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Salvi P, Grillo A, Gautier S, Labat C, Salvi L, Valbusa F, Baldi C, Rovina M, Simon G, Gao L, Tan I, Fabris B, Carretta R, Avolio AP, Parati G, Benetos A. Myocardial oxygen supply and demand imbalance predicts mortality in older nursing home residents: The PARTAGE study. J Am Geriatr Soc 2024; 72:1048-1059. [PMID: 38217343 DOI: 10.1111/jgs.18752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND A mismatch between myocardial oxygen supply and demand is the most common cause of ischemic myocardial injury in older persons. The subendocardial viability ratio (SEVR) can usefully estimate the degree of myocardial perfusion relative to left-ventricular workload. The aim of the present study was to evaluate the ability of SEVR to predict long-term mortality in the older population. Additionally, we aimed to identify the SEVR cutoff value best predicting total mortality. METHODS This is a multicenter, longitudinal study involving a large population of individuals older than 80 years living in nursing homes. Patients with cancer, severe dementia, and very low level of autonomy were excluded from the study. Participants were monitored for 10 years. Adverse outcomes were recorded every 3 months from inclusion to the end of the study. SEVR reflects the balance between subendocardial oxygen supply and demand, and was estimated non-invasively by analyzing the carotid pressure waveform recorded by applanation arterial tonometry. RESULTS A total of 828 people were enrolled (mean age: 87.7 ± 4.7 years, 78% female). 735 patients died within 10 years and 24 were lost to follow-up. SEVR was inversely associated with mortality at univariate Cox-regression model (risk ratio, 0.683 per unit increase in SEVR; 95% confidence interval (CI) [0.502-0.930], p = 0.015) and in a model including age, sex, body mass index, Activity of Daily Living index and Mini-Mental State Examination score (risk ratio, 0.647; 95% CI [0.472-0.930]). The lowest tertile of SEVR was associated with higher 10-years total mortality than the middle (p < 0.001) and the highest (p < 0.004) tertile. A SEVR cutoff value of 83% was identified as the best predictor of total mortality. CONCLUSIONS SEVR may be considered as a marker of "cardiovascular frailty." An accurate non-invasive estimation of SEVR could be a useful and independent parameter to assess survival probability in very old adults. TRIAL REGISTRATION NCT00901355, registered on ClinicalTrials.gov website.
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Affiliation(s)
- Paolo Salvi
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Andrea Grillo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Sylvie Gautier
- CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", Université de Lorraine, Nancy, France
| | - Carlos Labat
- CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", Université de Lorraine, Nancy, France
| | - Lucia Salvi
- Medicina II Cardiovascolare, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Filippo Valbusa
- Department of Internal Medicine, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar, Italy
| | - Corrado Baldi
- Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Matteo Rovina
- Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giulia Simon
- Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Lan Gao
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Isabella Tan
- Macquarie Medical School, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Bruno Fabris
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
- Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Renzo Carretta
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
- Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Alberto P Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, Australia
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Athanase Benetos
- CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", Université de Lorraine, Nancy, France
- INSERM, DCAC u1116, Université de Lorraine, Nancy, France
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Namba Y, Kobayashi T, Hashimoto M, Onoe T, Mashima H, Oishi K, Honmyo N, Abe T, Kuroda S, Ohdan H. The efficacy and safety of pure laparoscopic liver resection for hepatocellular carcinoma in super-elderly patients over 80 years: A multicenter propensity analysis. J Hepatobiliary Pancreat Sci 2024; 31:234-242. [PMID: 38009434 DOI: 10.1002/jhbp.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Very few reports have evaluated the safety of laparoscopic liver resection in super-elderly patients. We assessed the short-term outcomes of laparoscopic liver resection in patients with hepatocellular carcinoma aged ≥80 years, using propensity score matching. METHODS We retrospectively analyzed the data of 287 patients (aged ≥80 years) who underwent liver resection for hepatocellular carcinoma at eight hospitals belonging to Hiroshima Surgical study group of Clinical Oncology, between January 2012 and December 2021. The perioperative outcomes were compared between laparoscopic and open liver resection, using propensity score matching. RESULTS Of the 287 patients, 83 and 204 were included in the laparoscopic and open liver resection groups, respectively. Propensity score matching was performed, and 52 patients were included in each group. The operation (p = .68) and pringle maneuver (p = .11) time were not different between the groups. There were no significant differences in the incidences of bile leakage or organ failure. The laparoscopic liver resection group had significantly less intraoperative bleeding and a lower incidence of cardiopulmonary complications (both p < .01). CONCLUSIONS Laparoscopic liver resection can be safely performed in elderly patients aged ≥80 years.
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Affiliation(s)
- Yosuke Namba
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masakazu Hashimoto
- Department of Gastroenterological-Breast and Transplant Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takashi Onoe
- Department of Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Hiroaki Mashima
- Department of Surgery and Endoscopic Surgery, JA Onomichi General Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Naruhiko Honmyo
- Department of Surgery, Hiroshima City North Medical Center, Asa Citizens Hospital, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery and Gastroenterological Surgery, East Hiroshima Medical Hospital, Hiroshima, Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Visvanathan R, Lange K, Selvam J, Dollard J, Boyle E, Jones K, Ingram K, Shibu P, Wilson A, Ranasinghe DC, Karnon J, Hill KD. Findings from three methods to identify falls in hospitals: Results from the Ambient Intelligent Geriatric Management system fall prevention trial. Australas J Ageing 2024; 43:199-204. [PMID: 37861202 DOI: 10.1111/ajag.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports). METHODS A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used. RESULTS Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%). CONCLUSIONS This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.
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Affiliation(s)
- R Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - K Lange
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Selvam
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Dollard
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - E Boyle
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Jones
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - P Shibu
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
| | - A Wilson
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - D C Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - J Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - K D Hill
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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Jensen MLV, Aabenhus RM, Holzknecht BJ, Bjerrum L, Siersma V, COrdoba G, Jensen JN. Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population. Scand J Public Health 2024; 52:31-38. [PMID: 36076357 DOI: 10.1177/14034948221119638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The development of effective interventions to reduce inappropriate use of antibiotics in the elderly population requires knowledge on who can benefit from such interventions. Thus, we aimed to identify and characterise antibiotic heavy users among elderly patients in general practice with respect to sociodemographic variables. METHODS We conducted a retrospective nationwide register-based study on all Danish elderly citizens (⩾65 years) who redeemed an antibiotic prescription in 2017. Heavy users were defined as the 10% with the highest excess use, that is, their recorded use minus the average use for their sex, age group and comorbidity level as estimated from a linear regression model. Comparative analyses of sociodemographic characteristics (civil status, employment status, urbanity, educational level and country of origin) of heavy users and non-heavy users were performed using logistic regression models. RESULTS The study population consisted of 251,733 elderly individuals, who in total redeemed 573,265 prescriptions of antibiotics. Heavy users accounted for 68% of all excess use of antibiotics. In multivariable analyses, individuals with an educational level above basic schooling, non-retired, residing in an urban municipality and being born in a country outside Scandinavia all had lower odds of being a heavy user. Widowed, divorced or single individuals had higher odds of being a heavy user compared with married individuals. Relative importance analyses showed that civil status and educational level contributed considerably to the explained variance. CONCLUSIONS This study found an association between sociodemographic characteristics and risk of being a heavy user, indicating that sociodemographic variation exists with regard to antibiotic prescribing.
