78 control subjects (24 men and 54 women; average age 66 years). We found much higher plasma levels of RANTES in AD patients compared to controls. A negative correlation of RANTES levels with age, disease duration, Fazekas scale score, and the medial temporal lobe atrophy (MTA) score (Scheltens’s scale) was found in AD patients, i.e., the higher levels corresponded to earlier stages of the disease. Plasma RANTES levels were not correlated with cognitive scores. In AD patients, RANTES levels were positively correlated with the levels of pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-α, which is consistent with the well-known fact that AD is associated with inflammatory processes. RANTES levels were also positively correlated with insulin levels in AD patients, with insulin resistance (HOMA-R) and pancreatic beta cell function (HOMA-F). This study evaluated several clinical and metabolic factors that may affect plasma levels of RANTES, but these factors could not explain the increases in RANTES levels observed in AD patients. Plasma levels of RANTES appear to be an interesting peripheral marker for early stages of AD. The study was approved by the Ethics Committee of Institute of Endocrinology, Prague, Czech Republic on July 22, 2011.
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Affiliation(s)
- Gabriela Vacinova
- Department of Molecular Endocrinology, Institute of Endocrinology; Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czech Republic
| | - Daniela Vejražkova
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Robert Rusina
- Department of Neurology, Third Faculty of Medicine of Charles University and Thomayer Hospital Prague, Czech Republic
| | - Iva Holmerová
- II. Internal Medicine Clinic, Third Faculty of Medicine, Charles University, Prague; Faculty of Humanitites, Charles University Prague, Czech Republic
| | - Hana Vaňková
- II. Internal Medicine Clinic, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva Jarolímová
- II. Internal Medicine Clinic, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Včelák
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Běla Bendlová
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Markéta Vaňková
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
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Abstract
Objectives: With rates of dementia continuing to rise, the impetus on improving care for people with dementia is growing. Unmet needs of people with dementia living in nursing homes have been linked with worsening neuropsychiatric symptoms, higher levels of depression, and reduced quality of life. Furthermore, proxy accounts exploring the needs of people with dementia have frequently been shown to be unreliable. Therefore, this literature review aims to explore the self-reported needs and experiences of people with dementia in nursing homes.Method: A scoping review of the literature was carried out using the databases PubMed and PsycINFO to search for relevant articles according to PRISMA guidelines. Search terms were designed to include both quantitative and qualitative study designs. Thematic synthesis was used to categorise findings into themes related to self-reported needs and experiences.Results: A total of 41 articles met the eligibility criteria. An analysis of study characteristics revealed more than half of studies used a qualitative design. Thematic synthesis resulted in eight themes: activities, maintaining previous roles, reminiscence, freedom and choice, appropriate environment, meaningful relationships, support with grief and loss, end-of-life care.Conclusion: Whilst the voice of people with dementia has previously been neglected in research, this review has shown that people with dementia in nursing homes are able to describe their experiences and communicate their needs. The findings in this review have provided a contribution towards guiding evidence-based practice that is tailored to the needs of nursing home residents with dementia.
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Affiliation(s)
- Kate Shiells
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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9
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Vaňková M, Vacínová G, Včelák J, Vejražková D, Lukášová P, Rusina R, Holmerová I, Jarolímová E, Vaňková H, Bendlová B. Plasma levels of adipokines in patients with Alzheimer's disease - where is the "breaking point" in Alzheimer's disease pathogenesis? Physiol Res 2020; 69:S339-S349. [PMID: 33094632 DOI: 10.33549/physiolres.934536] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Peripheral insulin resistance is associated with decreasing adiponectin and increasing leptin plasma levels, and also with cognitive decline. The effects of adipokines on brain function have been published from both animal and human studies. In particular, the influence of leptin and adiponectin on the development of Alzheimer's disease (AD) has been extensively investigated. However, the association between adipsin and AD is as yet unknown. In 37 patients with AD and 65 controls that followed the same study protocol, we tested whether adiponectin, leptin, and adipsin could be used as biomarkers in the early stages of AD. In contrast with conclusions of cognition studies in insulin resistant states, our study found a correlation of impaired neuropsychological performance with increasing adiponectin and decreasing leptin in AD patients. Nevertheless, no significant differences between patients and controls were found. AD women had significantly increased adipsin compared to controls, and there was a positive correlation of adipsin with age and disease duration. Although adipokines do not appear to be suitable biomarkers for early AD diagnosis, they certainly play a role in the pathogenesis of AD. Further studies will be needed to explain the cause of the adipokine "breaking point" that leads to the pathogenesis of overt AD.
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Affiliation(s)
- M Vaňková
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic.
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10
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O'Neill D, Briggs R, Holmerová I, Samuelsson O, Gordon AL, Martin FC. COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. Eur Geriatr Med 2020; 11:645-650. [PMID: 32557250 PMCID: PMC7298916 DOI: 10.1007/s41999-020-00347-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022]
Abstract
The nursing home sector has seen a disproportionately high number of deaths as part of the COVID-19 pandemic. This reflects, in part, the frailty and vulnerability of older people living in care homes but has also, in part, been a consequence of the failure to include care homes in the systematic planning of a response to COVID, as well as a measure of neglect of standards and quality improvement in the sector. In response, the EUGMS published a set of medical standards of care developed in consultation with experts across its member national societies in 2015. The standards consisted of seven core principles of medical care for physicians working in nursing homes as a first step in developing a programme of clinical, academic and policy engagement in improving medical care for older people who are living and frequently also dying as residents in nursing homes. The gravity of the concerns arising for nursing home care from the COVID-19 pandemic, as well as emerging insights on care improvement in nursing homes indicate that an update of these medical standards is timely. This was performed by the writing group from the original 2015 guidelines and is intended as an interim measure pending a more formal review incorporating a systematic review of emerging literature and a Delphi process.
