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Leinert C, Fotteler M, Kocar TD, Brefka S, Schindler B, Denkinger MD. [Discharge planning from hospital]. Z Gerontol Geriatr 2022; 55:717-719. [PMID: 36355072 DOI: 10.1007/s00391-022-02136-1] [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] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph Leinert
- Institut für Geriatrische Forschung, Universitätsklinik Ulm, Ulm, Deutschland. .,AGAPLESION Bethesda Klinik Ulm, Ulm, Deutschland. .,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Deutschland. .,Geriatrisches Zentrum und Institut für Geriatrische Forschung, Universitätsklinikum Ulm, Zollernring 26, 89073, Ulm, Deutschland.
| | - Marina Fotteler
- Institut für Geriatrische Forschung, Universitätsklinik Ulm, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Deutschland.,Institut DigiHealth, Hochschule für angewandte Wissenschaften Neu-Ulm, Neu-Ulm, Deutschland
| | - Thomas D Kocar
- Institut für Geriatrische Forschung, Universitätsklinik Ulm, Ulm, Deutschland.,AGAPLESION Bethesda Klinik Ulm, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Deutschland
| | - Simone Brefka
- Institut für Geriatrische Forschung, Universitätsklinik Ulm, Ulm, Deutschland.,AGAPLESION Bethesda Klinik Ulm, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Deutschland
| | | | - Michael D Denkinger
- Institut für Geriatrische Forschung, Universitätsklinik Ulm, Ulm, Deutschland.,AGAPLESION Bethesda Klinik Ulm, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Deutschland
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2
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van Schoor NM, Timmermans EJ, Huisman M, Gutiérrez-Misis A, Lems W, Dennison EM, Castell MV, Denkinger MD, Pedersen NL, Maggi S, Deeg DJH. Predictors of resilience in older adults with lower limb osteoarthritis and persistent severe pain. BMC Geriatr 2022; 22:246. [PMID: 35331146 PMCID: PMC8944048 DOI: 10.1186/s12877-022-02926-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/21/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Resilience refers to the process in which people function well despite adversity. Persistent severe pain may be considered an adversity in people with lower limb osteoarthritis (LLOA). The objectives of this study are: (1) to identify what proportion of older adults with LLOA and persistent severe pain show good functioning; and (2) to explore predictors of resilience. METHODS Data from the European Project on OSteoArthritis (EPOSA) were used involving standardized data from six European population-based cohort studies. LLOA is defined as clinical knee and/or hip osteoarthritis. Persistent severe pain is defined as the highest tertile of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index both at baseline and follow-up. Resilience is defined as good physical, mental or social functioning at follow-up despite having LLOA with persistent severe pain. RESULTS In total, 95 (14.9%) out of 638 individuals with LLOA had persistent severe pain. Among these, 10 (11.0%), 54 (57.4%) and 49 (53.8%) had good physical, mental and social functioning, respectively. Only 4 individuals (4.5%) were resilient in all three domains of functioning. Younger age, male sex, higher education, higher mastery, smoking and alcohol use, higher physical activity levels, absence of chronic diseases, and more contacts with friends predicted resilience in one or more domains of functioning. CONCLUSIONS Few people with LLOA and persistent severe pain showed good physical functioning and about half showed good mental or social functioning. Predictors of resilience differed between domains, and might provide new insights for treatment.
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Affiliation(s)
- Natasja M. van Schoor
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Erik J. Timmermans
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - Martijn Huisman
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alicia Gutiérrez-Misis
- grid.5515.40000000119578126Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonomous University of Madrid, Madrid, Spain ,grid.440081.9Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Willem Lems
- grid.509540.d0000 0004 6880 3010Department of Rheumatology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elaine M. Dennison
- grid.123047.30000000103590315MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Maria Victoria Castell
- grid.440081.9Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,grid.5515.40000000119578126CS Dr. Castroviejo. Primary Care (SERMAS). Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Michael D. Denkinger
- grid.6582.90000 0004 1936 9748Geriatric Research Unit and Geriatric Center, Agaplesion Bethesda Hospital, University of Ulm, Ulm, Germany
| | - Nancy L. Pedersen
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Stefania Maggi
- grid.418879.b0000 0004 1758 9800National Research Council, Neuroscience Institute, Padua, Italy
| | - Dorly J. H. Deeg
- grid.12380.380000 0004 1754 9227Department of Epidemiology and Data Science, UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
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3
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Siviero P, Limongi F, Gesmundo A, Zambon S, Cooper C, Dennison EM, Edwards MH, van der Pas S, Timmermans EJ, van Schoor NM, Schaap LA, Dallmeier D, Denkinger MD, Peter R, Castell MV, Otero Á, Pedersen NL, Deeg DJH, Maggi S. Factors Associated With Functional Decline in Hand and Hip/Knee Osteoarthritis After One Year: Data From a Population-Based Study. Arthritis Care Res (Hoboken) 2021; 73:1343-1353. [PMID: 32770733 DOI: 10.1002/acr.24404] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/30/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate factors that together with hand or hip/knee osteoarthritis (OA) could contribute to functional decline over a year's time in elderly individuals. METHODS The data of 1,886 individuals between ages 65 and 85 years in a prospective, observational population-based study with 12-18 months of follow-up in the context of the European Project on Osteoarthritis were analyzed. The outcome measures were self-reported hand and hip/knee functional decline, evaluated using a minimum clinically important difference of 4 on the Australian/Canadian Hand OA Index and of 2 on the Western Ontario and McMaster Universities Osteoarthritis Index hip/knee physical function subscales, both normalized to 0-100. Using regression models adjusted for sex, age, country, and education level, the baseline factors considered were clinical hand or hip/knee OA, pain, analgesic/antiinflammatory medications, comorbidities, social isolation, income, walking time, grip strength, physical activity time, and medical/social care. RESULTS After a year, 453 participants were identified as having worse hand functionality and 1,389 as not worse. Hand OA, anxiety, walking time, and grip strength were risk factors for hand functional decline; pain was a confounder of the effect of hand OA. Analgesic/antiinflammatory medications mediated the combined effect of hip/knee OA plus pain on functional decline in the 554 individuals classified as having worse hip/knee functionality and the 1,291 persons who were not worse. Peripheral artery disease, obesity, and cognitive impairment were other baseline risk factors. CONCLUSION Study findings showed that together with emotional status and chronic physical and cognitive conditions, OA affects hand and hip/knee functional decline.
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Affiliation(s)
| | | | - Antonella Gesmundo
- University of Padua, Padua, and Ospedale Riabilitativo di Alta Specializzazione, Motta di Livenza, Treviso, Italy
| | | | - Cyrus Cooper
- University of Southampton and Southampton General Hospital, Southampton, UK
| | - Elaine M Dennison
- University of Southampton and Southampton General Hospital, Southampton, UK
| | - Mark H Edwards
- University of Southampton and Southampton General Hospital, Southampton, and Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Suzan van der Pas
- Amsterdam UMC, Amsterdam Public Health Research Institute, and VU University Medical Center, Amsterdam, The Netherlands
| | - Erik J Timmermans
- Amsterdam UMC, Amsterdam Public Health Research Institute, and VU University Medical Center, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Amsterdam UMC, Amsterdam Public Health Research Institute, and VU University Medical Center, Amsterdam, The Netherlands
| | - Laura A Schaap
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | - Ángel Otero
- Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Dorly J H Deeg
- Amsterdam UMC, Amsterdam Public Health Research Institute, and VU University Medical Center, Amsterdam, The Netherlands
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Portenhauser AA, Terhorst Y, Schultchen D, Sander LB, Denkinger MD, Stach M, Waldherr N, Dallmeier D, Baumeister H, Messner EM. Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores. JMIR Aging 2021; 4:e23313. [PMID: 33605884 PMCID: PMC8081158 DOI: 10.2196/23313] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5%) were evidence-based; 49% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps.
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Affiliation(s)
- Alexandra A Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany.,Department of Psychological Research Methods, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, University of Ulm, Ulm, Germany
| | - Natalie Waldherr
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research, University of Ulm, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
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Giovannini S, Onder G, van der Roest HG, Topinkova E, Gindin J, Cipriani MC, Denkinger MD, Bernabei R, Liperoti R. Use of antidepressant medications among older adults in European long-term care facilities: a cross-sectional analysis from the SHELTER study. BMC Geriatr 2020; 20:310. [PMID: 32854659 PMCID: PMC7457305 DOI: 10.1186/s12877-020-01730-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/23/2020] [Indexed: 11/12/2022] Open
Abstract
Background Late-life depression is common among older adults living in nursing homes (NHs). Over the last 30 years there has been an increase in the rates of prescription of antidepressant medications across all ages, with the largest rise reported in older adults. This study aimed to describe the pattern of antidepressant medication use among NH residents from 7 European countries and Israel and to examine patient and facilities characteristics that may account for it. Methods We conducted a cross-sectional analysis of data from the SHELTER study, an observational longitudinal cohort study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument in 7 European Countries and Israel. Descriptive statistics were used to examine sample characteristics. Potential correlates of antidepressant medication use were identified using multiple logistic regression modeling. Results Among 4023 residents entering the study, 32% had depressive symptoms and nearly half of these individuals used antidepressants. Antidepressant medication use varied by country, with a prevalence in the overall sample of 35.6% (n = 1431). Among antidepressant users, 59.9% were receiving selective serotonin reuptake inhibitors (SSRI). The strongest correlates of antidepressant use included reported diagnosis of anxiety, depression, bipolar disorder, pain, falls and high level of social engagement. Age over 85 years, living in facilities located in rural areas and a diagnosis of schizophrenia reduced the likelihood of being prescribed with an antidepressant. Conclusions A large proportion of residents in European long-term care facilities receive antidepressant medications. The decision to prescribe antidepressants to NH residents seems to be influenced by both patient and facility characteristics. Future longitudinal studies should evaluate the efficacy and safety of antidepressant use in NHs thus providing evidence for recommendations for clinical practice.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | | | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jacob Gindin
- The Centre for Standards in Health and Disability, Research Authority, University of Haifa, Haifa, Israel
| | - Maria Camilla Cipriani
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Siviero P, Veronese N, Smith T, Stubbs B, Limongi F, Zambon S, Dennison EM, Edwards M, Cooper C, Timmermans EJ, van Schoor NM, van der Pas S, Schaap LA, Denkinger MD, Peter R, Herbolsheimer F, Otero Á, Castell MV, Pedersen NL, Deeg DJH, Maggi S. Association Between Osteoarthritis and Social Isolation: Data From the EPOSA Study. J Am Geriatr Soc 2020; 68:87-95. [PMID: 31529624 PMCID: PMC6954097 DOI: 10.1111/jgs.16159] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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] [Received: 06/27/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether there is an association between osteoarthritis (OA) and incident social isolation using data from the European Project on OSteoArthritis (EPOSA) study. DESIGN Prospective, observational study with 12 to 18 months of follow-up. SETTING Community dwelling. PARTICIPANTS Older people living in six European countries. MEASUREMENTS Social isolation was assessed using the Lubben Social Network Scale and the Maastricht Social Participation Profile. Clinical OA of the hip, knee, and hand was assessed according to American College of Rheumatology criteria. Demographic characteristics, including age, sex, multijoint pain, and medical comorbidities, were assessed. RESULTS Of the 1967 individuals with complete baseline and follow-up data, 382 (19%) were socially isolated and 1585 were nonsocially isolated at baseline; of these individuals, 222 (13.9%) experienced social isolation during follow-up. Using logistic regression analyses, after adjustment for age, sex, and country, four factors were significantly associated with incident social isolation: clinical OA, cognitive impairment, depression, and worse walking time. Compared to those without OA at any site or with only hand OA, clinical OA of the hip and/or knee, combined or not with hand OA, led to a 1.47 times increased risk of social isolation (95% confidence interval = 1.03-2.09). CONCLUSION Clinical OA, present in one or two sites of the hip and knee, or in two or three sites of the hip, knee, and hand, increased the risk of social isolation, adjusting for cognitive impairment and depression and worse walking times. Clinicians should be aware that individuals with OA may be at greater risk of social isolation. J Am Geriatr Soc 68:87-95, 2019.