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Affiliation(s)
- Maria L V Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Rune M Aabenhus
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Barbara J Holzknecht
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lars Bjerrum
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Gloria COrdoba
- The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Denmark
| | - Jette N Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
- Capital Region Committee for the Prevention of Hospital Infections, Copenhagen, Denmark
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Tago M, Hirata R, Hirakawa Y, Makio S, Oishi T, Nakamura M, Yamashita S, Tokushima Y, Tokushima M, Katsuki NE, Aihara H, Fujiwara M. Listeria meningitis diagnosed by blood culture with fever, neurological symptoms, and no meningeal irritation signs. Clin Case Rep 2023; 11:e8020. [PMID: 37830068 PMCID: PMC10565091 DOI: 10.1002/ccr3.8020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
Key Clinical Message Listeria can cause neurological symptoms in immunocompromised and older patients. Additionally, it is impossible to rule out meningitis by the absence of typical meningeal irritation signs. Therefore, patients with fever and neurological impairments should be rapidly examined for blood and cerebrospinal fluid cultures to rule out Listeria meningitis. Abstract A woman in her 90s developed fever, dysarthria, and transient disturbance of consciousness. Physical examination revealed no meningeal irritation signs. Listeria monocytogenes were detected in her blood culture the following day. Because of an increased number of cells in cerebrospinal fluid, she was diagnosed with Listeria meningitis.
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Affiliation(s)
- Masaki Tago
- Department of General MedicineSaga University HospitalSagaJapan
| | - Risa Hirata
- Department of General MedicineSaga University HospitalSagaJapan
| | - Yuka Hirakawa
- Department of General MedicineSaga University HospitalSagaJapan
| | - Seijiro Makio
- Department of General MedicineSaga University HospitalSagaJapan
| | - Toru Oishi
- Department of General MedicineSaga University HospitalSagaJapan
| | | | - Shun Yamashita
- Department of General MedicineSaga University HospitalSagaJapan
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Sindzingre L, Witasse-Thézy AD, Chevallier A, Denis B, Lechowski L. [Frequency of incidentalomas on computed tomography scans in the hospitalised elderly]. Geriatr Psychol Neuropsychiatr Vieil 2023; 21:299-306. [PMID: 38093566 DOI: 10.1684/pnv.2023.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Incidentaloma is the result of the medical problem created by the development of imaging. Without a universal definition, incidentaloma describes any incidental finding revealed by a medical examination performed for another indication, and which will be the origin of a questioning intended to give it a clinical meaning. The frequency of incidentalomas is very variable depending on the imaging technique, the organ affected and the definition used. The aim of this study was to investigate the frequency of incidentalomas on computed tomography (CT) scans in a geriatric hospitalised population. METHODS In an observational, retrospective, monocentric study, we analysed, for a full year, all the planned CT scans performed, during a hospitalisation in acute and subacute care service of a Parisian geriatric hospital in search of incidentalomas. RESULTS 113 patients were included in the study, with a mean age of 87,4 years. The frequency of incidentalomas on CT scans in this population was 53 %, with an average of two incidentalomas per patient. Eight percent of the incidentalomas required further examination, specialist advice or treatment. We found incidentalomas in half of the brain and abdomino-pelvic CT scans and in a quarter of the chest CT scans. Age was not associated with the presence of incidentalomas. DISCUSSION Incidentaloma has become an important part of current medical practice. The geriatrician must know how to anticipate it and propose to his patient an adapted management.
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Affiliation(s)
- Louise Sindzingre
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
| | - Albane de Witasse-Thézy
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
| | - Anita Chevallier
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France, Service de radiologie médicale et imagerie interventionnelle, Hôpital Ambroise-Paré, Paris Groupe Hospitalo-Universitaire APHP. Université Paris-Saclay, France
| | - Bertrand Denis
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
| | - Laurent Lechowski
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
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Corvaisier M, Pierson A, Viollin AS, Asfar M, Duval G, Otekpo M, Annweiler C, Spiesser-Robelet L. [How to optimise the use of psychotropic drugs in the elderly? Focus groups in a geriatric unit]. Geriatr Psychol Neuropsychiatr Vieil 2023; 21:192-202. [PMID: 37519077 DOI: 10.1684/pnv.2023.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The elderly person (EP) treated with psychotropics is at risk of iatropathology. The guidelines for the proper use of these treatments are difficult to apply and the difficulties met by hospital teams are little described in the literature. Our objective was to investigate the problem of psychotropic management in EP among the medical and care teams. Three focus groups were run consecutively in 2021 with the geriatric team at Angers Hospital, France, to highlight the difficulties met daily and to bring innovative solutions. Following a thematic analysis of the content, 10 themes were described, including 4 emerging. These 4 themes are a greater precision of the conditional prescriptions of psychotropics, the choice of the moment of administration, the route of administration in case of agitation, and the revaluation during and after hospitalization management. Among the solutions mentioned, some will be gradually implemented according to a prioritization matrix as an awareness of teams to behavioral disorders and their management, or the development of teleconsultation to check the re-evaluation of prescriptions.
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Affiliation(s)
- Mathieu Corvaisier
- Département de pharmacie, faculté de santé, université d'Angers, Angers, France, EA4638, université d'Angers, Angers, France, Département de médecine gériatrie, centre de recherche sur l'autonomie et la longévité, centre hospitalier universitaire, Angers, France, Pharmacie à usage intérieur, centre hospitalier universitaire, Angers, France
| | - Augustine Pierson
- Département de médecine, faculté de santé, université d'Angers, Angers, France
| | - Anne-Solène Viollin
- Département de médecine, faculté de santé, université d'Angers, Angers, France
| | - Marine Asfar
- Département de médecine gériatrie, centre de recherche sur l'autonomie et la longévité, centre hospitalier universitaire, Angers, France
| | - Guillaume Duval
- EA4638, université d'Angers, Angers, France, Département de médecine gériatrie, centre de recherche sur l'autonomie et la longévité, centre hospitalier universitaire, Angers, France, Département de médecine, faculté de santé, université d'Angers, Angers, France
| | - Marie Otekpo
- Département de médecine gériatrie, centre de recherche sur l'autonomie et la longévité, centre hospitalier universitaire, Angers, France, Département de médecine, faculté de santé, université d'Angers, Angers, France
| | - Cédric Annweiler
- EA4638, université d'Angers, Angers, France, Département de médecine gériatrie, centre de recherche sur l'autonomie et la longévité, centre hospitalier universitaire, Angers, France, Département de médecine, faculté de santé, université d'Angers, Angers, France, Gérontopôle des Pays-de-la-Loire, Nantes, France
| | - Laurence Spiesser-Robelet
- Département de pharmacie, faculté de santé, université d'Angers, Angers, France, Pharmacie à usage intérieur, centre hospitalier universitaire, Angers, France, Laboratoire éducations et pratiques en santé, université Sorbonne Paris-Nord, Bobigny, France
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Shannon K, Neville S. Organizational Innovation in Long Term Care Enabled by Collaboration Between Government Agencies: A Critical Realist Case Study. Inquiry 2023; 60:469580221144079. [PMID: 36639919 PMCID: PMC9841830 DOI: 10.1177/00469580221144079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Long term care for older people is a highly regulated sector providing accommodation, health, and social care to vulnerable older adults. Older adults in New Zealand are among the highest users of long term care services globally. Traditionally those requiring specialist care for dementia are housed apart from other residents. In an example of organizational innovation, 1 provider relocated residents to a secure village where residents requiring specialist dementia care would be desegregated. We utilized a critical realist case study to explain the role of intersectoral collaboration among government agencies in supporting the transition while managing risk and ensuring regulatory compliance.
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Affiliation(s)
- Kay Shannon
- Auckland University of Technology, Auckland, New Zealand,Kay Shannon, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 1026, New Zealand.