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Affiliation(s)
- Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland.
| | | | | | | | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
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11
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Shiells K, Diaz Baquero AA, Štěpánková O, Holmerová I. Staff perspectives on the usability of electronic patient records for planning and delivering dementia care in nursing homes: a multiple case study. BMC Med Inform Decis Mak 2020; 20:159. [PMID: 32660474 PMCID: PMC7359585 DOI: 10.1186/s12911-020-01160-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user's perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective. METHODS An exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added. RESULTS Staff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes. CONCLUSIONS EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.
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Affiliation(s)
- Kate Shiells
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic.
| | - Angie Alejandra Diaz Baquero
- Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
- Department of Research & Development, Iberian Research Psycho-sciences Institute, INTRAS Foundation, Zamora, Spain
| | - Olga Štěpánková
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
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12
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Höfler M, Ratajczak P, Beránková A, Prieschl D, Šteffl M, Holmerová I, Auer SR. Data of a sub-analysis of the DEMDATA study: characteristics of Austrian and Czech nursing homes residents. BMC Res Notes 2019; 12:463. [PMID: 31358031 PMCID: PMC6664514 DOI: 10.1186/s13104-019-4495-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this data paper is to provide the data set of a sub-analysis of the DEMDATA study data. In the DEMDATA study, epidemiological data on the prevalence and severity of dementia, as well as functioning, behavioral problems and other health related factors in residents living in Austrian and Czech nursing homes were collected. The DEMDATA project further provides information on relatives’ perception of the life Quality of residents, care team burden as well as environmental factors. Participating nursing homes were randomly drawn and stratified. Inclusion criteria for participation were that the resident was living permanently in the institution and that he/she and/or a legal representative (where relevant) had signed an informed consent. Data description This paper provides data of cognitive, functional and behavioral assessments as well as other health related information of 1085 residents living in Austrian and Czech nursing homes. For each resident, several measurements on his or her cognitive, functional, and behavioral status are available. Also further health-related factors such as quality of life, pain, numbers of falls and hospital stays are provided.
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Affiliation(s)
- Margit Höfler
- Danube University Krems, Dr. Karl-Dorrekstrasse 30, 3500, Krems, Austria.
| | - Paulina Ratajczak
- Danube University Krems, Dr. Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | - Anna Beránková
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Doris Prieschl
- MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria
| | - Michal Šteffl
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Stefanie R Auer
- Danube University Krems, Dr. Karl-Dorrekstrasse 30, 3500, Krems, Austria.,MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria
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13
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Woods B, Arosio F, Diaz A, Gove D, Holmerová I, Kinnaird L, Mátlová M, Okkonen E, Possenti M, Roberts J, Salmi A, van den Buuse S, Werkman W, Georges J. Timely diagnosis of dementia? Family carers' experiences in 5 European countries. Int J Geriatr Psychiatry 2019; 34:114-121. [PMID: 30246266 PMCID: PMC6586062 DOI: 10.1002/gps.4997] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Timely diagnosis of dementia is recommended in national strategies. To what extent is it occurring across Europe, what factors are associated with it, and what is the impact on carers emotions of quality of diagnostic disclosure? METHODS/DESIGN Survey of family carers recruited through 5 Alzheimer's associations (Czech Republic, Finland, Italy, the Netherlands, and Scotland). One thousand four hundred and nine carers participated, 84% completing online. Fifty-two percent were adult children, and 37% were spouses, with median age 57. Most (83%) were female. RESULTS Nearly half (47%) of carers reported that an earlier diagnosis would have been preferable. Delaying factors included reluctance of the person with dementia, lack of awareness of dementia, the response of professionals, and delays within health systems. Recent diagnoses were no more likely to be considered timely, although professional responses appeared to be improving. Delayed diagnoses were more often reported by adult child carers and where the diagnosis was made in the later stages of dementia, or another condition had been previously diagnosed. In all countries except Italy, the diagnosis was shared with the person with dementia in the majority of cases. Timely diagnoses and higher quality diagnostic disclosure are associated with better adjustment and less negative emotional impact on carers in the short and medium term. CONCLUSIONS Although the study sample were well educated and likely to be in touch with an Alzheimer organisation, many continued to experience the diagnosis of dementia as coming too late, and further work on public awareness, as well as on professional responses, is needed.