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Affiliation(s)
- Paola Siviero
- National Research Council, Institute of Neuroscience-Aging Branch, Padova, Italy
| | - Nicola Veronese
- National Research Council, Institute of Neuroscience-Aging Branch, Padova, Italy
| | - Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychological Medicine, King's College, London, United Kingdom
| | - Federica Limongi
- National Research Council, Institute of Neuroscience-Aging Branch, Padova, Italy
| | - Sabina Zambon
- Department of Medicina, University of Padova, Padua, Italy
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Mark Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Erik J Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Suzan van der Pas
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michael D Denkinger
- AGAPLESION Bethesda Hospital, Geriatric Research Unit/Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Richard Peter
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Florian Herbolsheimer
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Ángel Otero
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Maria Victoria Castell
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Stefania Maggi
- National Research Council, Institute of Neuroscience-Aging Branch, Padova, Italy
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7
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Jonkman NH, Colpo M, Klenk J, Todd C, Hoekstra T, Del Panta V, Rapp K, van Schoor NM, Bandinelli S, Heymans MW, Mauger D, Cattelani L, Denkinger MD, Rothenbacher D, Helbostad JL, Vereijken B, Maier AB, Pijnappels M. Development of a clinical prediction model for the onset of functional decline in people aged 65-75 years: pooled analysis of four European cohort studies. BMC Geriatr 2019; 19:179. [PMID: 31248370 PMCID: PMC6595632 DOI: 10.1186/s12877-019-1192-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 06/18/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Identifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65-75 years old. METHODS Four population-based cohort studies were pooled for the analysis: ActiFE-ULM (Germany), ELSA (United Kingdom), InCHIANTI (Italy), LASA (Netherlands). Included participants were 65-75 years old at baseline and reported no limitations in functional ability in ADL at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Participants who reported at least some limitations at three-year follow-up on any of the five items were classified as experiencing functional decline. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation by alternating the data from the four cohort studies to assess the discrimination and calibration across the cohorts. RESULTS Two thousand five hundred sixty community-dwelling people were included in the analyses (mean age 69.7 ± 3.0 years old, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model included 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. The calibration intercept was 0.06 and the calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts. CONCLUSIONS Based on pooled cohort data analyses we were able to show that the onset of functional decline in ADL in three years in older people aged 65-75 years can be predicted by specific physical performance measures, age, body mass index, presence of depressive symptoms, and chronic conditions. The prediction model showed good discrimination and calibration, which remained stable across the four cohorts, supporting external validity of our findings.
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Affiliation(s)
- Nini H. Jonkman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Marco Colpo
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy
| | - Jochen Klenk
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre and Manchester University NHS Foundation Trust, Manchester, UK
| | - Trynke Hoekstra
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Vieri Del Panta
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Natasja M. van Schoor
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Stefania Bandinelli
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy
| | - Martijn W. Heymans
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Dominique Mauger
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Luca Cattelani
- Department of Computer Science and Engineering, University of Bologna, Bologna, Italy
| | - Michael D. Denkinger
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Geriatric Research Unit Ulm University and Geriatric Center, Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | | | - Jorunn L. Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrea B. Maier
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Faculty of Medicine Dentistry and Health Sciences, Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Siviero P, Limongi F, Gesmundo A, Zambon S, Cooper C, Dennison EM, Edwards MH, Timmermans EJ, van der Pas S, Schaap LA, van Schoor NM, Denkinger MD, Herbolsheimer F, Peter R, Castell MV, Otero Á, Queipo R, Pedersen NL, Deeg DJH, Maggi S. Minimal clinically important decline in physical function over one year: EPOSA study. BMC Musculoskelet Disord 2019; 20:227. [PMID: 31101033 PMCID: PMC6525447 DOI: 10.1186/s12891-019-2593-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/26/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Australian/Canadian hand Osteoarthritis Index (AUSCAN) and the Western Ontario and McMaster Universities knee and hip Osteoarthritis Index (WOMAC) are the most commonly used clinical tools to manage and monitor osteoarthritis (OA). Few studies have as yet reported longitudinal changes in the AUSCAN index regarding the hand. While there are published data regarding WOMAC assessments of the hip and the knee, the two sites have always evaluated separately. The current study therefore sought to determine the minimal clinically important difference (MCID) in decline in the AUSCAN hand and WOMAC hip/knee physical function scores over 1 year using anchor-based and distribution-based methods. METHODS The study analysed data collected by the European Project on Osteoarthritis, a prospective observational study investigating six adult cohorts with and without OA by evaluating changes in the AUSCAN and WOMAC physical function scores at baseline and 12-18 months later. Pain and stiffness scores, the performance-based grip strength and walking speed and health-related quality of life measures were used as the study's anchors. Receiver operating characteristic curves and distribution-based methods were used to estimate the MCID in the AUSCAN and WOMAC physical function scores; only the data of those participants who possessed paired (baseline and follow up-measures) AUSCAN and WOMAC scores were included in the analysis. RESULTS Out of the 1866 participants who were evaluated, 1842 had paired AUSCAN scores and 1845 had paired WOMAC scores. The changes in the AUSCAN physical function score correlated significantly with those in the AUSCAN pain score (r = 0.31). Anchor- and distribution-based approaches converged identifying 4 as the MCID for decline in the AUSCAN hand physical function. Changes in the WOMAC hip/knee physical function score were significantly correlated with changes in both the WOMAC pain score (r = 0.47) and the WOMAC stiffness score (r = 0.35). The different approaches converged identifying two as the MCID for decline in the WOMAC hip/knee physical function. CONCLUSIONS The most reliable MCID estimates of decline over 1 year in the AUSCAN hand and WOMAC hip/knee physical function scores were 4 and 2 points, respectively.
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Affiliation(s)
- Paola Siviero
- National Research Council, Neuroscience Institute - Aging Branch, Via Giustiniani 2, ,35128 Padova, Italy
| | - Federica Limongi
- National Research Council, Neuroscience Institute - Aging Branch, Via Giustiniani 2, ,35128 Padova, Italy
| | - Antonella Gesmundo
- Department of Medicine, University of Padova, Via 8 Febbraio 2, 35122 Padova, Italy
| | - Sabina Zambon
- Department of Medicine, University of Padova, Via 8 Febbraio 2, 35122 Padova, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Mark H. Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
- Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY UK
| | - Erik J. Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Suzan van der Pas
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Laura A. Schaap
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Michael D. Denkinger
- Bethesda Geriatric Clinic, University of Ulm, Zollernring 26, 89073 Ulm, Germany
| | - Florian Herbolsheimer
- Institute of the History Philosophy and Ethics of Medicine, University of Ulm, Frauensteige 6, 89075 Ulm, Germany
| | - Richard Peter
- Institute of the History Philosophy and Ethics of Medicine, University of Ulm, Frauensteige 6, 89075 Ulm, Germany
| | - Maria Victoria Castell
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Ángel Otero
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Rocio Queipo
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O.Box 281, Nobels väg 12A, SE-171 77 Stockholm, Sweden
| | - Dorly J. H. Deeg
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Stefania Maggi
- National Research Council, Neuroscience Institute - Aging Branch, Via Giustiniani 2, ,35128 Padova, Italy
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Brefka S, Dallmeier D, Mühlbauer V, von Arnim CAF, Bollig C, Onder G, Petrovic M, Schönfeldt-Lecuona C, Seibert M, Torbahn G, Voigt-Radloff S, Haefeli WE, Bauer JM, Denkinger MD. A Proposal for the Retrospective Identification and Categorization of Older People With Functional Impairments in Scientific Studies-Recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) Research Group. J Am Med Dir Assoc 2019; 20:138-146. [PMID: 30638832 DOI: 10.1016/j.jamda.2018.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/22/2018] [Accepted: 11/06/2018] [Indexed: 12/23/2022]
Abstract
When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia. All assessments identified that reflected functional status were analyzed. Assessments were categorized across 4 different functional status levels. These levels span from functionally not impaired, slightly impaired, significantly impaired, to severely impaired/disabled. If available from the literature, cut-offs for these 4 functioning levels were extracted. If not, or if the existing cut-offs did not match the predefined functional levels, cut-off points were defined by an expert group composed of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists, and epidemiologists using a patient-centered approach. We identified 51 instruments that included measures of functional status. Although some of the assessments had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by the expert group and are presented as described. The functional status assessments that were identified and operationalized across 4 functional levels could now be used for a retrospective characterization of functional status in randomized controlled trials and observational studies. Allocated categories only serve as approximations and should be validated head-to-head in future studies. Moreover, as general standard, upcoming studies involving older adults should include and explicitly report functional impairment as a baseline characteristic of all participants enrolled.