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Azzoug C, Nuémi G, Menu D, De Maistre E, Boulin M, Putot A, Manckoundia P. Direct Oral Anticoagulants versus Vitamin K Antagonists in Individuals Aged 80 Years and Older: An Overview in 2021. Int J Environ Res Public Health 2023; 20:1448. [PMID: 36674204 PMCID: PMC9859400 DOI: 10.3390/ijerph20021448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Two main types of oral anticoagulants are available in France: vitamin K antagonists (VKA) and, more recently, direct oral anticoagulants (DOAC). The benefit−risk profile appears to be favorable for DOAC, which is as effective as VKA but safer (fewer cases of severe and cerebral bleeding). In a study in 2017, we observed that older adults did not seem to receive the same modalities of oral anticoagulants as younger individuals for various reasons. To assess anticoagulation prescribing practices over time, we repeated this cross-sectional study by comparing very old individuals taking DOAC to those taking VKA. Ambulatory individuals aged 80 years and older were included. They were affiliated with the Mutualité Sociale Agricole of Burgundy and were refunded for a medical prescription of oral anticoagulation in March 2021. The demographic characteristics, registered chronic diseases (RCD), number and types of prescribed drugs, and mortality of the DOAC group and the VKA group were compared. A total of 4275 subjects were included in the study: 67.44% (2883) received DOAC and 32.56% (1392) received VKA. The two groups were similar in age. In the DOAC group, there were more women (54.98% vs. 46.98%) (p < 0.001), fewer RCD (91.47% vs. 93.68%) (p = 0.014), and lower rates of venous thromboembolism (2.53% vs. 6.75%) (p < 0.001), severe heart failure (56.50% vs. 68.03%) (p < 0.001), and severe kidney diseases (1.38% vs. 3.59%) (p < 0.001), but there were more subjects with Alzheimer’s disease (7.49% vs. 4.31%) (p = 0.001). Individuals in the DOAC group had fewer prescriptions of furosemide (48.53% vs. 55.75%) (p < 0.001) and fibrates (2.32% vs. 3.88%) (p = 0.044). They also had more prescriptions of proton pump inhibitors (43.95% vs. 39.44%) (p = 0.006) and antirheumatics (1.60% vs. 0.65%) (p = 0.009) than those in the VKA group. There was no difference in mortality. This study revealed that prescribing practices for DOAC have changed over time.
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Affiliation(s)
- Chana Azzoug
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France
| | - Gilles Nuémi
- Medical Information Department, University Hospital, 21079 Dijon, France
| | - Didier Menu
- “Mutualité Sociale Agricole” of Burgundy Franche Comté, 21000 Dijon, France
| | | | - Mathieu Boulin
- Pharmacy Department, University Hospital, 21079 Dijon, France
| | - Alain Putot
- Department of Internal Medicine and Infectious Diseases, Pays du Mont Blanc Hospital, 74700 Sallanches, France
- Physiopathologie et Épidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy, 21000 Dijon, France
| | - Patrick Manckoundia
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France
- INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy, 21000 Dijon, France
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Alves S, Paúl C, Ribeiro O. Transition to bereavement: A prospective longitudinal study of health-related quality of life in informal caregivers of oldest-old individuals. Front Med (Lausanne) 2022; 9:1031143. [PMID: 36530892 PMCID: PMC9748087 DOI: 10.3389/fmed.2022.1031143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/10/2022] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Experiencing bereavement may be challenging. Despite the oldest-old population increase, a subgroup at greater risk of death, few studies focus on the grieving process of informal caregivers (ICs). This study analyzed the transition to bereavement of ICs of oldest-old individuals (≥80 years) over 1-year and compares the evolution of the health-related quality of life (HrQoL) between those experiencing bereavement and those who continued care through the study period. MATERIALS AND METHODS A prospective longitudinal observational study was conducted enrolling 204 ICs of the Metropolitan Area of Porto (North Portugal), of which 36 experienced the death of care receiver (CR). ICs' health profile and burden were assessed. CRs' functional and cognitive status were also appraised. RESULTS Bereaving caregivers were mostly female, CRs' children, and had on average 60.4 years at baseline. Caregivers spent a mean of 10.1 h/day (SD = 7.7) caring, for 80.6 months (SD = 57.5). The time elapsed since CR's death was 6 months (SD = 3.5) from entering in the study. CRs who died had a mean age of 88.3 (SD = 5.4) years at baseline, and were very dependent. Over a 1-year follow-up, bereaving caregivers showed a significant decrease in mental health following CR's death; on the other hand, caregivers who continued caring improved mental health [F(1, 159) = 4.249, p = 0.041]. DISCUSSION Ending the caregiver career was marked by a decline in mental health whereas to continue caring was marked by an improvement in this outcome. While it is highly expected that the CR's death will be perceived as a relief considering both the caregiver's characteristics (e.g., medicines) and the CR condition (e.g., high dependence levels), the results suggest an opposite direction. CRs' death seems to arise an emotional burden for IC, at least during the first year, possibly triggering feelings of loneliness and a life without purpose that seems to aggravate mental health issues. CONCLUSION The transition to bereavement among ICs seems to lead to a caregiver mental health decline while those who continued caring (and thereby, experiencing caregiving stressors) seems to improve in this outcome. Ceasing caregiving stressors does not seem to contribute better experiencing bereavement among ICs, suggesting the need for support throughout this phase.
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Affiliation(s)
- Sara Alves
- Center for Health Technology and Services Research (CINTESIS@RISE), ICBAS, Porto, Portugal
- Abel Salazar Institute of Biomedical Sciences – University of Porto (ICBAS-UP), Porto, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS@RISE), ICBAS, Porto, Portugal
- Abel Salazar Institute of Biomedical Sciences – University of Porto (ICBAS-UP), Porto, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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Palacios-Fernandez S, Salcedo M, Belinchon-Romero I, Gonzalez-Alcaide G, Ramos-Rincón JM. Epidemiological and Clinical Features in Very Old Men and Women (≥80 Years) Hospitalized with Aortic Stenosis in Spain, 2016-2019: Results from the Spanish Hospital Discharge Database. J Clin Med 2022; 11:jcm11195588. [PMID: 36233458 PMCID: PMC9571913 DOI: 10.3390/jcm11195588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aging population poses challenges for hospital systems. Aortic stenosis is among the most frequent diseases in very old patients. The aim of this study was to describe gender and age differences in the clinical characteristics of very old patients hospitalized with aortic stenosis (AoS) in Spain from 2016 to 2019. (2): Methods: A retrospective observational study analyzing data from the national surveillance system for hospital data. Variables analyzed were age group, sex, length of stay, deaths, and comorbidity. (3) Results: The analysis included 46,967 discharges. Altogether, 7.6% of the admissions ended in death. The main reason for admission was heart failure (34.3%), and this increased with age (80−84 years: 26% versus 95−99 years: 56.6%; p < 0.001). The main treatment procedure was the transcatheter aortic valve replacement (12.7%), performed in 14.3% of patients aged 80−84 versus 0.5% in patients aged 95−99 (p < 0.001). In the multivariable analysis, women were admitted with more comorbidities (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.06−1.20). Mortality was similar, albeit women were admitted less for syncope (OR 0.83, 95% CI 0.74−0.93). Women also underwent fewer coronary catheterizations (OR 0.81, 95% CI 0.77−0.87) and echocardiograms (OR 0.96, 95% CI 0.94−0.98). (4) Conclusions: Aortic stenosis leads to a high number of hospital admissions. Women with AoS presented more heart failure and less cardiovascular pathology than men. Also, women are admitted with fewer episodes of syncope and have fewer ultrasounds and catheterizations.
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Affiliation(s)
| | - Mario Salcedo
- Department of Internal Medicine, San Pedro Hospital, 26006 Logroño, Spain
| | | | | | - José-Manuel Ramos-Rincón
- Department of Clinical Medicine, Miguel Hernandez University, 03550 Alicante, Spain
- Department of Internal Medicine, Alicante General University Hospital-Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Correspondence:
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12
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Campo-Prieto P, Cancela-Carral JM, Rodríguez-Fuentes G. Feasibility and Effects of an Immersive Virtual Reality Exergame Program on Physical Functions in Institutionalized Older Adults: A Randomized Clinical Trial. Sensors (Basel) 2022; 22:6742. [PMID: 36146092 PMCID: PMC9505598 DOI: 10.3390/s22186742] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre−post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.