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Affiliation(s)
- Bob Woods
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | | | - Ana Diaz
- Alzheimer EuropeLuxembourgLuxembourg
| | | | | | | | | | - Eila Okkonen
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
| | | | - Jennifer Roberts
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | - Anna Salmi
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
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14
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Holmerová I, Auer SR, Beránková A, Höfler M, Ratajczak P, Šteffl M. Cognitive status and use of analgesics and anxiolytics in residents of nursing homes in the Czech Republic. Clin Interv Aging 2018; 13:2511-2515. [PMID: 30587943 PMCID: PMC6294074 DOI: 10.2147/cia.s188601] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The treatment of pain and treatment of anxiety are two of the most complex issues in nursing homes worldwide, mainly because of the large numbers of people with cognitive impairment who reside in this environment. Aim The aim of this study was to investigate the administration of analgesics and anxiolytics to people living in nursing homes, taking into account cognitive status. Methods For this cross-sectional study, we used data from 404 residents who lived in nine randomly selected nursing homes in the Czech Republic and participated in the Czech-Austrian Long-Term Care Research Project called DEMDATA. Information about medication administration was obtained from medical records. Cognitive impairment was evaluated by the Mini-Mental State Examination, and pain was measured by the Pain Assessment in Advanced Dementia. To measure anxiety, we used the Behavioral Pathology in Alzheimer’s Disease Rating Scale in residents with severe-to-moderate dementia and also the standardized questionnaire EuroQol in other residents. Results In all, 68% (95% CI 62–74) of residents with pain did not receive any analgesic medication and 31% (95% CI 25–38) of residents were administered some analgesics and continued to report pain. The lowest reported occurrence of pain, as well as the lowest prevalence of analgesic administration, was in residents with moderate-to-severe dementia. We found that an alarming percentage of residents in the nursing homes were not treated sufficiently. Conclusion This study indicates that treatment effects should be better monitored.
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Affiliation(s)
- Iva Holmerová
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Stefanie R Auer
- Danube University Krems, 3500 Krems, Austria.,MAS Alzheimerhilfe, 4820 Bad Ischl, Austria
| | - Anna Beránková
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | | | | | - Michal Šteffl
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic,
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15
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Fitzpatrick D, Samuelsson O, Holmerová I, Martin F, O’Neill D. 119An EuGMS Survey to Determine who are the Principal Medical Care Providers of European Nursing Home Residents. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.92] [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: 11/13/2022] Open
Affiliation(s)
- Donal Fitzpatrick
- EUGMS Long Term Care Special Interest Group, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Olafur Samuelsson
- EUGMS Long Term Care Special Interest Group, Reykjavik, Iceland
- National University Hospital of Iceland, Reykjavik, Iceland
| | - Iva Holmerová
- EUGMS Long Term Care Special Interest Group, Dublin, Ireland
- Charles University, Prague, Czech Republic
| | - Finbar Martin
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- EUGMS Long Term Care Special Interest Group, London, United Kingdom
| | - Desmond O’Neill
- EUGMS Long Term Care Special Interest Group, Dublin, Ireland
- Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
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16
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Auer SR, Höfler M, Linsmayer E, Beránková A, Prieschl D, Ratajczak P, Šteffl M, Holmerová I. Cross-sectional study of prevalence of dementia, behavioural symptoms, mobility, pain and other health parameters in nursing homes in Austria and the Czech Republic: results from the DEMDATA project. BMC Geriatr 2018; 18:178. [PMID: 30103672 PMCID: PMC6090593 DOI: 10.1186/s12877-018-0870-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 01/24/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background This paper provides a first comparative exploratory analysis of our findings from DEMDATA, a collaborative project between Austria and the Czech Republic. Analysed here are data from the residents and the environment assessment protocol. Methods In a cross sectional study design, residents from randomly drawn and stratified nursing homes were investigated using a common study protocol. Results From a total resident pool of 1666 persons, 1085 (571 in Austria, 514 in the Czech Republic) persons signed a consent form and participated in the data collection. More than 70% of residents assessed were female and the population was on average 85 years old. A discrepancy between the presence of a medical diagnosis in the charts of the residents and the results of cognitive testing was found. In Austria, 85.2%, in the Czech Republic 53.0% of residents had cognitive impairment. In Austria 80.0%, and in the Czech Republic 56.7% had behavioural problems. With respect to pain, 44.8% in Austria, and 51.5% in the Czech Republic had mild to severe pain. 78.4% of Austrian and 74.5% of the residents had problems with mobility and both populations were in danger of malnutrition. Conclusions Most of the prevalence rates are comparable with previous studies also using direct resident assessment. Variations in prevalence rates seem to result mainly from the assessment technique (direct cognitive testing vs. medical chart review). The high prevalence rates for dementia, behavioural symptoms, pain and malnutrition indicate an immediate call for attention to further research and practice development.
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Affiliation(s)
- Stefanie R Auer
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria. .,MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria.