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Affiliation(s)
- Simone Brefka
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Viktoria Mühlbauer
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Christine A F von Arnim
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany; University Clinic Ulm, Department of Neurology, Ulm, Germany
| | - Claudia Bollig
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany; Medical Center, University of Freiburg, Cochrane Germany, Freiburg, Germany
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mirko Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University, Ghent, Belgium
| | - Carlos Schönfeldt-Lecuona
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany; University Clinic Ulm, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - Moritz Seibert
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany; University Clinic Ulm, Department of Neurology, Ulm, Germany
| | - Gabriel Torbahn
- Medical Center, University of Freiburg, Cochrane Germany, Freiburg, Germany; Institute for Biomedicine of Aging, Friedrich Alexander University Erlangen-Nürnberg, Germany
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Freiburg, Germany; Medical Center, University of Freiburg, Cochrane Germany, Freiburg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
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10
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Timmermans EJ, de Koning EJ, van Schoor NM, van der Pas S, Denkinger MD, Dennison EM, Maggi S, Pedersen NL, Otero Á, Peter R, Cooper C, Siviero P, Castell MV, Herbolsheimer F, Edwards M, Limongi F, Deeg DJH, Schaap LA. Within-person pain variability and physical activity in older adults with osteoarthritis from six European countries. BMC Musculoskelet Disord 2019; 20:12. [PMID: 30611248 PMCID: PMC6320627 DOI: 10.1186/s12891-018-2392-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study examines the association of both pain severity and within-person pain variability with physical activity (PA) in older adults with osteoarthritis (OA). METHODS Data from the European Project on OSteoArthritis were used. At baseline, clinical classification criteria of the American College of Rheumatology were used to diagnose OA in older adults (65-85 years). At baseline and 12-18 months follow-up, frequency and duration of participation in the activities walking, cycling, gardening, light and heavy household tasks, and sports activities were assessed with the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire. Physical activity was calculated in kcal/day, based on frequency, duration, body weight and the metabolic equivalent of each activity performed. At baseline and 12-18 months follow-up, pain severity was assessed using the pain subscales of the Western Ontario and McMaster Universities OA Index and the Australian/Canadian Hand OA Index. Within-person pain variability was assessed using two-week pain calendars that were completed at baseline, 6 months follow-up and 12-18 months follow-up. RESULTS Of all 669 participants, 70.0% were women. Sex-stratified multiple linear regression analyses showed that greater pain severity at baseline was cross-sectionally associated with less PA in women (Ratio = 0.95, 95% CI = 0.90-0.99), but not in men (Ratio = 0.99, 95% CI = 0.85-1.15). The longitudinal analyses showed a statistically significant inverse association between pain severity at baseline and PA at follow-up in women (Ratio = 0.94, 95% CI = 0.89-0.99), but not in men (Ratio = 1.00, 95% CI = 0.87-1.11). Greater pain variability over 12-18 months was associated with more PA at follow-up in men (Ratio = 1.18, 95% CI = 1.01-1.38), but not in women (Ratio = 0.94, 95% CI = 0.86-1.03). CONCLUSIONS Greater pain severity and less pain variability are associated with less PA in older adults with OA. These associations are different for men and women. The observed sex differences in the various associations should be studied in more detail and need replication in future research.
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Affiliation(s)
- Erik J. Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Public Health Research Institute, De Boelelaan 1089A, 1081HV, Amsterdam, Netherlands
| | - Elisa J. de Koning
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Public Health Research Institute, De Boelelaan 1089A, 1081HV, Amsterdam, Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Public Health Research Institute, De Boelelaan 1089A, 1081HV, Amsterdam, Netherlands
| | - Suzan van der Pas
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Public Health Research Institute, De Boelelaan 1089A, 1081HV, Amsterdam, Netherlands
| | - Michael D. Denkinger
- Geriatric Research Unit / Institute of Epidemiology and Medical Biometry, AGAPLESION Bethesda Hospital, Ulm University, Ulm, Germany
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Stefania Maggi
- National Research Council, Aging Branch, Institute of Neuroscience, Padova, Italy
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Ángel Otero
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Richard Peter
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Paola Siviero
- National Research Council, Aging Branch, Institute of Neuroscience, Padova, Italy
| | - Maria Victoria Castell
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Florian Herbolsheimer
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Mark Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Federica Limongi
- National Research Council, Aging Branch, Institute of Neuroscience, Padova, Italy
| | - Dorly J. H. Deeg
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Public Health Research Institute, De Boelelaan 1089A, 1081HV, Amsterdam, Netherlands
| | - Laura A. Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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11
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ten Koppel M, Onwuteaka-Philipsen BD, Pasman HR, Bernabei R, Carpenter I, Denkinger MD, Onder G, van der Roest HG, Topinkova E, van Hout HPJ. Are older long term care residents accurately prognosticated and consequently informed about their prognosis? Results from SHELTER study data in 5 European countries. PLoS One 2018; 13:e0200590. [PMID: 30020976 PMCID: PMC6051611 DOI: 10.1371/journal.pone.0200590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Informing residents in long term care facilities (LTCFs) about their prognosis can help them prepare for the end of life. This study aimed to examine which proportion of European LTCF residents, close to death, are accurately prognosticated and consequently informed about their prognosis; and to examine factors related to accurate prognostication and discussion of prognosis. METHODS A subsample of SHELTER study data was used, consisting of: 500 residents from 5 European countries, who died within 6 months after their last assessment, and had a valid answer on the item 'End stage disease, 6 or fewer months to live'. This item was used to indicate whether an accurate prognosis was established and discussed with residents. Generalized estimating equations were used to examine factors related to establishment and discussion of accurate prognosis. RESULTS 86.4% of residents close to death did not receive an accurate prognosis. Residents with cancer; fatigue; dehydration; and normal mode of nutritional intake were more likely to have an accurate prognosis established and discussed. Accurate prognostication and prognosis discussion was less likely for residents who: had a diagnosis under 'other'; initiated interactions; and residents from Germany, Italy and the Netherlands. CONCLUSIONS The great majority of residents close to death did not receive an accurate prognosis. Prognostication tools might help clinicians to increase their prognostic accuracy and communication training might help to discuss prognosis with residents.
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Affiliation(s)
- Maud ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - H. Roeline Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Bernabei
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Iain Carpenter
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Michael D. Denkinger
- Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Graziano Onder
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Henriëtte G. van der Roest
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hein P. J. van Hout
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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12
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Rapp K, Mikolaizak S, Rothenbacher D, Denkinger MD, Klenk J. Prospective analysis of time out-of-home and objectively measured walking duration during a week in a large cohort of older adults. Eur Rev Aging Phys Act 2018; 15:8. [PMID: 29946372 PMCID: PMC6004085 DOI: 10.1186/s11556-018-0197-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/30/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is considered an effective measure to promote health in older people. There is evidence that the number of outdoor trips increases physical activity by increasing walking duration. The objective of this study was to analyse the relationship between daily time out-of-home and walking duration. Furthermore, predictors for walking duration and time out-of-home were evaluated. METHODS Walking duration was measured prospectively over a 1 week period by a body-fixed sensor and the time out-of-home was assessed by a questionnaire at the same days. Seven thousand, two hundred and forty-three days from 1289 older people (mean age 75.4 years) with both sensor-based measures and completed questionnaires were included in the analyses. To account for several observation days per participant multilevel regression analyses were applied. Analyses were stratified according to the time out-of-home (more or less than 100 min/day). RESULTS In the group with less than 100 min out-of-home, each additional minute out-of-home added 20 s to overall walking duration. If the time exceeded 100 min the additional increase of walking duration was only moderate or weak. Leaving the home once added 40 min of walking, the following trips 15 to 20 min. Increasing age, lower gait speed, comorbidities, low temperature, rain and specific week days (Sunday) decreased both the time out-of-home and walking duration. Other variables like gender (female), isolation or living with a spouse reduced the time out-of-home without affecting walking duration. CONCLUSIONS Being out-of-home increases daily walking duration. The association is strongest if the time out-of-home is 100 min or less.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Stefanie Mikolaizak
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | | | - Jochen Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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13
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Braisch U, Dallmeier D, Koenig W, Rothenbacher D, Denkinger MD. Association of established N-Terminal pro-Brain Natriuretic Peptide predictors varies across quantiles in older people: The ActiFE Study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- U Braisch
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
- Universität Ulm, Inst. für Epidemiologie und Medizinische Biometrie, Ulm
| | - D Dallmeier
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
| | - W Koenig
- Universität Ulm, Innere Medizin II, Ulm
- Deutsches Herzzentrum München, München
| | - D Rothenbacher
- Universität Ulm, Inst. für Epidemiologie und Medizinische Biometrie, Ulm
| | - MD Denkinger
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
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14
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Siviero P, Zambon S, Limongi F, Castell MV, Cooper C, Deeg DJH, Denkinger MD, Dennison EM, Edwards MH, Gesmundo A, Otero Á, Pedersen NL, Peter R, Queipo R, Timmermans EJ, van Schoor NM, Maggi S. How Hand Osteoarthritis, Comorbidity, and Pain Interact to Determine Functional Limitation in Older People: Observations From the European Project on OSteoArthritis Study. Arthritis Rheumatol 2017; 68:2662-2670. [PMID: 27214708 DOI: 10.1002/art.39757] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/12/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self-reported and performance-based physical function in a general population of elderly persons. METHODS We studied data from 2,942 participants ages 65-85 years in the European Project on OSteoArthritis, a collaborative observational study of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcome measures included self-reported physical function of the hands measured by the AUStralian/CANadian Osteoarthritis Hand Index (AUSCAN) for hand OA physical function subscale and performance-based grip strength measured using a strain gauge dynamometer. RESULTS Comorbidity was not a confounder in the association of hand OA with self-reported and performance-based functional limitations, while the role of pain as a mediator was confirmed. Anxiety, depression, stroke, and osteoporosis were associated with AUSCAN scores reflecting more impairment. Depression and osteoporosis were associated with less grip strength. CONCLUSION Although comorbidity was decidedly and independently associated with hand functional limitation, it had no effect on the relationship of hand OA with physical function. Hand OA was found to be associated with both self-reported and performance-based physical function impairment; the association was found to be partially mediated by pain, which reduced its impact.