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Affiliation(s)
- Pablo Campo-Prieto
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, 36005 Pontevedra, Spain
- HealthyFit Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, 36213 Vigo, Spain
| | - José Mª Cancela-Carral
- HealthyFit Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, 36213 Vigo, Spain
- Department of Special Didactics, Faculty of Education and Sports Science, University of Vigo, 36005 Pontevedra, Spain
| | - Gustavo Rodríguez-Fuentes
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, 36005 Pontevedra, Spain
- HealthyFit Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, 36213 Vigo, Spain
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13
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Avendaño-Coy J, Martín-Espinosa NM, Ladriñán-Maestro A, Gómez-Soriano J, Suárez-Miranda MI, López-Muñoz P. Effectiveness of Microcurrent Therapy for Treating Pressure Ulcers in Older People: A Double-Blind, Controlled, Randomized Clinical Trial. Int J Environ Res Public Health 2022; 19:10045. [PMID: 36011679 PMCID: PMC9408011 DOI: 10.3390/ijerph191610045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to assess the effectiveness of microcurrent therapy for healing pressure ulcers in aged people. A multicentric, randomized clinical trial was designed with a sham stimulation control. The experimental group received an intervention following a standardized protocol for curing ulcers combined with 10 h of microcurrent therapy daily for 25 days. The sham group received the same curing protocol plus a sham microcurrent stimulation. The studied healing-related variables were the Pressure Ulcer Scale for Healing (PUSH) and the surface, depth, grade, and number of ulcers that healed completely. Three evaluations were conducted: pre-intervention (T1), 14 days following the start of the intervention (T2), and 1 day after the intervention was completed (T3). In total, 30 participants met the inclusion criteria (n = 15 in each group). The improvement in the PUSH at T2 and T3 was 16.8% (CI95% 0.5-33.1) and 25.3% (CI95% 7.6-43.0) greater in the experimental group versus the sham control, respectively. The reduction in the wound area at T2 and T3 was 20.1% (CI95% 5.2-35.0) and 28.6% (CI95% 11.9-45.3) greater in the experimental group versus the control, respectively. Microcurrent therapy improves the healing of pressure ulcers in older adults, both quantitatively and qualitatively.
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Affiliation(s)
- Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Noelia M. Martín-Espinosa
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
| | | | - Julio Gómez-Soriano
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
| | | | - Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
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14
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Scott JET, Luszcz MA, Walker R, Mazzucchelli T, Windsor TD. Barriers to activity engagement in older adulthood: Results of a community survey. Australas J Ageing 2022; 42:176-184. [PMID: 35962524 DOI: 10.1111/ajag.13124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/30/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Losses that occur with age can create barriers to meaningful activity engagement, a crucial aspect of ageing well. Research on this topic is frequently qualitative, with few studies accessing large community samples. This study (a) assessed the frequency specific personal and environmental barriers (such as poor health and limited transport access), identified by older adults in previous research, were endorsed; (b) used latent class analysis (LCA) to identify population subgroups based on combinations of these barriers, and (c) examined associations of subgroups with purpose in life and quality of life. METHODS Four hundred and thirty-two randomly selected Australian adults aged 65+ years (average age 76.7, 58% female) completed a telephone survey. They were asked whether certain barriers affected engagement and provided data on sense of purpose and quality of life. RESULTS Physical health/mobility were the most frequently reported barriers, followed by sensory difficulties, financial limitations, and caring responsibilities. The LCA revealed up to three subgroups/classes of participants according to the barriers endorsed. Class 1 had low endorsement of all barriers, including physical health. The majority of Class 2 endorsed physical health barriers and other barriers more frequently than Class 1. Class 3 were comparable to Class 2, but also frequently endorsed community access barriers. Class 1 were younger and reported a greater sense of purpose and higher quality of life. CONCLUSIONS Physical health/mobility barriers to engagement are those most frequently endorsed by older adults. These barriers may increase vulnerability to, or exacerbate the impact of additional barriers, such as sensory difficulties, access to transport and lack of finances.
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Affiliation(s)
- Julia E T Scott
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Mary A Luszcz
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences/Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Trevor Mazzucchelli
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Tim D Windsor
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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15
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Barbier C, Nizard J, Blanchet A, Suissa V, Guérin S, Derkinderen P, de Decker L, Berrut G, Chapelet G. [Is the Snoezelen method a non-pharmacological alternative for patients with neurocognitive disorders?]. Geriatr Psychol Neuropsychiatr Vieil 2022; 20:162-172. [PMID: 35929382 DOI: 10.1684/pnv.2022.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuropsychiatric disorders are one of the frequent complications of neurocognitive disease, and have an impact on the quality of life of patients and caregivers. Non-phamacologic interventions are recommended as first-line treatment. The Snoezelen method is a multisensory stimulation method based on the assumption that acting on sensoriality can improve neuropsychiatric symptoms and thus quality of life, but its level of evidence is controversial. To explore this, we performed a systematic literature review of randomized controlled articles focusing on the use of the Snoezelen method in patients with cognitive disorders. Eighteen studies were included. The clinical outcomes studied were multiple (behavior, mood, cognition, functional capacities and biomedical parameters). When the Snoezelen method was compared to the “standard activities” group, it appears to be effective on short-term behavior. This was more negligible when the method was compared to others non-pharmacological interventions. Although the Snoezelen method could be effective on mood, cognition, and functional abilities, its level of evidence remains low. Furthers mixed studies (quantitative and qualitative) would be an interesting approach to delve into this topic in the most holistic way by integrating the patients, the caregivers and the cost of the method.
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Affiliation(s)
- Chloé Barbier
- Centre hospitalier universitaire de Nantes, Pôle de gérontologie Clinique, Nantes, France
| | - Julien Nizard
- Service douleur, soins palliatifs et soins de support, et UIC22, (PHU2) Centre hospitalo-universitaire (CHU) Hôpital Laennec, Nantes, et EA4391 Excitabilité Nerveuse Thérapeutique, France
| | - Alain Blanchet
- Laboratoire « Vulnérabilité, Capabilité et Rétablissement » de l’École de Psychologues Praticiens de l’Institut Catholique de Paris, France
| | - Véronique Suissa
- Laboratoire de psychopathologie & neuropsychologie (EA2027), Université Paris VIII ; Agence des médecines complémentaires et alternatives (A-MCA), France
| | - Serge Guérin
- Inseec Business School, MSc « Directeur des établissements de santé », Inseec Paris, France
| | - Pascal Derkinderen
- Service de neurologie du CHU de Nantes, Université de Nantes, INSERMU1235, Nantes, France
| | - Laure de Decker
- Centre hospitalier universitaire de Nantes, Pôle de gérontologie Clinique, Nantes, France
| | - Gilles Berrut
- Centre hospitalier universitaire de Nantes, Pôle de gérontologie Clinique, Nantes, France
| | - Guillaume Chapelet
- Centre hospitalier universitaire de Nantes, Pôle de gérontologie Clinique, Nantes, France
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16
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Brett L, Jorgensen M, Myton R, Georgiou A, Westbrook JI. Characteristics of older Australian community aged care clients who fall: Incidents reported by care staff. Health Soc Care Community 2022; 30:469-475. [PMID: 32876376 DOI: 10.1111/hsc.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/30/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
Falls are the leading cause of injury and hospitalisation for older adults (aged 65 years or older) worldwide. Data collected by community aged care providers are an underutilised source of information about precipitating risk factors and consequences of falls for older adults living in the community. The objective of this longitudinal, observational study was to describe and compare the characteristics of older Australians who did and did not have falls reported by community aged care staff. We analysed 19 months of routinely collected care management and incident data for 1,596 older clients from a large Australian community care provider. Differences in sociodemographic characteristics, care needs and community care service use were compared between those who had one or more reported falls and those who had none. Fall-related outcomes (injuries, hospitalisations, relocation to residential aged care) were examined. The average age of clients was 82 years and most were women (66%). Seventy-seven (4.8%) clients had one or more reported falls over the study period (total falls = 92). Clients who had falls reported by care staff were more likely to be older adults, male and use more hours of community care services per week. There were 38 falls-related injuries, 5 falls-related hospitalisations and 20 clients relocated to residential aged care after a reported fall. This study demonstrates the potential for using routinely collected community aged care data to understand risk factors and monitor longitudinal outcomes for a population at high risk of falls.