| | - Margit Höfler
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | | | - Anna Beránková
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Doris Prieschl
- MAS Alzheimerhilfe, Lindau Strasse 28, 4820, Bad Ischl, Austria
| | - Paulina Ratajczak
- Danube University Krems, Dr.Karl-Dorrekstrasse 30, 3500, Krems, Austria
| | - Michal Šteffl
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
| | - Iva Holmerová
- Charles University, Šimůnkova 1600, 8- Kobylisy, 182 00, Prague, Czech Republic
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17
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Macháčová K, Vaňková H, Holmerová I, Čábelková I, Volicer L. Ratings of activities of daily living in nursing home residents: comparison of self- and proxy ratings with actual performance and the impact of cognitive status. Eur J Ageing 2018; 15:349-358. [PMID: 30532672 DOI: 10.1007/s10433-018-0456-5] [Citation(s) in RCA: 3] [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] [Indexed: 11/28/2022] Open
Abstract
This study was conducted to examine differences between self- and proxy ratings of activities in daily living (ADL) in nursing home residents and to compare them with actual performance. An impact of cognitive status on these ratings was also determined. Data were obtained from 164 dyads of nursing home residents (self-ratings) and their professional care providers (proxy ratings). Statistical procedures included t tests, intraclass correlations, Pearson's correlations, analysis of variance (ANOVA) and ROC curves. Paired t test provided evidence that residents in general overestimated their abilities for all ADLs (p < .01 in all cases), but a substantial subset of 54 residents, with mean MMSE of 18, agreed with their care providers. The mean MMSE score of those who overestimated their abilities was 13 (N = 57). The ANOVA revealed that greater rating differences were associated with more severe cognitive impairment (MMSE, F = 9.93, p < .001). Proxy ratings of walking were not significantly different from actual performances (p = .145), while self-ratings overestimated it (p < .001). Although residents in general overestimated their ADL abilities and results of comparison with actual performance indicated that proxies may be closer to the actual status in this population, a considerable number of those with milder cognitive impairment were able to assess their ADLs with reasonable accuracy.
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Affiliation(s)
- Kateřina Macháčová
- 1Centre of Expertise in Longevity and Long-Term Care, International Longevity Centre Czech Republic at Faculty of Humanities, Charles University, U Kříže 8, 158 00 Prague 5, Czech Republic
| | - Hana Vaňková
- 1Centre of Expertise in Longevity and Long-Term Care, International Longevity Centre Czech Republic at Faculty of Humanities, Charles University, U Kříže 8, 158 00 Prague 5, Czech Republic
| | - Iva Holmerová
- 1Centre of Expertise in Longevity and Long-Term Care, International Longevity Centre Czech Republic at Faculty of Humanities, Charles University, U Kříže 8, 158 00 Prague 5, Czech Republic.,Centre of Gerontology, Šimůnkova 1600, 182 00 Prague 8, Czech Republic
| | - Inna Čábelková
- 3Faculty of Humanities, Charles University, U Kříže 8, 158 00 Prague 5, Czech Republic
| | - Ladislav Volicer
- 4School of Aging Studies, University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620 USA.,5Third Faculty of Medicine, Charles University, Ruská 2411/87, 100 00 Prague 10, Czech Republic
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18
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Piťha J, Topinková E, Bláha V, Jurašková B, Bureš I, Holmerová I, Vrablík M. Statin therapy in elderly patients. Vnitr Lek 2018; 64:1021-1027. [PMID: 30606018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiovascular events occur most frequently in patients at higher age groups. The elderly suffer not only more advanced and complex changes of cardiovascular system but, also, other chronic conditions. Moreover, compared to middle-age, different therapeutic response is often observed due to changes of pharmaco-kinetics and -dynamics; these patients use other medications, which may trigger drug interactions. The situation is further complicated by non-adherence related to frequent cognitive impairment. On one hand the elderly enjoy the greatest absolute benefit from adequate cardiovascular treatment while on the other they might be more susceptible to adverse reactions. In spite of the fact statins represent preventative medications, they must be indicated cautiously taken into consideration comorbidities, frailty and disability occurring in advanced age. Frail and disabled patients have greater risk of statin adverse effects, however, even these patients have lower mortality rates while being on statins. In seniors with life expectancy exceeding 5 years statins, when indicated, bring unambiguously proven benefit and should be considered high-priority medications. Key words: atherosclerosis - cardiovascular disease - dyslipidemia - elderly - frailty - management - statins.
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19
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Holmerová I, Hort J, Rusina R, Wimo A, Šteffl M. Costs of dementia in the Czech Republic. Eur J Health Econ 2017; 18:979-986. [PMID: 27785577 DOI: 10.1007/s10198-016-0842-x] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the cost of dementia in the Czech Republic. METHODS One hundred and nineteen patient-caregiver dyads participated in our multicenter observational cost-of-illness study. The modified Resource Utilization in Dementia Questionnaire was used as the main tool to collect data from patients and caregivers. Medical specialists provided additional data from medical records. The average costs of dementia were calculated and patients were then divided by the level of cognitive impairment. A generalized linear model was used to determine if differences were present for selected cost variables. RESULTS The mean (standard deviation) for direct cost per a patient in a month was estimated to be €243.0 (138.0), €1727.1 (1075.6) for the indirect cost, and €1970.0 (1090.3) for the total cost of dementia in the Czech Republic. All of the costs increased as dementia severity increased. Both the indirect and total costs significantly (p < 0.05) increased if patients were living with their primary caregiver, and if the severity of cognitive impairment was increased. CONCLUSIONS The indirect cost, which was represented mainly by informal care, comprised the main part of the total cost of care for patients with dementia in the Czech Republic. Both total and indirect care costs increased significantly the cognition declined.
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Affiliation(s)
- Iva Holmerová
- Faculty of Humanities, Centre of Expertise Longevity and Long Term Care and Centre of Gerontology, Charles University Prague, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, Faculty of Medicine 2, Memory Clinic, Charles University Prague, Prague, Czech Republic
| | - Robert Rusina
- Department of Neurology, Faculty of Medicine 1, Charles University Prague, Prague, Czech Republic
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Huddinge, Sweden
| | - Michal Šteffl
- Faculty of Physical Education and Sport, Charles University Prague, Veleslavin, 16252 6, Prague, Czech Republic.