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Affiliation(s)
- Paola Siviero
- National Research Council, Neuroscience Institute, Padua, Italy.
| | - Sabina Zambon
- National Research Council, Neuroscience Institute, and University of Padova, Padua, Italy
| | | | | | - Cyrus Cooper
- University of Southampton, Southampton General Hospital, Southampton, UK
| | - Dorly J H Deeg
- VU University Medical Center, Amsterdam, The Netherlands
| | | | - Elaine M Dennison
- University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mark H Edwards
- University of Southampton, Southampton General Hospital, Southampton, UK
| | | | - Ángel Otero
- Universidad Autonoma de Madrid, Madrid, Spain
| | | | | | - Rocio Queipo
- University of Southampton, Southampton General Hospital, Southampton, UK
| | | | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
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15
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Liperoti R, Sganga F, Landi F, Topinkova E, Denkinger MD, van der Roest HG, Foebel AD, Finne-Soveri H, Bernabei R, Onder G. Antipsychotic Drug Interactions and Mortality Among Nursing Home Residents With Cognitive Impairment. J Clin Psychiatry 2017; 78:e76-e82. [PMID: 28129493 DOI: 10.4088/jcp.15m10303] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Among elderly individuals with dementia, the use of antipsychotics has been associated with serious adverse events including ischemic stroke and death. Multiple medications can interact with antipsychotics and increase the risk of such adverse events. The purpose of this retrospective, longitudinal cohort study was to estimate the prevalence of potential antipsychotic drug interactions and their effect on increasing the risk of death among cognitively impaired elderly individuals treated with antipsychotics. METHODS We conducted a retrospective longitudinal cohort study in 59 nursing homes of 7 European Union countries and Israel. The study was conducted during the years 2009 to 2011. Participants were cognitively impaired individuals aged 65 years or older residing in the participating nursing homes and being treated with antipsychotics (N = 604). Risk of death associated with potential antipsychotic drug interactions was the main outcome. The inter-Resident Assessment Instrument for Long Term Care Facilities (interRAI LTCF) was used to assess participants. Follow-up time was 12 months. RESULTS The prevalence of potential antipsychotic drug interactions was 46.0%. Antipsychotic drug interactions were associated with higher mortality (incidence rate of 0.26 per person-year in the antipsychotic drug-interaction group versus 0.17 per person year in the no antipsychotic drug-interaction group). After adjusting for potential confounders, risk of death was higher in the group of residents with potential antipsychotic drug interactions relative to those unexposed to such interactions (hazard ratio = 1.71; 95% CI, 1.15-2.54). CONCLUSIONS Part of the observed excess risk of death associated with the use of antipsychotic medications in elderly individuals with cognitive impairment may be attributable to antipsychotic drug interactions. Antipsychotics should be used with extreme caution especially among those individuals receiving concomitant cardiovascular or psychotropic medications.
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Affiliation(s)
- Rosa Liperoti
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy. .,Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Sganga
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Henriëtte G van der Roest
- EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Andrea D Foebel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Harriet Finne-Soveri
- Ageing and Services Unit, National Institutes of Health and Welfare (THL), Helsinki, Finland
| | - Roberto Bernabei
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Szczerbińska K, Topinková E, Brzyski P, van der Roest HG, Richter T, Finne-Soveri H, Denkinger MD, Gindin J, Onder G, Bernabei R. Delivery of Care to Nursing Home Residents With Diabetes: Results From the SHELTER Study. J Am Med Dir Assoc 2016; 17:807-13. [PMID: 27342004 DOI: 10.1016/j.jamda.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To describe health care and preventive service provision to nursing home (NH) residents with diabetes mellitus (DM) and to analyze factors determining use of selected services. DESIGN In the period between 2009 and 2011, the Services and Health for Elderly in Long TERm care (SHELTER) project, a 12-month prospective cohort study, was conducted to assess 4037 NH residents aged 60 years and older residing in 59 NHs in 7 European countries and Israel. METHODS The InterRAI tool for long-term care facilities was used to assess care needs and provided health care services. Descriptive statistics and multivariate logistic regression were applied to describe differences between NH residents with (DR) and without DM (non-DR), and to find factors determining use of services and care provided to both groups. RESULTS DR more often than non-DR were hospitalized (18.2% vs 14.3%) and required rehabilitation (23.8% vs 18.2%) or clinically complex care (15.9% vs 13.7%). They also more frequently received a repositioning program (26.8% vs 22.7%), a wound care (15.1% vs 9.8%), and some preventive services as yearly eye examination (41.0% vs 35.9%), pneumococcal vaccination (33.5% vs 26.6%), mammography in women (12.1% vs 7.4%), and colonoscopy (5.6% vs 3.6%). Yet, rates of some of them (mammography, colonoscopy, hearing and dental examinations) were very low in both study cohorts with exception of annual influenza vaccination (82.1%) and yearly blood pressure checkup (95.0%). Interestingly, DM enhanced odds only for mammography [odds ratio (OR) 1.55, 95% confidence interval [CI] 1.15-2.09, P = .004) and eye examination (OR 1.21, 95% CI 1.03-1.42; P = .018). CONCLUSIONS DR more frequently receive care related to DM clinical complexity; nevertheless, the recommended frequency of preventive procedures is not met both in DR and non-DR.
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Affiliation(s)
- Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Eva Topinková
- Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Piotr Brzyski
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Henriette G van der Roest
- EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Tomáš Richter
- Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Harriet Finne-Soveri
- Unit for Ageing and Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, University of Ulm, Ulm, Germany
| | - Jacob Gindin
- The Centre for Standards in Health and Disability, Research Authority, University of Haifa, Haifa, Israel
| | - Graziano Onder
- Centro Medicina dell'Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Roberto Bernabei
- Centro Medicina dell'Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
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Nagel G, Herbolsheimer F, Riepe M, Nikolaus T, Denkinger MD, Peter R, Weinmayr G, Rothenbacher D, Koenig W, Ludolph AC, von Arnim CAF. Serum Vitamin D Concentrations and Cognitive Function in a Population-Based Study among Older Adults in South Germany. J Alzheimers Dis 2016; 45:1119-26. [PMID: 25649649 DOI: 10.3233/jad-143219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our objective was to investigate the associations of vitamin D serum levels with dementia and cognitive function in specific domains in community dwelling older adults. Between 2009 and 2010, we conducted a cross-sectional study in 1,373 individuals (56% men) aged 65+ years in the "Activity and Function in the Elderly in Ulm" (ActiFE) study. Dementia was defined as a Mini-Mental State Examination (MMSE) score ≤ 24. The 25-OHD serum level [ng/mL] was measured by an electrochemilumineszenz immunoassay (ECLIA). Logistic regression models were used to calculate odds ratios (OR)s for cognitive domains (cut-point: 10th percentile) by serum 25-OHD concentrations (both continuously and by cut-point of 20 ng/ml for vitamin D deficiency). Mean age of the study population was 75.6 (SD 6.6) years.We identified 75 participants (43% women) with dementia. 25-OHD concentrations were significantly lower in the participants with dementia compared to persons with a MMSE score >24. We also observed an association of continuous 25-OHD serum concentrations with prevalence of dementia (crude OR 1.05, 95% confidence interval (CI), 1.01-1.08, p-value 0.009) per 1 ng/mL decrease, after adjustment the OR was 1.03, 95% CI, 0.995-1.08 (p-value 0.09). Although vitamin D deficiency was tentatively associated with severity of dementia measured by MMSE (OR 1.35, 95% CI, 0.84-2.19), the association was not statistically significant. However, deficits in specific cognitive domains such as executive functions, wordlist encoding, and visual memory (encoding and recall) were significantly associated with low vitamin D concentration. Our results suggest an association between vitamin D deficiency and cognitive function in specific domains in community dwelling older adults.
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Prinz N, Stingl J, Dapp A, Denkinger MD, Fasching P, Jehle PM, Merger S, Mühldorfer S, Pieper U, Schuler A, Zeyfang A, Holl RW. High rate of hypoglycemia in 6770 type 2 diabetes patients with comorbid dementia: A multicenter cohort study on 215,932 patients from the German/Austrian diabetes registry. Diabetes Res Clin Pract 2016; 112:73-81. [PMID: 26563590 DOI: 10.1016/j.diabres.2015.10.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 04/15/2015] [Revised: 10/13/2015] [Accepted: 10/20/2015] [Indexed: 12/14/2022]
Abstract
AIMS Dementia and type 2 diabetes (T2D) are two major phenomena in older people. To compare anti-hyperglycemic therapy and diabetes-related comorbidities between elderly T2D patients with or without comorbid dementia. METHODS 215,932 type 2 diabetes patients aged ≥ 40 years (median [Q1;Q3]: 70.4 [61.2;77.7] years) from the standardized, multicenter German/Austrian diabetes patient registry, DPV, were studied. To identify patients with comorbid dementia, the registry was searched by ICD-10 codes, DSM-IV/-5 codes, respective search terms and/or disease-specific medication. For group comparisons, multiple hierarchic regression modeling with adjustments for age, sex, and duration of diabetes was applied. RESULTS 3.1% (n=6770; 57% females) of the eligible T2D patients had clinically recognized comorbid dementia. After adjustment for demographics, severe hypoglycemia (insulin group: 14.8 ± 0.6 vs. 10.4 ± 0.2 events per 100 patient-years, p<0.001), hypoglycemia with coma (insulin group: 7.6 ± 0.4 vs. 3.9 ± 0.1 events per 100 patient-years, p<0.001), depression (9.9 vs. 4.7%, p<0.001), hypertension (74.7 vs. 72.2%, p<0.001), stroke (25.3 vs. 6.5%, p<0.001), diabetic foot syndrome (6.0 vs. 5.2%, p=0.004), and microalbuminuria (34.7 vs. 32.2%, p<0.001) were more common in dementia patients compared to T2D without dementia. Moreover, patients with dementia received insulin therapy more frequently (59.3 vs. 54.7%, p<0.001), but metabolic control (7.7 ± 0.1 vs. 7.7 ± 0.1%) was comparable to T2D without dementia. CONCLUSIONS In T2D with dementia, higher rates of hypoglycemia and other diabetes-related comorbidities were observed. Hence, the risks of a glucocentric and intense diabetes management with insulin and a focus on tight glycemic control without considering other factors may outweigh the benefits in elderly T2D patients with comorbid dementia.