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Affiliation(s)
- Lindsey Brett
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Mikaela Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Rimma Myton
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- NPS MedicineWise, NSW, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Volgman AS, Nair G, Lyubarova R, Merchant FM, Mason P, Curtis AB, Wenger NK, Aggarwal NT, Kirkpatrick JN, Benjamin EJ. Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:166-179. [PMID: 35027110 DOI: 10.1016/j.jacc.2021.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
The prevalence of atrial fibrillation (AF) is increasing as the population ages. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Syncope and fall-related injuries are the most common reasons for nonprescription of oral anticoagulation (OAC), and are more common in older adults when OACs are used with antiarrhythmic drugs. Digoxin may be useful for rate control, but associations with increased mortality limit its use. Beyond rate and rhythm control considerations, stroke prophylaxis is critical to AF management, and the benefits of direct OACs, compared with warfarin, extend to older adults. Invasive procedures such as AF catheter ablation, pacemaker implantation/atrioventricular junction ablation, and left atrial appendage occlusion may be useful in appropriately selected cases. However, older adults have generally been under-represented in clinical trials.
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Affiliation(s)
| | - Gatha Nair
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Radmila Lyubarova
- Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Faisal M Merchant
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pamela Mason
- Department of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Anne B Curtis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Nanette K Wenger
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neelum T Aggarwal
- Departments of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Emelia J Benjamin
- Boston Medical Center, and Boston University School of Medicine and School of Public Health, Boston, Massachusetts, USA
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18
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Davies LE, Kingston A, Todd A, Hanratty B. Prescribing at 95 years of age: cross-sectional findings from the Newcastle 85+ study. Int J Clin Pharm 2022; 44:1072-7. [PMID: 35906504 DOI: 10.1007/s11096-022-01454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous research has examined prescribing amongst 85-year-olds in English primary care, but less is known about prescribing amongst 95-year-olds in spite of population ageing. AIM We describe the most commonly prescribed medicines in a cohort of 95-year-olds, using 10-year follow-up data from the Newcastle 85+ Study (n = 90). METHOD A total of 1040 participants were recruited to the Newcastle 85+ Study through general practices at 85-years of age, and 90 surviving participants were re-contacted and assessed at 95-years of age. Prescribed medications from general practice medical records were examined through cross-tabulations and classified as preventative or for symptom control based on their customary usage. RESULTS Preventative medications with unclear evidence of benefit such as statins (36.7%), aspirin (21.1%) and bisphosphonates (18.9%) were frequently prescribed. CONCLUSIONS Future research in a larger clinical dataset could investigate this preliminary trend, which suggests that benefit/risk information for preventive medication, and evidence for deprescribing, is needed in the very old.
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Blauth FG, Vilar LADS, Pontes VDCB, Moriguti JC, Ferriolli E, Lima NKDC. The effect of frailty on the 24-hour blood pressure pattern in the very elderly. J Clin Hypertens (Greenwich) 2022; 24:67-73. [PMID: 34882943 PMCID: PMC8783362 DOI: 10.1111/jch.14409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
Frailty plays a crucial role in the management of hypertension in the very elderly and has a strong association with cardiovascular diseases. Nevertheless, its influence on the 24-hour blood pressure pattern, including elevated asleep systolic blood pressure (BP) and the lack of BP fall during sleep (non-dipping) has not been explored in a population above 80 years. Patients older than 80 years were classified into frail or robust subtypes by the five item frailty phenotype criteria. All participants were submitted to office blood pressure measurements and ambulatory BP monitoring over a 24-hour period. Nocturnal dipping was defined as nighttime BP fall ≥10%. Thirty-eight frail and 36 non-frail individuals (mean age 85.3 ± 3.7 years; 67% females) were analyzed. Awake systolic and diastolic BP were similar for frail and robust individuals. Frail patients had higher systolic BP during sleep (128 ± 15 mm Hg vs. 122 ±13 mm Hg p = .04) and reduced systolic BP fall [1 (-4.5 - 5)% vs. 6.8 (2.1 - 12.8)% p < .01]. Frailty was independently associated with higher risk of non-dipping (OR 12.4; CI 1.79 - 85.9) and reduced nighttime systolic BP fall (-6.1%; CI -9.6 - -2.6%). In conclusions, frailty has a substantial influence on nighttime BP values and pattern in patients older than 80 years.
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Affiliation(s)
- Fernando Gioppo Blauth
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Laís Araújo dos Santos Vilar
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Victor de Carvalho Brito Pontes
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Júlio César Moriguti
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Eduardo Ferriolli
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Nereida Kilza da Costa Lima
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
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20
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Joyce J, Ryan J, Owen A, Hu J, Power JM, Shah R, Woods R, Storey E, Britt C, Freak-Poli R. Social isolation, social support, and loneliness and their relationship with cognitive health and dementia. Int J Geriatr Psychiatry 2021; 37:10.1002/gps.5644. [PMID: 34741340 PMCID: PMC9068834 DOI: 10.1002/gps.5644] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Poor social health is prevalent in older adults and may be associated with worse cognition, and increased dementia risk. The aim of this study was to determine whether social isolation, social support and loneliness are independently associated with cognitive function and incident dementia over 5 years in older adults, and to investigate potential gender differences. METHODS Participants were 11,498 community-dwelling relatively healthy Australians aged 70-94, in the ASPREE Longitudinal Study of Older Persons (ALSOP). Social isolation, social support, loneliness and cognitive function were assessed through self-report. Outcomes examined were cognitive decline (>1.5 SD decline in cognitive performance since baseline) and incident dementia (adjudicated according to DSM-IV criteria). RESULTS Most participants self-reported good social health (92%) with very few socially isolated (2%), with low social support (2%) or lonely (5%). Among women, social isolation and low social support were consistently associated with lower cognitive function (e.g., social support and cognition β = -1.17, p < 0.001). No consistent longitudinal associations were observed between baseline social health and cognitive decline (over median 3.1 years) or incident dementia (over median 4.4 years; social isolation: HR = 1.00, p = 0.99; low social support: HR = 1.79, p = 0.11; loneliness: HR = 0.72, p = 0.34 among women and men). CONCLUSION Our study provides evidence that social isolation and a low social support are associated with worse cognitive function in women, but not men. Social health did not predict incident cognitive decline or dementia, but we lacked power to stratify dementia analyses by gender.