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20
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Iliffe S, Wilcock J, Synek M, Carboch R, Hradcová D, Holmerová I. Case Management for People with Dementia and its Translations: A Discussion Paper. Dementia 2017; 18:951-969. [DOI: 10.1177/1471301217697802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, UK
| | - Michal Synek
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Radek Carboch
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic; Department of Sociology, Faculty of Social Studies, Masaryk University, Czech Republic
| | - Dana Hradcová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-term Care, Faculty of Humanities, Charles University in Prague, Czech Republic
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21
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Vaňková M, Hill M, Velíková M, Včelák J, Vacínová G, Dvořáková K, Lukášová P, Vejražková D, Rusina R, Holmerová I, Jarolímová E, Vaňková H, Kancheva R, Bendlová B, Stárka L. Preliminary evidence of altered steroidogenesis in women with Alzheimer's disease: Have the patients "OLDER" adrenal zona reticularis? J Steroid Biochem Mol Biol 2016; 158:157-177. [PMID: 26704533 DOI: 10.1016/j.jsbmb.2015.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 07/09/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 12/27/2022]
Abstract
Alzheimer's disease (AD) represents more than half of total dementias. Various factors including altered steroid biosynthesis may participate in its pathophysiology. We investigated how the circulating steroids (measured by GC-MS and RIA) may be altered in the presence of AD. Sixteen women with AD and 22 age- and BMI-corresponding controls aged over 65 years were enrolled in the study. The steroid levels (47 steroids and steroid polar conjugates) and their ratios in AD female patients indicated increased CYP11A1 activity, weakened activity of the CYP17A1C17,20 lyase metabolic step and attenuated sulfotransferase SULT2A1 activity at higher activity of the CYP17A1 17-hydroxylase step. The patients showed diminished HSD3B2 activity for C21 steroids, abated conversion of 17-hydroxyprogesterone to cortisol, and significantly elevated cortisol. The women with AD had also attenuated steroid 7α-hydroxylation forming immunoprotective Δ(5)-C19 steroids, attenuated aromatase activity forming estradiol that induces autoimmunity and a shift from the 3β-hydroxy-5α/β-reduced C19 steroids to their neuroinhibitory and antiinflammatory GABAergic 3α-hydroxy- counterparts and showed higher levels of the 3α-hydroxy-5α/β-reduced C21 steroids and pregnenolone sulfate (improves cognitive abilities but may be both protective and excitotoxic). Our preliminary data indicated functioning of alternative "backdoor" pathway in women with AD showing higher levels of both 5α/β-reduced C21 steroids but reduced levels of both 5α/β-reduced C21 steroids, which implied that the alternative "backdoor" pathway might include both 5α- and 5β-reduced steroids. Our study suggested relationships between AD status in women based on the age of subjects and levels of 10 steroids measured by GC-MS.
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Affiliation(s)
- Markéta Vaňková
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | - Martin Hill
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | - Marta Velíková
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | - Josef Včelák
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | - Gabriela Vacínová
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | | | - Petra Lukášová
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | | | - Robert Rusina
- Department of Neurology, Thomayer's Hospital, Vídeňská 800, Prague 140 59, Czech Republic.
| | - Iva Holmerová
- Faculty of Humanities, Charles University in Prague, Ovocný trh 5, Prague 110 00, Czech Republic.
| | - Eva Jarolímová
- Faculty of Humanities, Charles University in Prague, Ovocný trh 5, Prague 110 00, Czech Republic.
| | - Hana Vaňková
- Faculty of Humanities, Charles University in Prague, Ovocný trh 5, Prague 110 00, Czech Republic; Third Faculty of Medicine, Charles University in Prague, Ovocný trh 5, Prague 110 00, Czech Republic.
| | - Radmila Kancheva
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | - Běla Bendlová
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
| | - Luboslav Stárka
- Institute of Endocrinology, Národní 8, Prague 116 94, Czech Republic.
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Holmerová I, Wija P. [End-of-life care in the Czech Republic]. Cas Lek Cesk 2016; 155:43-47. [PMID: 27481202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Rapid demographic changes and rising prevalence of chronic disease bring about changing demands on health and social care. Declining mortality in higher age groups and increasing life expectancy results in changing structure of users of health services, the structure of causes of death and, of course, in the age distribution of deaths. The Czech Republic is among the countries with the most rapidly aging populations.Although large majority of people wish to age and also to die at home, in 2012, nearly three-quarters of people died in a hospital or other health and social facilities. Despite the deteriorating health of residents of residential social services and the high and increasing number of people dying in those institutions, the availability and quality of health care in those facilities is very problematic. Palliative care and long-term care should respond to the changing needs of our population, arising from rapidly ageing population and increasing prevalence of chronic diseases, regardless of whether such care is provided in health or social care facilities.