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Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany.
| | - Julia Stingl
- Federal Institute for Drugs and Medical Devices, and Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Albrecht Dapp
- Diabetes Center, Hospital District Tuttlingen, Medical Clinic Spaichingen, Spaichingen, Germany
| | - Michael D Denkinger
- Geriatric Center Ulm/Alb-Donau, Geriatric Medicine at Ulm University, Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Peter Fasching
- 5th Medical Department, Wilhelminenspital, Vienna, Austria
| | - Peter M Jehle
- Department of Internal Medicine, Paul-Gerhardt-Stift, Academic hospital of the Martin-Luther-University Halle-Wittenberg, Lutherstadt Wittenberg, Germany
| | - Sigrun Merger
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | | | - Urte Pieper
- Department of Internal Medicine, Hospital Wolgast, Wolgast, Germany
| | - Andreas Schuler
- Department of Internal Medicine, Helfenstein Hospital Geislingen/Steige, Geislingen/Steige, Germany
| | - Andrej Zeyfang
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany; Agaplesion Bethesda Hospital Stuttgart, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm and German Center for Diabetes Research (DZD), Ulm, Germany
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19
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Herbolsheimer F, Schaap LA, Edwards MH, Maggi S, Otero Á, Timmermans EJ, Denkinger MD, van der Pas S, Dekker J, Cooper C, Dennison EM, van Schoor NM, Peter R. Physical Activity Patterns Among Older Adults With and Without Knee Osteoarthritis in Six European Countries. Arthritis Care Res (Hoboken) 2016; 68:228-36. [PMID: 26212673 DOI: 10.1002/acr.22669] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/10/2015] [Accepted: 07/14/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate patterns of physical activity in older adults with knee osteoarthritis (OA) compared to older adults without knee OA across 6 European countries. We expect country-specific differences in the physical activity levels between persons with knee OA compared to persons without knee OA. A varying degree of physical activity levels across countries would express a facilitating or impeding influence of the social, environmental, and other contextual factors on a physically active lifestyle. METHODS Baseline cross-sectional data from the European Project on Osteoarthritis were analyzed. In total, 2,551 participants from 6 European countries (Germany, Italy, The Netherlands, Spain, Sweden, and the UK) were included. RESULTS Participants with knee OA were less likely to follow physical activity recommendations and had poorer overall physical activity profiles than those without knee OA (mean 62.9 versus 81.5 minutes/day, respectively; P = 0.015). The magnitude of this difference varied across countries. Detailed analysis showed that low physical activity levels in persons with knee OA could be attributed to less everyday walking time (odds ratio 1.31, 95% confidence interval 1.07-1.62). CONCLUSION This study highlighted the fact that having knee OA is associated with a varying degree of physical activity patterns in different countries. This national variation implies that low levels of physical activity among persons with knee OA cannot be explained exclusively by individual or disease-specific factors, but that social, environmental, and other contextual factors should also be taken into account.
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Affiliation(s)
| | - Laura A Schaap
- VU University Medical Center, Amsterdam, The Netherlands
| | - Mark H Edwards
- University of Southampton and Southampton General Hospital, Southampton, UK
| | - Stefania Maggi
- University of Padua and National Research Council, Padua, Italy
| | - Ángel Otero
- Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | | | | | | | - Joost Dekker
- VU University Medical Center, Amsterdam, The Netherlands
| | - Cyrus Cooper
- University of Southampton and Southampton General Hospital, Southampton, UK
| | - Elaine M Dennison
- University of Southampton and Southampton General Hospital, Southampton, UK
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20
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Foebel AD, Onder G, Finne-Soveri H, Lukas A, Denkinger MD, Carfi A, Vetrano DL, Brandi V, Bernabei R, Liperoti R. Physical Restraint and Antipsychotic Medication Use Among Nursing Home Residents With Dementia. J Am Med Dir Assoc 2016; 17:184.e9-14. [DOI: 10.1016/j.jamda.2015.11.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 12/01/2022]
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21
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Denkinger MD, Leins H, Schirmbeck R, Florian MC, Geiger H. HSC Aging and Senescent Immune Remodeling. Trends Immunol 2015; 36:815-824. [PMID: 26611154 DOI: 10.1016/j.it.2015.10.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 01/10/2023]
Abstract
Aging-associated changes in the function of the immune system are referred to as senescent immune remodeling (SIR). Here we review the current understanding on the cellular and molecular mechanisms underlying SIR. We focus on aging-associated changes in T and B cells, and discuss recent evidence supporting the notion that aging of the hematopoietic stem cell (HSC) compartment directly contributes to SIR due to aging-associated alterations in stem cell differentiation. We conclude by outlining strategies to attenuate SIR, including approaches to rejuvenate HSCs, which may open new avenues for targeting SIR in the clinic.
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Affiliation(s)
- Michael D Denkinger
- Institute for Molecular Medicine, Stem Cells and Aging, Ulm University, Ulm, Germany; aging research center, Ulm University, Ulm, Germany; AGAPLESION Bethesda Clinic, Geriatric Medicine, Ulm University, Ulm, Germany; Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Hanna Leins
- AGAPLESION Bethesda Clinic, Geriatric Medicine, Ulm University, Ulm, Germany; Department of Internal Medicine I, University Hospital of Ulm, Ulm, Germany
| | | | - Maria Carolina Florian
- Institute for Molecular Medicine, Stem Cells and Aging, Ulm University, Ulm, Germany; aging research center, Ulm University, Ulm, Germany
| | - Hartmut Geiger
- Institute for Molecular Medicine, Stem Cells and Aging, Ulm University, Ulm, Germany; aging research center, Ulm University, Ulm, Germany; Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA.
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22
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Yamada Y, Denkinger MD, Onder G, van der Roest HG, Finne-Soveri H, Bernabei R, Topinkova E. Joint Associations of Dual Sensory Impairment and No-Activity Involvement With 1-Year Mortality in Nursing Homes: Results From the SHELTER Study. J Gerontol A Biol Sci Med Sci 2015; 71:643-8. [PMID: 26582074 DOI: 10.1093/gerona/glv191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 10/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Concurrent vision and hearing impairment, known as dual sensory impairment (DSI), is associated with increased mortality. We aimed to examine individual and joint associations of DSI and involvement in activities with mortality in a large European nursing home study. METHODS In total, 2,851 nursing home residents in 59 facilities in eight countries were followed for 1 year in the Services and Health for Elderly in Long TERm Care study. Vision and hearing impairment and average time of involvement in activities were assessed by trained research staff using the interRAI Long Term Care Facilities. Association between DSI and 1-year all-cause mortality was examined using Cox proportional hazards models adjusted for age, sex, facility, diagnoses of coronary heart disease and diabetes mellitus, self-rated health, end-stage disease, and functional and cognitive status. The modifying effect of involvement in activities on the association was investigated by the additive hazard model. RESULTS DSI, defined as moderate to severe impairment in both senses, was independently associated with a 35% increased risk of 1-year mortality compared with non-DSI. Residents with DSI who were involved in activities did not have higher mortality, while residents with DSI who were not involved in activities had 51% higher mortality than non-DSI residents who were involved in activities, equivalent to approximately 209 additional deaths per 1,000 person-years (p = .012) due to the interaction between DSI and no involvement in activities. CONCLUSIONS DSI is associated with increased mortality at nursing homes when combined with no involvement in activities.
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Affiliation(s)
- Yukari Yamada
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic. Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Japan.
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Graziano Onder
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Henriëtte G van der Roest
- EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands. Elderly Care Research Unit at LUCAS and Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | - Roberto Bernabei
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Timmermans EJ, Schaap LA, Herbolsheimer F, Dennison EM, Maggi S, Pedersen NL, Castell MV, Denkinger MD, Edwards MH, Limongi F, Sánchez-Martínez M, Siviero P, Queipo R, Peter R, van der Pas S, Deeg DJ. The Influence of Weather Conditions on Joint Pain in Older People with Osteoarthritis: Results from the European Project on OSteoArthritis. J Rheumatol 2015; 42:1885-92. [DOI: 10.3899/jrheum.141594] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/22/2022]
Abstract
Objective.This study examined whether daily weather conditions, 3-day average weather conditions, and changes in weather conditions influence joint pain in older people with osteoarthritis (OA) in 6 European countries.Methods.Data from the population-based European Project on OSteoArthritis were used. The American College of Rheumatology classification criteria were used to diagnose OA in older people (65–85 yrs). After the baseline interview, at 6 months, and after the 12–18 months followup interview, joint pain was assessed using 2-week pain calendars. Daily values for temperature, precipitation, atmospheric pressure, relative humidity, and wind speed were obtained from local weather stations. Multilevel regression modelling was used to examine the pain-weather associations, adjusted for several confounders.Results.The study included 810 participants with OA in the knee, hand, and/or hip. After adjustment, there were significant associations of joint pain with daily average humidity (B = 0.004, p < 0.01) and 3-day average humidity (B = 0.004, p = 0.01). A significant interaction effect was found between daily average humidity and temperature on joint pain. The effect of humidity on pain was stronger in relatively cold weather conditions. Changes in weather variables between 2 consecutive days were not significantly associated with reported joint pain.Conclusion.The associations between pain and daily average weather conditions suggest that a causal relationship exist between joint pain and weather variables, but the associations between day-to-day weather changes and pain do not confirm causation. Knowledge about the relationship between joint pain in OA and weather may help individuals with OA, physicians, and therapists to better understand and manage fluctuations in pain.