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Affiliation(s)
- Johanna Joyce
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Jessie Hu
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Raj Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Robyn Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Carlene Britt
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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Zirves M, Demirer I, Pfaff H. Everyday Life and Social Contacts of Dementia and Non-Dementia Residents over 80 Years in Long-Term Inpatient Care: A Multi-Level Analysis on the Effect of Staffing. Int J Environ Res Public Health 2021; 18:11300. [PMID: 34769817 DOI: 10.3390/ijerph182111300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
The relationship between nurse staffing, physical outcomes of residents, as well as quality of care receives major attention. The impact of staffing levels on residents’ ability to organize their everyday life and maintain social contacts, however, has not been analyzed to date. This study examines whether a relationship between the staff-to-resident ratio for registered nurses and nursing home residents with and without dementia aged over 80 exists. Secondary data collected in the project inQS (indikatorengestützte Qualitätsförderung) were used (n = 1782, mean age = 88.14). The analyzed cross-sectional data were collected in winter 2019 in facilities of the Diocesan Caritas Association in Germany. A sum score formed from variables measuring residents’ abilities to independently organize their everyday life and maintain social contacts functioned as the dependent variable. A multi-level regression analysis was performed. The results revealed that the ability of residents without dementia was significantly associated with the staff-to-resident ratio of registered nurses. This was not true for residents with dementia. For the latter, however, whether the facility offers a segregated care unit turned out to be significant. Additional and longitudinal research is indispensable to explain the inequality between the two groups analyzed.
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Fröhlich S, Kutz DF, Müller K, Voelcker-Rehage C. Characteristics of Resting State EEG Power in 80+-Year-Olds of Different Cognitive Status. Front Aging Neurosci 2021; 13:675689. [PMID: 34456708 PMCID: PMC8387136 DOI: 10.3389/fnagi.2021.675689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Abstract
Compared with healthy older adults, patients with Alzheimer's disease show decreased alpha and beta power as well as increased delta and theta power during resting state electroencephalography (rsEEG). Findings for mild cognitive impairment (MCI), a stage of increased risk of conversion to dementia, are less conclusive. Cognitive status of 213 non-demented high-agers (mean age, 82.5 years) was classified according to a neuropsychological screening and a cognitive test battery. RsEEG was measured with eyes closed and open, and absolute power in delta, theta, alpha, and beta bands were calculated for nine regions. Results indicate no rsEEG power differences between healthy individuals and those with MCI. There were also no differences present between groups in EEG reactivity, the change in power from eyes closed to eyes open, or the topographical pattern of each frequency band. Overall, EEG reactivity was preserved in 80+-year-olds without dementia, and topographical patterns were described for each frequency band. The application of rsEEG power as a marker for the early detection of dementia might be less conclusive for high-agers.
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Affiliation(s)
- Stephanie Fröhlich
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, Faculty of Psychology and Sport Sciences, University of Münster, Münster, Germany.,Department of Sports Psychology (With Focus on Prevention and Rehabilitation), Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Dieter F Kutz
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, Faculty of Psychology and Sport Sciences, University of Münster, Münster, Germany.,Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Katrin Müller
- Department of Sports Psychology (With Focus on Prevention and Rehabilitation), Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany.,Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, Faculty of Psychology and Sport Sciences, University of Münster, Münster, Germany.,Department of Sports Psychology (With Focus on Prevention and Rehabilitation), Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
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Yoshida I, Ozaki A, Morita T, Tsubokura M, Kami M. Characteristics of Flood Fatalities in Japan's Typhoon Hagibis in 2019: Secondary Analysis of Public Data and Media Reports. Disaster Med Public Health Prep 2021;:1-5. [PMID: 34286680 DOI: 10.1017/dmp.2021.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Typhoon Hagibis struck Japan on October 12, 2019. This study documents and characterizes deaths caused by Hagibis and helps identify strategies to reduce mortality in future disasters. METHODS Japanese residents, who were killed by Typhoon Hagibis, as reported by Japan's Fire and Disaster Management Agency, were considered for the study. Details were collected from mainstream Japanese media, and flooding data from hazard maps published by local municipalities. RESULTS Out of the 99 total fatalities, 65 (73.0%) were aged 65 years or above. Among those who drowned indoors (20), 18 (90.0%) lived in high-risk areas of flooding, and their bodies were found on the first floor of their residences. A total of 10 (55.6%) out of the 18 fatalities lived in homes with 2 or more floors, indicating that they could have moved upstairs to avoid the floodwater. However, 6 (33.3%) could not do so due to existing health issues. CONCLUSIONS Relatively elderly people, particularly those in areas at high risk of flooding, were most affected. Seeking higher ground is a standard safety measure in times of flooding, but this may not be possible for everyone depending on their health status, structure of their residence, and the depth of floodwaters.
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Palacios-Ceña D, Florencio LL, Hernández-Barrera V, Fernandez-de-las-Peñas C, de Miguel-Diez J, Martínez-Hernández D, Carabantes-Alarcón D, Jimenez-García R, Lopez-de-Andres A, Lopez-Herranz M. Trends in Incidence and Outcomes of Hospitalizations for Urinary Tract Infection among Older People in Spain (2001-2018). J Clin Med 2021; 10:jcm10112332. [PMID: 34073638 PMCID: PMC8198653 DOI: 10.3390/jcm10112332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 01/21/2023] Open
Abstract
(1) Background: To assess time trends in the incidence and in-hospital outcomes of urinary tract infection (UTI) in older people (≥65 years) in Spain (2001–2018) according to sex and to identify the factors independently associated with in-hospital mortality (IHM). (2) Methods: Using the Spanish National Hospital Database, we analyzed comorbidity, procedures, diagnosis, isolated microorganisms, and outcomes. (3) Results: We included 583,693 admissions (56.76% women). In both sexes, the incidence increased with age over time (p < 0.001). In men and women, the highest IHM was found among the oldest patients (>84 years) with values of 9.16% and 8.6%, respectively. The prevalence of bacteremia increased from 4.61% to 4.98% from 2001 to 2018 (p < 0.001) and sepsis decreased from 3.16% to 1.69% (p < 0.001). The risk of dying increased with age (>84 years) (OR 3.63; 95% CI 3.5–3.78) and with almost all comorbidities. Urinary catheter was a risk factor for women (OR 1.1; 95% CI 1.02–1.18) and protective for men (OR 0.71; 95% CI 0.66–0.76). Isolation of Staphylococcus aureus increased the risk of IHM by 40% among men (OR 1.4; 95% CI 1.28–1.53). After adjusting for confounders, IHM decreased over time. (4) Conclusions: The incidence of UTIs was higher in older patients and increased over time; however, IHM decreased during the same period. Female sex, age, comorbidities, sepsis, and a Staphylococcus aureus isolation increased risk of IHM.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain; (D.P.-C.); (L.L.F.); (C.F.-d.-l.-P.)
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain; (D.P.-C.); (L.L.F.); (C.F.-d.-l.-P.)
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | - Cesar Fernandez-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain; (D.P.-C.); (L.L.F.); (C.F.-d.-l.-P.)
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - David Martínez-Hernández
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-H.); (D.C.-A.); (R.J.-G.)
| | - David Carabantes-Alarcón
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-H.); (D.C.-A.); (R.J.-G.)
| | - Rodrigo Jimenez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-H.); (D.C.-A.); (R.J.-G.)
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-H.); (D.C.-A.); (R.J.-G.)
- Correspondence:
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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25
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Borne E, Meyer N, Blanchard O, Lombard M, Vogel T, Lang PO, Michel B. Statin (mis)use in older people: A cross-sectional study using French health insurance databases. Pharmacoepidemiol Drug Saf 2021; 30:1084-1090. [PMID: 33949722 DOI: 10.1002/pds.5262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To describe the occurrence of potential statin misuse, its characteristics and associated factors in older people. METHODS A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) using French health insurance databases. Study population comprised community-dwelling patients and nursing homes residents aged 80 and over, who received at least one statin prescription between January 1, 2017 to April 30, 2017 (N = 38 268). Potential statin misuse was identified considering off-label uses, high-intensity doses, drug contraindications and statin-drug interactions. RESULTS At least one potential statin misuse was detected for 19 468 patients (50.9%). Off-label prescription was the most frequent misuse observed (53.6%), followed by high-intensity statin dose (30.5%). Polypharmacy (five to nine drugs) and excessive polypharmacy (10 or more drugs) were the main risk factors associated with potential statin misuse (adjusted OR = 2.6 and 4.7 respectively). Nursing home, multi-morbidity and the presence of multiple prescriptions from different doctors for the same patient were other risk factors significantly associated. Two sensitivity analyzes (reconsiderations of off-label and high statin dose definitions) revealed the same statistical trend. CONCLUSION Potential statin misuse is frequent in people aged 80 and over. These findings should serve as a warning to health care professionals and hopefully will contribute to ensure an appropriate and safe use of statin in aged population.