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Hradcová D, Hájková L, Mátlová M, Vaňková H, Holmerová I. Quality of care for people with dementia in residential care settings and the “Vážka” Quality Certification System of the Czech Alzheimer Society. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bohannon RW, Šteffl M, Musálek M, Miroslav P, Houdová V, Holmerová I. Hip extension strength: Description and validity of a new procedure applied to older women. ISOKINET EXERC SCI 2014. [DOI: 10.3233/ies-140541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/15/2022]
Affiliation(s)
- Richard W. Bohannon
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Michal Šteffl
- Department of Physiology and Biochemistry, Charles University Prague, Faculty of Physical Education and Sport, Prague, Czech Republic
| | - Martin Musálek
- Department of Physiology and Biochemistry, Charles University Prague, Faculty of Physical Education and Sport, Prague, Czech Republic
| | - Petr Miroslav
- Department of Physiology and Biochemistry, Charles University Prague, Faculty of Physical Education and Sport, Prague, Czech Republic
| | - Veronika Houdová
- Biomedical Laboratory, Faculty of Physical Education and Sport, Charles University Prague, Prague, Czech Republic
| | - Iva Holmerová
- Centre of Gerontology, Faculty of Humanities, Charles University Prague, Prague, Czech Republic
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Svačina S, Jurašková B, Karen I, Šmahelová A, Olšovský J, Červený R, Holmerová I, Pelikánová T. [Not Available]. Vnitr Lek 2013; 59:1088-1095. [PMID: 24466607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Janečková H, Dragomirecká E, Holmerová I, Vaňková H. The Attitudes of Older Adults Living in Institutions and Their Caregivers to Ageing. Cent Eur J Public Health 2013; 21:63-71. [DOI: 10.21101/cejph.a3774] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Varjassyová A, Hořínek D, Andel R, Amlerova J, Laczó J, Sheardová K, Magerová H, Holmerová I, Vyhnálek M, Bradáč O, Geda YE, Hort J. Recognition of facial emotional expression in amnestic mild cognitive impairment. J Alzheimers Dis 2013; 33:273-80. [PMID: 22954669 PMCID: PMC3918473 DOI: 10.3233/jad-2012-120148] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined whether recognition of facial emotional expression would be affected in amnestic mild cognitive impairment (aMCI). A total of 50 elderly persons met the initial inclusion criteria; 10 were subsequently excluded (Geriatric Depression Score > 5). 22 subjects were classified with aMCI based on published criteria (single domain aMCI [SD-aMCI], n = 10; multiple domain aMCI [MD-aMCI], n = 12); 18 subjects were cognitively normal. All underwent standard neurological and neuropsychological evaluations as well as tests of facial emotion recognition (FER) and famous faces identification (FFI). Among normal controls, FFI was negatively correlated with Mini-Mental Status Examination scores and positively correlated with executive function. Among patients with aMCI, FER was correlated with attention/speed of processing. No other correlations were significant. In a multinomial logistic regression model adjusted for age, gender, and education, a poorer score on FER, but not on FFI, was associated with greater odds of being classified as MD-aMCI (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.05-13.91; p = 0.042). This association was not explained by memory or global cognitive score. There was no association between FER or FFI and SD-aMCI (OR, 1.13; 95% CI, 0.36-3.57; p = 0.836). Therefore, FER, but not FFI, may be impaired in MD-aMCI. This implies that in MD-aMCI, the tasks of FER and FFI may involve segregated neurocognitive networks.
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Affiliation(s)
- Alexandra Varjassyová
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Daniel Hořínek
- Department of Neurosurgery, 1 Medical School, Charles University and Central Military Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Neurosurgery, Philipps-Universität Marburg, Marburg, Germany
| | - Ross Andel
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jana Amlerova
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Jan Laczó
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Kateřina Sheardová
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Hana Magerová
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | | | - Martin Vyhnálek
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, 1 Medical School, Charles University and Central Military Hospital, Prague, Czech Republic
| | - Yonas E. Geda
- Departments of Psychiatry & Psychology, Neurology, and Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jakub Hort
- Memory Disorders Clinic, Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
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Holmerová I, Koopmans R, Skela Savič B, Egervári A, Hermann B, Ruseckiene R, Tolson D. Advancing Long Term Care: Central European Perspectives. J Am Med Dir Assoc 2012; 13:578-80. [DOI: 10.1016/j.jamda.2012.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
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Rusina R, Kovacs GG, Fiala J, Hort J, Ridzoň P, Holmerová I, Ströbel T, Matěj R. FTLD-TDP with motor neuron disease, visuospatial impairment and a progressive supranuclear palsy-like syndrome: broadening the clinical phenotype of TDP-43 proteinopathies. A report of three cases. BMC Neurol 2011; 11:50. [PMID: 21569259 PMCID: PMC3112085 DOI: 10.1186/1471-2377-11-50] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 05/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Frontotemporal lobar degeneration with ubiquitin and TDP-43 positive neuronal inclusions represents a novel entity (FTLD-TDP) that may be associated with motor neuron disease (FTLD-MND); involvement of extrapyramidal and other systems has also been reported. Case presentation We present three cases with similar clinical symptoms, including Parkinsonism, supranuclear gaze palsy, visuospatial impairment and a behavioral variant of frontotemporal dementia, associated with either clinically possible or definite MND. Neuropathological examination revealed hallmarks of FTLD-TDP with major involvement of subcortical and, in particular, mesencephalic structures. These cases differed in onset and progression of clinical manifestations as well as distribution of histopathological changes in the brain and spinal cord. Two cases were sporadic, whereas the third case had a pathological variation in the progranulin gene 102 delC. Conclusions Association of a "progressive supranuclear palsy-like" syndrome with marked visuospatial impairment, motor neuron disease and early behavioral disturbances may represent a clinically distinct phenotype of FTLD-TDP. Our observations further support the concept that TDP-43 proteinopathies represent a spectrum of disorders, where preferential localization of pathogenetic inclusions and neuronal cell loss defines clinical phenotypes ranging from frontotemporal dementia with or without motor neuron disease, to corticobasal syndrome and to a progressive supranuclear palsy-like syndrome.