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Scheuing N, Stingl J, Dapp A, Denkinger MD, Fasching P, Jehle PM, Merger S, Mühldorfer S, Pieper U, Schuler A, Zeyfang A, Holl RW. Glukozentrische Diabetestherapie bei geriatrischen Patienten mit Demenz sinnvoll? Multizentrische DPV-Daten von insgesamt 215.932 Typ-2-Diabetespatienten zeigen signifikant erhöhte Hypoglykämierate bei 6.771 Patienten mit komorbider Demenz. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549772] [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: 10/23/2022]
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Stubbs B, Denkinger MD, Brefka S, Dallmeier D. What works to prevent falls in older adults dwelling in long term care facilities and hospitals? An umbrella review of meta-analyses of randomised controlled trials. Maturitas 2015; 81:335-42. [PMID: 25935294 DOI: 10.1016/j.maturitas.2015.03.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/08/2023]
Abstract
Preventing falls in long term care facilities (LTCF) and hospitals is an international priority. Many interventions have been investigated and summarised in meta-analyses (MA) and there is a need to synthesise the top of the hierarchy of evidence in one place. Therefore we conducted an umbrella review of MA of randomised controlled trials (RCTs) of falls prevention interventions LTCF and hospitals. Two independent reviewers searched major electronic databases from inception till October 2014 for MA containing ≥3 RCTs investigating any intervention to prevent falls in LTCF or hospitals in older adults aged ≥60 years. Methodological quality was assessed by the AMSTAR tool and data were narratively synthesised. The methodological quality of the MA was moderate to high across the 10 included MA. Nine MA provided data for LTCF and only two considered hospital settings. Only one MA defined a fall and two reported adverse events (although minor). Consistent evidence suggests that multifactorial interventions reduce falls (including the rate, risk and odds of falling) in LTCF and hospitals. Inconsistent evidence exists for exercise and vitamin D as single interventions in LTCF, whilst no MA has investigated this in hospitals. No evidence exists for hip protectors and medication review on falls in LTCF. In conclusion, multifactorial interventions appear to be the most effective interventions to prevent falls in LTCF and hospital settings. This is not without limitations and more high quality RCTs are needed in hospital settings in particular. Future RCTs and MA should clearly report adverse events.
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Affiliation(s)
- Brendon Stubbs
- Faculty of Education and Health, University of Greenwich, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, UK.
| | - Michael D Denkinger
- Competence Centre of Geriatrics and Aging Research Ulm/Alb-Donau, Zollernring 26, 89075 Ulm, Germany
| | - Simone Brefka
- AGAPLESION Bethesda Clinic, Geriatrics Ulm University, Zollernring 26, 89073 Ulm, Germany.
| | - Dhayana Dallmeier
- Competence Centre of Geriatrics and Aging Research Ulm/Alb-Donau, Zollernring 26, 89075 Ulm, Germany
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Yamada Y, Denkinger MD, Onder G, Henrard JC, van der Roest HG, Finne-Soveri H, Richter T, Vlachova M, Bernabei R, Topinkova E. Dual Sensory Impairment and Cognitive Decline: The Results From the Shelter Study. J Gerontol A Biol Sci Med Sci 2015; 71:117-23. [PMID: 25869524 DOI: 10.1093/gerona/glv036] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [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: 01/08/2023] Open
Abstract
OBJECTIVES To examine whether nursing home residents with concurrent vision and hearing impairment, dual sensory impairment (DSI), have a greater cognitive decline over time than do those without sensory impairment and whether social engagement modifies this association. METHODS Based on the Services and Health for Elderly in Long TERm Care study, 1,989 nursing home residents who were assessed using the interRAI LTCF at 6-month intervals over 1 year were included. Multivariate linear regression models with time-variant exposure variables of sensory impairment and social engagement using generalized estimating equations were performed to predict cognitive function measured by the Cognitive Performance Scale (range 0-6). RESULTS Residents with DSI had a greater cognitive decline [changes in Cognitive Performance Scale over 1 year = 1.12 (95% confidence interval = 0.81:1.42)] compared to those with either vision or hearing impairment [0.67 (0.53:0.64)] and those without sensory impairment [0.56 (0.48:0.64)]. A lower level of social engagement was also associated with a greater cognitive decline. The combined exposure variable of sensory impairment and social engagement revealed the greatest cognitive decline for socially disengaged residents with DSI [1.87 (1.24:2.51)] and the potential effect modification of social engagement on the association between DSI and cognitive decline; DSI was not associated with a greater cognitive decline among socially engaged residents, while it was associated among socially disengaged residents DISCUSSION Cognitive function declines faster in nursing home residents with DSI only when residents were not socially engaged. Therefore, residents with DSI might cognitively benefit from interventions to improve involvement in social life at nursing homes.
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Affiliation(s)
- Yukari Yamada
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic. Department of Nursing, Faculty of Health Sciences, Palacky Univestiy, Olomouc, Czech Republic.
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Graziano Onder
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Jean-Claude Henrard
- Research Unit Health-Environment-Ageing, Versailles- Saint-Quentin en Yvelines University, Paris, France
| | - Henriëtte G van der Roest
- EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands. Elderly Care Research Unit at LUCAS and Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | - Tomas Richter
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martina Vlachova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roberto Bernabei
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Szczerbińska K, Topinková E, Brzyski P, van der Roest HG, Richter T, Finne-Soveri H, Denkinger MD, Gindin J, Onder G, Bernabei R. The Characteristics of Diabetic Residents in European Nursing Homes: Results from the SHELTER Study. J Am Med Dir Assoc 2015; 16:334-40. [DOI: 10.1016/j.jamda.2014.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
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Denkinger MD, Lukas A, Nikolaus T, Hauer K. Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review. Am J Geriatr Psychiatry 2015; 23:72-86. [PMID: 24745560 DOI: 10.1016/j.jagp.2014.03.002] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 02/05/2014] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fear of falling (FOF) is an important threat to autonomy. Current interventions to reduce FOF have yielded conflicting results. A possible reason for this discrepancy could be its multicausality. Some risk factors may not have been identified and addressed in recent studies. The last systematic review included studies until 2006. METHODS To identify additional risk factors for FOF and to test those mentioned previously, we conducted a systematic literature review. Studies examining FOF in community-dwelling older adults between 2006 and October 2013 were screened. RESULTS Outcomes are summarized with respect to different constructs such as FOF, fall-related self-efficacy/balance confidence, and FOF-related activity restriction. Odds ratios and p values are reported. There is no clear pattern with regard to the different FOF-related constructs studied. The only parameters robustly associated across all constructs were female gender, performance-based and questionnaire-based physical function, the use of a walking aid, and, less robust, a history of falls and poor self-rated health. Conflicting results were identified for depression and anxiety, multiple drugs, and psychotropic drugs. Other potentially modifiable risk factors were only mentioned in one or two studies and warrant further investigation. Parameters with mainly negative results are also presented. CONCLUSION Only few risk factors identified were robustly associated across all FOF-related constructs and should be included in future studies on FOF. Some newer factors have to be tested again in different cohorts. The comprehensive overview might assist in the conceptualization of future studies.
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Affiliation(s)
- Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany.
| | - Albert Lukas
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany
| | - Thorsten Nikolaus
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Clinic, Geriatric Centre of Heidelberg University, Heidelberg, Germany
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Foebel AD, Liperoti R, Onder G, Finne-Soveri H, Henrard JC, Lukas A, Denkinger MD, Gambassi G, Bernabei R. Use of Antipsychotic Drugs Among Residents With Dementia in European Long-Term Care Facilities: Results From the SHELTER Study. J Am Med Dir Assoc 2014; 15:911-7. [DOI: 10.1016/j.jamda.2014.07.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/15/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
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Yamada Y, Vlachova M, Richter T, Finne-Soveri H, Gindin J, van der Roest H, Denkinger MD, Bernabei R, Onder G, Topinkova E. Prevalence and Correlates of Hearing and Visual Impairments in European Nursing Homes: Results From the SHELTER Study. J Am Med Dir Assoc 2014; 15:738-43. [DOI: 10.1016/j.jamda.2014.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 11/25/2022]
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Rothenbacher D, Klenk J, Denkinger MD, Herbolsheimer F, Nikolaus T, Peter R, Boehm BO, Rapp K, Dallmeier D, Koenig W. Prospective evaluation of renal function, serum vitamin D level, and risk of fall and fracture in community-dwelling elderly subjects. Osteoporos Int 2014; 25:923-32. [PMID: 24221451 DOI: 10.1007/s00198-013-2565-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Received: 06/01/2013] [Accepted: 10/21/2013] [Indexed: 01/21/2023]
Abstract
SUMMARY This prospective study in elderly showed that kidney function plays a minor role in explaining the high prevalence of vitamin D deficiency seen in noninstitutionalized elderly subjects. However, 25-hydroxyvitamin D levels were clearly inversely associated with risk for first fall, which was especially seen in subjects with calcium levels above median. INTRODUCTION Few prospective studies in elderly exist that have investigated the association of renal dysfunction and vitamin D status on risk of falls. The aim of this study is to evaluate the association of renal function with 25-hydroxyvitamin D (25-OH-D) levels and, secondly, to assess the role of both factors on the risk of falls and subsequent bone fractures. METHODS This is a prospective population-based cohort study among noninstitutionalized elderly subjects during a 1-year follow-up. 25-OH-D levels and renal function were estimated, the latter by cystatin C-based equations. Information on falls was assessed prospectively. RESULTS Overall, 1,385 subjects aged 65 and older were included in the study (mean age 75.6 years), of whom 9.2 % had a 25-OH-D serum level above 75 nmol/L (US units 30 ng/mL); 41.4 %, between 50 and 75 nmol/L (US units 20 to 29 ng/mL, insufficiency); and 49.4 %, <50 nmol/L (US units <20 ng/mL, deficiency). We found no association of chronic kidney disease with risk of first fall. In contrast, 25-OH-D serum categories were clearly associated with risk of first fall and we found evidence of effect modification with calcium levels. In the group with a calcium level above the median (≥ 9.6 mg/dL), subjects with 25-OH-D serum level between 50 and 75 nmol/L and with concentrations <50 nmol/L had a hazard rate ratio (HRR) of 1.75 (1.03-2.87) and 1.93 (1.10-3.37) for risk of first fall. 25-OH-D serum levels were also associated with several markers of inflammation and hemodynamic stress. CONCLUSIONS We demonstrated an association of 25-OH-D serum levels and risk of first fall, which was especially evident in subjects with serum calcium in upper normal, independent of renal function.