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Affiliation(s)
- Emilie Borne
- OMEDIT Grand Est, Regional Health Agency, Strasbourg, France
| | - Nicolas Meyer
- Department of Public Health, University Hospitals of Strasbourg, Strasbourg, France.,Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Odile Blanchard
- Regional Direction of Medical Service, CNAM, Strasbourg, France
| | - Martial Lombard
- Regional Direction of Medical Service, CNAM, Strasbourg, France
| | - Thomas Vogel
- Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Department of Geriatrics, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Bruno Michel
- OMEDIT Grand Est, Regional Health Agency, Strasbourg, France.,Department of Pharmacy, University Hospitals of Strasbourg, Strasbourg, France.,Faculty of Pharmacy, UR 7296 Laboratory of Neuro-cardiovascular Pharmacology and Toxicology, University of Strasbourg, Strasbourg, France
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Evans E, Gutman R, Resnik L, Zonfrillo MR, Lueckel SN, Kumar RG, DeVone F, Dams-O'Connor K, Thomas KS. Successful Community Discharge Among Older Adults With Traumatic Brain Injury in Skilled Nursing Facilities. J Head Trauma Rehabil 2021; 36:E186-E198. [PMID: 33528173 PMCID: PMC8096636 DOI: 10.1097/htr.0000000000000638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). SETTING Skilled nursing facilities. PARTICIPANTS Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. DESIGN Retrospective cohort study using Medicare administrative data merged with the National Trauma Data Bank using a multilayered Bayesian record linkage approach. MAIN OUTCOME MEASURE Successful community discharge: discharged alive within 100 days of SNF admission and remaining in the community for 30 days or more without dying or admission to a healthcare facility. RESULTS Medicaid enrollment, incontinence, decreased independence with activities of daily living, and cognitive impairment were associated with lower odds of successful discharge, whereas race "other" was associated with higher odds of successful discharge. Injury factors including worse injury severity (Glasgow Coma Scale and Abbreviated Injury Scale scores) and fall-related injury mechanism were not associated with successful discharge. CONCLUSION Among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning. Acute injury severity indices may have limited utility in predicting discharge disposition once a patient is admitted to an SNF for post-acute care.
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Affiliation(s)
- Emily Evans
- Department of Health Services, Policy and Practice Center for Gerontology and Healthcare Research, Brown School of Public Health (Drs Evans, Resnik, and Thomas) and Department of Biostatistics (Dr Gutman and Mr DeVone), Brown University School of Public Health, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island (Drs Resnik and Thomas); Departments of Emergency Medicine and Pediatrics (Dr Zonfrillo) and Division of Acute Care Surgery and Surgical Critical Care, Rhode Island Hospital (Dr Lueckel), Warren Alpert School of Medicine of Brown University, Providence, Rhode Island; and Department of Rehabilitation and Human Performance (Drs Kumar and Dams-O'Connor) and Department of Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York
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27
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Boyd M, Calvert C, Tatton A, Wu Z, Bloomfield K, Broad JB, Hikaka J, Higgins AM, Connolly MJ. Lonely in a crowd: loneliness in New Zealand retirement village residents. Int Psychogeriatr 2021; 33:481-93. [PMID: 32290882 DOI: 10.1017/S1041610220000393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population. DESIGN A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the "Older People in Retirement Villages Study." SETTING RVs, Auckland, New Zealand. PARTICIPANTS Participants included RV residents living in 33 RVs (n = 578). MEASUREMENTS Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs). RESULTS Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15-16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15-10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43-7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99-2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53-4.35; high risk: OR 4.20, 95% CI 1.47-11.95). CONCLUSION A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.
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Manckoundia P, Nuemi G, Hacquin A, Menu D, Rosay C, Vovelle J, Nuss V, Baudin-Senegas C, Barben J, Putot A. Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients Aged 80 Years and Older. Int J Environ Res Public Health 2021; 18:4443. [PMID: 33922331 DOI: 10.3390/ijerph18094443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
The effectiveness of direct oral anticoagulants (DOAC) is non-inferior to vitamin K antagonists (VKA) to treat atrial fibrillation and venous thromboembolism (VTE). In this cross-sectional study, we compared older persons taking DOACs to those taking VKAs. We included ambulatory individuals ≥80 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for a medical prescription in September 2017. The demographic conditions, registered chronic diseases (RCD), and number and types of prescribed drugs were compared in the DOAC group and VKA group. Of the 3190 included individuals, 1279 (40%) were prescribed DOACs and 1911 (60%) VKAs. Individuals taking VKAs were older than those taking DOACs (87.11 vs. 86.35 years). In the DOAC group, there were more women (51.92% vs. 48.25%) (p = 0.043), less RCD (89.60% vs. 92.73%) (p = 0.002), less VTE (1.80% vs. 6.59%), less severe heart failure (58.09% vs. 67.87%), less severe hypertension (18.22% vs. 23.60%), less severe kidney diseases (1.49% vs. 3.82%), and fewer drugs per prescription (6.15 vs. 6.66) (p < 0.01 for all). The DOAC group were also less likely to be taking angiotensin receptor blockers (10.79% vs. 13.97%), furosemide (40.81% vs. 49.66%) or digoxin (10.32% vs. 13.66%) than the VKA group (p = 0.009, p < 0.001, and p = 0.005). DOACs were less prescribed than VKAs. Individuals taking VKAs were older and had more severe comorbidities and more drugs per prescription than those taking DOACs.
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Stolz E, Mayerl H, Hoogendijk EO, Armstrong JJ, Roller-Wirnsberger R, Freidl W. Acceleration of health deficit accumulation in late-life: evidence of terminal decline in frailty index three years before death in the US Health and Retirement Study. Ann Epidemiol 2021; 58:156-161. [PMID: 33812966 DOI: 10.1016/j.annepidem.2021.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life. MATERIAL AND METHODS A total of 23,393 observations from up to the last 21 years of life of 5713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual, self- and proxy-reported assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points. RESULTS The average normal (preterminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI-value of 0.29 in the total sample, 0.27 for men, and 0.30 for women. CONCLUSION We found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria.
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
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30
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Nilsson MY, Andersson S, Magnusson L, Hanson E. Ambient assisted living technology-mediated interventions for older people and their informal carers in the context of healthy ageing: A scoping review. Health Sci Rep 2021; 4:e225. [PMID: 33392394 PMCID: PMC7770427 DOI: 10.1002/hsr2.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS There is a growing demand for health and social care services to provide technology-mediated interventions that promote the health and well-being of older people with health or care needs and of their informal carers. The objectives of this study were to scope and review the nature and extent of prior intervention studies involving ambient assisted living technology-mediated interventions for older people and their informal carers, and how and in what ways (if any) the goals and aims of these interventions reflected the domains of the World Health Organization framework for healthy ageing. METHODS We conducted a scoping review. Data were collected between June and October 2018 with an updated search in October 2020. A total of 85 articles were eligible for inclusion. RESULTS Nine categories described the aims and content of the included studies. The healthy ageing domain "Ability to meet basic needs" was mirrored in four categories, whereas "Ability to contribute to society" was not addressed at all. CONCLUSION The ways in which domains of healthy ageing are mirrored suggest that there is an emphasis on individual factors and individual responsibility, and a lack of attention given to broader, environmental factors affecting healthy ageing. Only a few of the studies used a dyadic approach when assessing health outcomes concerning older people and their informal carers.