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Affiliation(s)
- Robert Rusina
- Department of Neurology, Thomayer Teaching Hospital and Institute for Postgraduate Education in Medicine, Prague, Czech Republic.
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Abstract
Authors provide results of their review of research in the field of biogerontology. Despite the fact that the term "biogerontology" is not commonly used in Czech scientific practice, there have been many research efforts in this field. Up to present, the Czech research teams have focused on the theoretical and biological models of ageing, its immunological aspects, the risk factors of unsuccessfull human ageing, and also metabolic and nutritional factors. Many research teams are dealing with the mechanisms of the neurodegeneration. The authors conclude that better coordination and systematic funding of research in gerontology is needed because of the actual demographic challenges.
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Holmerová I, Machácová K, Vanková H, Veleta P, Jurasková B, Hrnciariková D, Volicer L, Andel R. Effect of the Exercise Dance for Seniors (EXDASE) Program on Lower-Body Functioning Among Institutionalized Older Adults. J Aging Health 2009; 22:106-19. [DOI: 10.1177/0898264309351738] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The authors conducted a randomized control trial to examine the effect of the Exercise Dance for Seniors (EXDASE) program on lower-body functioning among older individuals from residential care facilities in the Czech Republic. Method: Participants were randomly assigned into an experimental or control group. The experimental group completed a 3-month EXDASE program. Lower-body functioning was assessed using four performance-based measures. A 2 (group) × 2 (test) general linear model for repeated measures was used to explore whether differences in performance could be attributed to the intervention. Results: The authors found Group × Test interactions for the chair stand test, F(1, 50) = 14.37, p < .001, the 2-minute step test, F(1, 50) = 7.33, p = .009, the chair sit-and-reach test, F(1, 50) = 5.28, p = .026, and the timed up-and-go test, F (1, 44) = 6.59, p = .014, indicating that the experimental group outperformed the control group from pretest to posttest. Discussion: A relatively simple dance-based exercise can support lower-body functioning in previously sedentary, frail older adults.
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Affiliation(s)
- Iva Holmerová
- Centre of Gerontology, Prague, Czech Republic, Charles University, Prague, Czech Republic
| | - Katerina Machácová
- Charles University, Prague, Czech Republic, Wayne State University, Detroit, MI
| | | | - Petr Veleta
- Centre of Gerontology, Prague, Czech Republic
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Laczó J, Vlček K, Vyhnálek M, MaŤoška V, Buksakowska I, Magerová H, Varjassyová A, Holmerová I, Vaňková H, Hořínek D, Tolar M, Andel R, Bojar M, Hort J. P3‐053: APOE E4 affects spatial working memory and attention in patients with amnestic mild cognitive impairment. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jan Laczó
- Charles University2nd Medical SchoolDepartment of NeurologyPrague 5Czech Republic
| | - Kamil Vlček
- Czech Academy of SciencesInstitute of PhysiologyDepartment of Neurophysiology of Memory and Computational NeurosciencesPrague 4Czech Republic
| | - Martin Vyhnálek
- Charles University2nd Medical SchoolDepartment of NeurologyPrague 5Czech Republic
| | - Václav MaŤoška
- Homolka HospitalDepartment of Clinical BiochemistryHematology and ImmunologyPrague 5Czech Republic
| | - Irena Buksakowska
- Charles University2nd Medical SchoolDepartment of NeurologyPrague 5Czech Republic
| | - Hana Magerová
- Charles University2nd Medical SchoolDepartment of NeurologyPrague 5Czech Republic
| | | | | | | | - Daniel Hořínek
- Charles University1st Medical SchoolDepartment of NeurosurgeryPrague 6Czech Republic
| | - Martin Tolar
- Yale University School of MedicineDepartment of NeurologyNew HavenCTUSA
| | - Ross Andel
- University of South FloridaSchool of Aging Studies and Florida Alzheimer's Disease Research CenterTampaFLUSA
| | - Martin Bojar
- Charles University2nd Medical SchoolDepartment of NeurologyPrague 5Czech Republic
| | - Jakub Hort
- Charles University2nd Medical SchoolDepartment of NeurologyPrague 5Czech Republic
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Laczó J, Vlcek K, Vyhnálek M, Vajnerová O, Ort M, Holmerová I, Tolar M, Andel R, Bojar M, Hort J. Spatial navigation testing discriminates two types of amnestic mild cognitive impairment. Behav Brain Res 2009; 202:252-9. [PMID: 19463709 DOI: 10.1016/j.bbr.2009.03.041] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 03/27/2009] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
Abstract
The hippocampus is essential for consolidation of declarative information and spatial navigation. Alzheimer's disease (AD) diagnosis tends to be preceded by a long prodromal period and mild cognitive impairment (MCI). Our goal was to test whether amnestic MCI comprises two different subgroups, with hippocampal and non-hippocampal memory impairment, that vary with respect to spatial navigation ability. A total of 52 patients were classified into two subgroups: non-amnestic MCI (naMCI) (n=10) and amnestic MCI (aMCI) (n=42). The aMCI subgroup was further stratified into memory impairment of hippocampal type-hippocampal aMCI (HaMCI) (n=10) (potential preclinical AD) and isolated retrieval impairment-non-hippocampal (NHaMCI) (n=32). Results were compared to control (n=28) and AD (n=21) groups. We used the Hidden Goal Task, a human analogue of the Morris Water Maze, to examine spatial navigation either dependent (egocentric) or independent of individual's position (allocentric). Overall, the HaMCI group performed poorer on spatial navigation than the NHaMCI group, especially in the latter trials when the HaMCI group exhibited limited capacity to learn and the NHaMCI group exhibited a learning effect. Finally, the HaMCI group performed almost identically as the AD group. Spatial navigation deficit is particularly pronounced in individuals with hippocampus-related memory impairment and may signal preclinical AD.