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Affiliation(s)
- D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany,
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Denkinger MD, Flick SE, Nikolaus T, Becker C, Aminian K, Lindemann U. Assessing physical activity in inpatient rehabilitation—sensor-based validation of the PAIR. Eur Rev Aging Phys Act 2014. [DOI: 10.1007/s11556-014-0137-0] [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: 10/25/2022] Open
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Lukas A, Mayer B, Fialová D, Topinkova E, Gindin J, Onder G, Bernabei R, Nikolaus T, Denkinger MD. Treatment of pain in European nursing homes: results from the Services and Health for Elderly in Long TERm Care (SHELTER) study. J Am Med Dir Assoc 2013; 14:821-31. [PMID: 23746948 DOI: 10.1016/j.jamda.2013.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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: 02/20/2013] [Revised: 04/18/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe. SETTING, PARTICIPANTS, AND MEASUREMENTS Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n = 1900). A deeper analysis was performed for the subsample of residents who reported "current pain," defined as pain at least 1 day within the past 3 days (n = 838), and those who reported "current pain of moderate to severe intensity" (n = 590). RESULTS Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians' availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians' availability, and severe pain intensity were negatively associated. CONCLUSION Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement.
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Affiliation(s)
- Albert Lukas
- Agaplesion Bethesda Clinic, Competence Center of Geriatrics and Aging Research, University of Ulm, Ulm, Germany.
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Lukas A, Mayer B, Fialová D, Topinkova E, Gindin J, Onder G, Bernabei R, Nikolaus T, Denkinger MD. Pain characteristics and pain control in European nursing homes: cross-sectional and longitudinal results from the Services and Health for Elderly in Long TERm care (SHELTER) study. J Am Med Dir Assoc 2013; 14:421-8. [PMID: 23375521 DOI: 10.1016/j.jamda.2012.12.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 12/16/2012] [Accepted: 12/19/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE AND DESIGN Few studies have compared cross-national characteristics of residents with pain in European long term care facilities. The SHELTER project, a cross-national European study on nursing home residents, provides the opportunity to examine this issue. The present study aimed to evaluate key figures about pain and compare them with seven European countries and Israel. SETTING, PARTICIPANTS, AND MEASUREMENTS A total of 3926 nursing home residents were assessed by the interRAI instrument for Long Term Care Facilities (interRAI LTCF). Prevalence of pain, frequency, intensity, consistency, and control were estimated and compared cross-nationally. Correlates between patient-related characteristics and inadequate pain management were tested using bivariate and multivariate logistic regression models. RESULTS Overall, 1900 (48.4%) residents suffered from pain. Pain prevalence varied significantly among countries, ranging from 19.8% in Israel to 73.0% in Finland. Pain was positively associated with female gender, fractures, falls, pressure ulcers, sleeping disorders, unstable health conditions, cancer, depression, and number of drugs. It was negatively associated with dementia. In a multivariate logistic regression model, all associations remained except for sleeping disorders. Clinical correlations varied considerably among countries. Although in 88.1% of cases, pain was self-rated by the residents as sufficiently controlled, in only 56.8% of cases was pain intensity self-rated as absent or mild. Pain control and intensity improved within 1 year. CONCLUSION Pain prevalence is high and varies considerably across Europe. Although most residents considered pain as adequately controlled, a closer look confirmed that many still suffer from high pain intensities. Analyzing the reasons behind these differences may help to improve pain management.
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Affiliation(s)
- Albert Lukas
- AGAPLESION Bethesda Clinic, Competence Center of Geriatrics and Aging Research, University of Ulm, Germany.
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Lukas A, Kilian R, Hay B, Muche R, von Arnim CAF, Otto M, Riepe M, Jamour M, Denkinger MD, Nikolaus T. [Maintenance of health and relief for caregivers of elderly with dementia by using "initial case management": experiences from the Lighthouse Project on Dementia, Ulm, ULTDEM-study]. Z Gerontol Geriatr 2012; 45:298-309. [PMID: 22538793 DOI: 10.1007/s00391-012-0337-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND When facing the well-known demographic development with an increasing number of people suffering from dementia, there is a need of programmes to support nursing relatives and care at home. Many support services have been established in the past few years but they are rarely used by the relatives and the patients. The purpose of the Lighthouse Project Ulm (ULTDEM Study) was to prove the effectiveness of a single advisory approach in order to provide support services after care level classification and to relieve the burden placed on relatives caring for family members suffering from dementia ("initial case management"). METHODS The ULTDEM Study is a prospective, open, randomized, controlled, interventional study with different parallel outcome measures (burden of caring, quality of life and mood). After the randomization, the interventional group was given comprehensive, individual advice about available treatment possibilities for dementia patients. Control group participants received standard treatment. Inclusion criteria were application of a care level (0 or 1) as well as dementia diagnosis. All participants (patients/relatives) underwent an initial and a 6 month comprehensive assessment. RESULTS Our results show that a single advisory approach does not lead to a significant difference in outcome measures in interventional and control groups. Those tendencies described have to be interpreted as clinically not relevant. Although utilization of support services increases, it remains similar in both study groups. A confirmatory interpretation has not been possible due to a lack of adjustment to the findings regarding multiple testing and an insufficient degree of recruitment. Possible causes will be discussed such as premature intervention during the course of the disease, a lack of intervention blinding, recruitment bias and lack of an influence on adherence with regard to the use of support services. IMPLICATIONS The study demonstrates that there is a substantial information deficit for persons affected by dementia and their relatives. Innovative ways still have to be developed to ensure that this information actually reaches the target audience.
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Affiliation(s)
- A Lukas
- AGAPLESION Bethesda Klinik Ulm, Akademisches Krankenhaus der Universität Ulm, Zollernring 26-28, 89073 Ulm.
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Denkinger MD, Lukas A, Herbolsheimer F, Peter R, Nikolaus T. Physical activity and other health-related factors predict health care utilisation in older adults: the ActiFE Ulm study. Z Gerontol Geriatr 2012; 45:290-7. [PMID: 22622677 DOI: 10.1007/s00391-012-0335-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Health care utilisation (HCU) can be a useful outcome for estimating costs and patient needs. It can also be used as a surrogate parameter for healthy ageing. The aim of this study was to analyse the associations of formerly described and potentially new parameters influencing health care utilisation in older adults in Germany. PATIENTS AND METHODS The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based study in 1,506 community dwelling older adults aged 65-90 years in Ulm and surrounding areas in southwestern Germany. Between March 2009 and April 2010 a full geriatric assessment was performed including accelerometer-based average daily walking duration, comorbidity, medication, physical and psychological functioning, health care utilisation, sociodemographic factors etc. The association between above named measures and health care utilisation, represented by the number of drugs, the days in hospital and the number of physician contacts over one year was calculated in multiple regression models. Analysis was conducted among subjects with complete information (n = 1,059, mean age 76 years, 55% male). RESULTS The average number of drugs was 4.5 and over 95% of participants visited a physician at least once a year while still more than 65% contacted their physician more than twice a year. Reduced physical activity, BMI, self-rated health and/or comorbidity and male sex were the best predictors of health care utilisation in community dwelling older adults when looking at both the number of drugs and the number of physician contacts over 12 months together. With regard to single diseases entities the best predictors of both the number of drugs and the number of physician contacts were asthma, chronic obstructive pulmonary disease (COPD)/chronic bronchitis and chronic neurological diseases (mostly Parkinson's disease). The number of drugs was most strongly associated with coronary heart disease, diabetes, and high blood pressure. CONCLUSION Reduced walking activity, self-rated health and/or comorbidity and male sex are the best predictors of health care utilisation as measured by the number of drugs and number of physician contacts over 12 months. Walking activity could be regarded as the most promising modifiable predictor of HCU in older adults.
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Affiliation(s)
- M D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Center Ulm University, Zollernring 26, 89073 Ulm, Germany.
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Rapp K, Klenk J, Benzinger P, Franke S, Denkinger MD, Peter R. Physical performance and daily walking duration: associations in 1271 women and men aged 65-90 years. Aging Clin Exp Res 2012; 24:455-60. [PMID: 22313581 DOI: 10.3275/8264] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Several tests of physical performance like gait speed or standing balance are part of the geriatric assessment. Measures of physical activity like daily walking duration are more difficult to assess but may be of higher relevance for daily requirements. It is therefore of interest to what extent physical performance measures are associated with physical activity. METHODS In a cohort study, baseline screening was performed in 1271 community-living people aged 65-90 years from Ulm, Germany. Average daily walking duration was assessed in all participants by accelerometers over a one-week period. Habitual gait speed, 5-Chair-Rise test, standing balance and handgrip strength served as measures of physical performance. The association between measures of physical performance and physical activity was calculated by linear regression analysis. RESULTS The mean daily walking duration was 104.8 minutes in men and 103.0 minutes in women. A positive relationship between gait speed and walking duration was observed in men and women with low gait speed (≤0.8 m/s) but not in participants above this threshold. Standing balance and hand grip strength were positively and 5-Chair-Rise test inversely related with average daily walking duration. A relationship between hand grip strength and walking duration was only observed in women aged 75 years and more. CONCLUSIONS Physical performance measures and objectively measured walking duration are related with each other but only a small percentage of the variance of daily walking duration was explained by physical performance measures. Therefore, factors other than physical performance seem to influence daily walking duration to a great extent.