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Affiliation(s)
- Jan Laczó
- Memory Disorders Clinic, Department of Neurology, 2nd Medical School, Charles University in Prague, Prague, Czech Republic.
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Vanková H, Holmerová I, Andel R, Veleta P, Janecková H. Functional status and depressive symptoms among older adults from residential care facilities in the Czech Republic. Int J Geriatr Psychiatry 2008; 23:466-71. [PMID: 17979213 DOI: 10.1002/gps.1905] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depressive symptoms are common among older adults, particularly those living in long-term care facilities. However, little is known about factors associated with depressive symptoms among long-term care residents in the Czech Republic and in other Eastern European countries. Moreover, the role of mobility and pain in depressive symptoms among long-term care residents is relatively understudied. OBJECTIVE We examined the relationship between functional status and depressive symptoms in 308 older adults from residential care facilities (RCFs) in the Czech Republic. METHOD We used baseline data from two randomized controlled trials testing the effects of dance and reminiscence therapies on quality of life in older RCF residents. Functional status was measured as cognitive function, general ability to perform basic Activities of Daily Living (ADLs), mobility, and functional limitation by pain. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. RESULTS In multiple regression analyses adjusted for sociodemographic factors and taking antidepressants, we found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms. The ability to perform basic ADLs and mobility were also related to depressive symptoms. CONCLUSION Our findings suggest factors that may be important in efforts to improve psychological well-being in this population.
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Holmerová I, Jurasková B, Kalvach Z, Rohanová E, Rokosová M, Vanková H. Dignity and palliative care in dementia. J Nutr Health Aging 2007; 11:489-494. [PMID: 17985065] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Care for patients with dementia poses multiple challenges to the caretaker, including issues concerning maintaining patient dignity. In this paper, we discuss dignity in the context of patient autonomy, self-respect and appreciation, and explore issues that relate to dignity of patients in dementia care. As patients become incapacitated by the disease, it becomes the caretaker's responsibility to assure that the patient continues to live with dignity. The uniform manifestation of dementia symptoms across individuals allows for implementation of patient-friendly activities to address their special needs and allow them to express the remaining autonomy. In advanced dementia, a beneficial long-term care outcome becomes secondary and should give way to strategies to maintain patient comfort and dignity. Although it may be challenging to stress dignity in a patient with advanced dementia, where multiple serious health problems are likely to co-exist, it remains important to realize that dignity can be, should be and must be supported, maintained and, in some situations, regained.
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Vrbová H, Holmerová I, Hrubantová L. Business ethics as a novel issue in health care economics. Sb Lek 1998; 98:225-32. [PMID: 9601815] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The problems of health care providing and solutions suggested to solve them should be discussed publicly at all appropriate levels in all developed countries. In this contribution, new approaches to understanding the problems of business ethics in health care are mentioned and recommended for discussion. An application of such principles of business ethics as trust, accountability, solidarity, transparency and social responsibility is considered in the four following areas. First, it is the allocation of limited resources in health care. This is the world-wide problem of the end of 20th century, as the development of medical technologies offers a wide range of new diagnostic and therapeutic procedures. In our country this coincides with the on-going, and still incompleted reform of health care. Second, the other area is that of connecting health-care and social problems, important namely for vulnerable groups such as children, the elderly and chronically ill. The third area is concerned with the privatization of health care, the newly emanating structure and function of the health care system and the role of health care provides in society. The last group contains issues concerning attempts to facilitate communication between health care specialists and general public, as well as attempts to support those institutions of the civic democratic society that are oriented toward health, sickness and health care providing.
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Affiliation(s)
- H Vrbová
- IIIrd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague Czech Republic
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Vrbová H, Holmerová I, Hrubantová L. Multiprofessional education in social medicine and clinical ethics. Sb Lek 1997; 98:331-334. [PMID: 9648609] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This contribution describes a project of multiprofessional education in social medicine and clinical ethics based on educational experience of 3rd Department of Internal Medicine, First Medical Faculty, Charles University in conjunction with the Centre of Gerontology Prague. This undergraduate program will be offered to medics, stomatologists and health science students including the English course and will invite to participate students from non-medical faculties such as social science, pedagogy, theology, interested in ethics of health care providing. Basic principles of the new project are: education in clinical setting, early student-patient contact, multiprofessional education in common seminars of problem based learning small groups and developing various forms of communication.
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Affiliation(s)
- H Vrbová
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University
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