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Affiliation(s)
- Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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Denkinger MD, Lindemann U, Nicolai S, Igl W, Jamour M, Nikolaus T. Assessing Physical Activity in Inpatient Rehabilitation: Validity, Practicality, and Sensitivity to Change in the Physical Activity in Inpatient Rehabilitation Assessment. Arch Phys Med Rehabil 2011; 92:2012-7. [DOI: 10.1016/j.apmr.2011.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 06/24/2011] [Indexed: 11/25/2022]
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Hancke K, Hasch M, Gerstenmayr A, Nikolaus T, Kreienberg R, Denkinger MD. Geriatric screening of older breast cancer patients – a pilot project. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286433] [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: 10/17/2022] Open
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Denkinger MD. REDUCED SENSITIVITY TO CHANGE-A RELEVANT LIMITATION OF THE VISUAL ANALOGUE SCALE TO ASSESS FEAR OF FALLING? J Am Geriatr Soc 2011; 59:773. [DOI: 10.1111/j.1532-5415.2011.03338.x] [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: 11/26/2022]
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Denkinger MD, Franke S, Rapp K, Weinmayr G, Duran-Tauleria E, Nikolaus T, Peter R. Accelerometer-based physical activity in a large observational cohort--study protocol and design of the activity and function of the elderly in Ulm (ActiFE Ulm) study. BMC Geriatr 2010; 10:50. [PMID: 20663209 PMCID: PMC2919539 DOI: 10.1186/1471-2318-10-50] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 07/27/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A large number of studies have demonstrated a positive effect of increased physical activity (PA) on various health outcomes. In all large geriatric studies, however, PA has only been assessed by interview-based instruments which are all subject to substantial bias. This may represent one reason why associations of PA with geriatric syndromes such as falls show controversial results. The general aim of the Active-Ulm study was to determine the association of accelerometer-based physical activity with different health-related parameters, and to study the influence of this standardized objective measure of physical activity on health- and disability-related parameters in a longitudinal setting. METHODS We have set up an observational cohort study in 1500 community dwelling older persons (65 to 90 years) stratified by age and sex. Addresses have been obtained from the local residents registration offices. The study is carried out jointly with the IMCA--Respiratory Health Survey in the Elderly implemented in the context of the European project IMCA II. The study has a cross-sectional part (1) which focuses on PA and disability and two longitudinal parts (2) and (3). The primary information for part (2) is a prospective 1 year falls calendar including assessment of medication change. Part (3) will be performed about 36 months following baseline. Primary variables of interest include disability, PA, falls and cognitive function. Baseline recruitment has started in March 2009 and will be finished in April 2010.All participants are visited three times within one week, either at home or in the study center. Assessments included interviews on quality of life, diagnosed diseases, common risk factors as well as novel cognitive tests and established tests of physical functioning. PA is measured using an accelerometer-based sensor device, carried continuously over a one week period and accompanied by a prospective activity diary. DISCUSSION The assessment of PA using a high standard accelerometer-based device is feasible in a large population-based study. The results obtained from cross-sectional and longitudinal analyses will shed light on important associations between PA and various outcomes and may provide information for specific interventions in older people.
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Affiliation(s)
| | | | - Kilian Rapp
- Institute of Epidemiology, Ulm University, Ulm, Germany
| | | | - Enric Duran-Tauleria
- Epidemiology and Public Health Unit, Institut de Prestacions d'Assitència Mèdical Personal Municipal (PAMEM), Barcelona, Spain
- IMIM - Hospital el Mar, Barcelona, Spain
| | | | - Richard Peter
- Institute of Epidemiology, Ulm University, Ulm, Germany
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Hancke K, Denkinger MD, König J, Kurzeder C, Wöckel A, Herr D, Blettner M, Kreienberg R. Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study. Ann Oncol 2010; 21:748-753. [PMID: 19825884 DOI: 10.1093/annonc/mdp364] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Hancke
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm.
| | - M D Denkinger
- Geriatric Department, Bethesda Geriatric Clinic, University of Ulm, Ulm
| | - J König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - C Kurzeder
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
| | - A Wöckel
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
| | - D Herr
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
| | - M Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - R Kreienberg
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
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Denkinger MD, Igl W, Jamour M, Bader A, Bailer S, Lukas A, Nikolaus T. Does functional change predict the course of improvement in geriatric inpatient rehabilitation? Clin Rehabil 2010; 24:463-70. [PMID: 20354056 DOI: 10.1177/0269215509353269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The evaluation of rehabilitation success as measured by different tools is becoming increasingly important in terms of time and money allocation. We wanted to know whether functional change in the first week predicts subsequent improvement in a geriatric inpatient rehabilitation clinic. DESIGN Observational longitudinal study. SETTING Geriatric inpatient rehabilitation clinic in Germany. SUBJECTS One hundred and sixty-one inpatients (117 women) with a median age of 82 years, capable of walking at baseline. MAIN MEASURES Weekly assessments of physical function were performed from admission until three weeks later. We used a self-rated tool (the function component of the Short Form - Late Life Function and Disability Index), a proxy-rated tool (the Barthel Index) and a performance-based tool (gait speed). We set up linear regression models to estimate the predictive capacity of change in physical function within the first week on change in physical function within the following two weeks. RESULTS Positive correlations were found between functional change within the first week and total change within three weeks. However, correlations of the same periods of change with subsequent change were negative. Correlations were highly significant for both analysis with P-values <0.0001 when the same measures for prediction and outcome were used. Correlations were inconsistent when prediction and outcome were different. CONCLUSIONS Improvement within the first week of inpatient rehabilitation is negatively correlated with subsequent functional change.
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Denkinger MD, Igl W, Lukas A, Bader A, Bailer S, Franke S, Denkinger CM, Nikolaus T, Jamour M. Relationship Between Fear of Falling and Outcomes of an Inpatient Geriatric Rehabilitation Population-Fear of the Fear of Falling. J Am Geriatr Soc 2010; 58:664-73. [DOI: 10.1111/j.1532-5415.2010.02759.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Denkinger MD, Weyerhäuser K, Nikolaus T, Coll-Planas L. [Reliability of the abbreviated version of the Late Life Function and Disability Instrument--a meaningful and feasible tool to assess physical function and disability in the elderly]. Z Gerontol Geriatr 2009; 42:28-38. [PMID: 18465103 DOI: 10.1007/s00391-008-0550-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 04/09/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The early assessment of prevalent disability and functional decline is of increasing importance for prevention issues and for the evaluation of change in clinical studies. The assessment of common daily tasks and resulting disability is essential for a complete impression of a patient's capabilities. There are plenty of instruments that cover basic and instrumental activities of daily living by assessing the person's dependence at a specific functional task. However, the early stages of everyday life limitations and functional decline are usually not being captured. In this article we have examined psychometric properties of the German adaptation of the abbreviated "late life function and disability instrument", a promising tool that is capable of capturing early aspects of functional decline and disability. METHODS Older Caucasian men and women (Median=82 years) with a wide range of functional status (Short Physical Performance Battery: Median=6, Min.=0, Max.=12) completed the abbreviated version of the LLFDI once (n=173). A subgroup was assessed twice to examine interrater (n=13) and intrarater (n=10) reliability. Cognitive and functional status was assessed at baseline. RESULTS Internal consistency (Cronbach's ) was acceptable for the personal role and social role of the frequency items of the disability component (0.55 to 0.62) and very good for all other parts of the instrument (0.78 to 0.89) without a significant difference when compared for overall cognitive performance or executive function. Test-retest reliability was very good (0.81 to 0.96) and interrater reliability was acceptable to very good (0.62 to 0.96) with only acceptable results for the limitation items of the disability component. The total scores of the two components did not demonstrate significant floor or ceiling effects and the interview lasted on average 17 minutes (range 8 to 35 min). INTERPRETATION The German adaptation of the abbreviated version of the "Late Life Function and Disability Instrument" has minimal ceiling and floor effects, acceptable to good internal consistency and interrater reliability, and very good test-retest reliability. Hence, it constitutes an excellent alternative to common self-rating instruments for the assessment of functional capacities in everyday activities.
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Affiliation(s)
- M D Denkinger
- Bethesda Geriatrische Klinik, Zollernring 26, 89073, Ulm, Deutschland.
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Denkinger MD, Igl W, Coll-Planas L, Bleicher J, Nikolaus T, Jamour M. Evaluation of the Short Form of the Late-Life Function and Disability Instrument in Geriatric InpatientsâValidity, Responsiveness, and Sensitivity to Change. J Am Geriatr Soc 2009; 57:309-14. [DOI: 10.1111/j.1532-5415.2008.02095.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Denkinger MD, Igl W, Coll-Planas L, Nikolaus T, Bailer S, Bader A, Jamour M. Practicality, validity and sensitivity to change of fear of falling self-report in hospitalised elderly--a comparison of four instruments. Age Ageing 2009; 38:108-12. [PMID: 19001557 DOI: 10.1093/ageing/afn233] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- M D Denkinger
- Robert Bosch Stiftung an der Bethesda Geriatrische Klinik, Ulm.
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Padrós J, Peris T, Salvà A, Denkinger MD, Coll-Planas L. Evaluation of a urinary incontinence unit for community-dwelling older adults in Barcelona: Implementation and improvement of the perceived impact on daily life, frequency and severity of urinary incontinence. Z Gerontol Geriatr 2008; 41:291-7. [DOI: 10.1007/s00391-008-0564-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 06/20/2008] [Indexed: 10/21/2022]
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Denkinger MD, Coll-Planas L, Jamour M, Nikolaus T. The assessment of physical activity in inpatient rehabilitation-an important aspect of the identification of frailty in hospitalized older people. J Am Geriatr Soc 2007; 55:967-8; author reply 968-9. [PMID: 17537110 DOI: 10.1111/j.1532-5415.2007.01192.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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