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Affiliation(s)
- Maria Y. Nilsson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Stefan Andersson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Lennart Magnusson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
| | - Elizabeth Hanson
- Department of Health and Caring SciencesSwedish Family Care Competence Centre, Linnaeus UniversityKalmarSweden
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Bemand TJ, Thomas S, Finucane P. The extent of polypharmacy and use of 'fall risk increasing drugs' in the oldest old admitted to a regional New South Wales hospital. Australas J Ageing 2021; 40:366-372. [PMID: 33569889 DOI: 10.1111/ajag.12909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/25/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE(S) Polypharmacy is associated with significant morbidity including cognitive decline and falls. We sought to quantify the extent of polypharmacy and use of medications associated with fall risk in the very old admitted to a regional NSW hospital. METHODS Cross-sectional study of patients aged over 80 years admitted to a regional NSW hospital from September to October 2019. Demographic data and medication usage on admission were collected. Polypharmacy was defined as regular use of five or more medications. RESULTS A total of 401 patients were included: mean age was 87.2 (±4.6) years and 56.9% were female. Of the participations, 82.9% experienced polypharmacy, and the mean number of medications was 8.2 (±4.2). Of the patients, 91.6% utilised medications associated with risk of falls. There was no association between age and number of preadmission regular medications. CONCLUSION Polypharmacy is extremely common prior to acute hospitalisation for regional older individuals. This highlights the importance of medication rationalisation to reduce medication-related harm.
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Affiliation(s)
- Timothy John Bemand
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia.,Wagga Wagga Rural Clinical School, University of New South Wales, Wagga Wagga, New South Wales, Australia
| | - Sarah Thomas
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Paul Finucane
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia.,Wagga Wagga Rural Clinical School, University of New South Wales, Wagga Wagga, New South Wales, Australia.,Wagga Wagga Clinical School, University of Notre Dame, Wagga Wagga, New South Wales, Australia.,University of Limerick, Limerick, Ireland
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Testa L, Hardy JE, Jepson T, Braithwaite J, Mitchell RJ. Health service utilisation and health outcomes of residential aged care residents referred to a hospital avoidance program: A multi-site retrospective quasi-experimental study. Australas J Ageing 2021; 40:e244-e253. [PMID: 33547756 DOI: 10.1111/ajag.12906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the health system utilisation patterns and health outcomes of residential aged care facility (RACF) residents reviewed by a hospital avoidance program to those of RACF residents who received usual care. METHODS A retrospective evaluation of a hospital avoidance program provided by a hospital-based medical and nursing outreach team. Residents reviewed by the program were randomly matched 1:1 to comparison group residents based on age group, sex and number of co-morbidities. Number of hospital admissions, excess hospital length of stay and excess hospital treatment costs were compared. RESULTS Residents reviewed by the program spent an average 9-10 days fewer in hospital with AUD$2,091 to $8,014 lower hospital treatment costs compared to comparison group residents. CONCLUSION Rapid provision of outreach services for the management of acute care of RACF residents may reduce the number of days residents spend in hospital, as well as reducing the associated hospital treatment costs.
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Affiliation(s)
- Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - James E Hardy
- Royal North Shore Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Therese Jepson
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Abe H, Tanaka S, Kawara F, Toyonaga T, Ariyoshi R, Sakaguchi H, Sako T, Ikezawa N, Kodama Y. Comparison of the safety and efficacy of peroral endoscopic myotomy between octogenarians and non-octogenarians. Dig Endosc 2021; 33:110-117. [PMID: 32274834 DOI: 10.1111/den.13686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/01/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study compared the safety and efficacy of peroral endoscopic myotomy for esophageal motility disorders between octogenarians and non-octogenarians. METHODS This retrospective observational study recruited 321 patients (28 octogenarians and 293 non-octogenarians) who underwent peroral endoscopic myotomy from two institutions. Clinical success (postoperative Eckardt score ≤ 3), technical success (completion of gastric and esophageal myotomy), and perioperative adverse events were compared between octogenarians and non-octogenarians. Perioperative adverse events were classified into major and minor adverse events based on the International Peroral Endoscopic Myotomy Survey criteria and were subdivided into technical and non-technical adverse events according to the presence of a direct causal relationship with the procedure. RESULTS There were no significant differences in the rates of clinical success 1 year after treatment (100% vs. 97.3%, P = 0.64) and technical success (100% vs. 99.7%, P = 0.91) between octogenarians and non-octogenarians. Octogenarians had a higher incidence of perioperative adverse events (28.6% vs. 10.2%, P = 0.00097), particularly major adverse events (25.0% vs. 3.0%, P < 0.0001). There were no significant differences in the incidence of minor adverse events (7.1% vs. 7.9%, P = 0.67). Although there was no difference in the incidence of technical adverse events (10.7% vs. 9.2%, P = 0.74), octogenarians had a significantly higher incidence of non-technical adverse events (17.9% vs. 1.0%, P = 0.0002). CONCLUSIONS There were no significant differences in short-term clinical success and technical success between octogenarians and non-octogenarians. However, octogenarians showed a significantly higher incidence of perioperative adverse events, particularly in major adverse events and non-technical adverse events. Peroral endoscopic myotomy for octogenarians should be carefully applied.
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Affiliation(s)
- Hirofumi Abe
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shinwa Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Fumiaki Kawara
- Division of Gastroenterology, Konan Medical Center, Hyogo, Japan
| | - Takashi Toyonaga
- Department of Endoscopic Medicine, Kobe University Hospital, Hyogo, Japan
| | - Ryusuke Ariyoshi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroya Sakaguchi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Tomoya Sako
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Nobuaki Ikezawa
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
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Hill A, Heyland DK, Rossaint R, Arora RC, Engelman DT, Day AG, Stoppe C. Longitudinal Outcomes in Octogenarian Critically Ill Patients with a Focus on Frailty and Cardiac Surgery. J Clin Med 2020; 10:jcm10010012. [PMID: 33374545 PMCID: PMC7793078 DOI: 10.3390/jcm10010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/13/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiac surgery (CSX) can be lifesaving in elderly patients (age ≥ 80 years) but may still be associated with complications and functional decline. Frailty represents a determinant to outcomes in critically ill patients, but little is known about its influence on elderly CSX-patients. This is a secondary exploratory analysis of a multi-center, prospective observational cohort study of 610 elderly patients admitted to the ICU and followed for one year to document long-term outcomes. CSX-ICU-patients (n = 49) were compared to surgical ICU patients (n = 184) with regard to demographics, frailty, and outcomes. Of all surgical patients, 102 (43%) were considered vulnerable or frail. The subdistribution hazard ratio (SHR) of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.54 (95% confidence interval (CI), 0.34, 0.86, p = 0.007). The p-value for effect modification between surgery group (CSX vs. surgical ICU patients) and Clinical Frailty Scale (CFS) group was not significant (p = 0.37) suggesting that the observed difference in the CFS effect between the CSX and surgical ICU patients is consistent with random error. A further subgroup analysis shows that among surgical ICU patients, the SHR of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.49 (95% CI, 0.29, 0.83) while the corresponding SHR for CSX patients was 0.77 (0.32–1.88). In conclusion, preoperative frailty reduced the rate of discharge to home in both surgical and CSX patients, but a larger sample of CSX patients is needed to adequately address this question in this patient group.
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Affiliation(s)
- Aileen Hill
- Department of Intensive Care Medicine, University Hospital RWTH, D-52074 Aachen, Germany
- 3CARE—Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany
- Correspondence: (A.H.); (C.S.)
| | - Daren K. Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen’s University, Kingston General Hospital, Kingston, ON K7L 2V7, Canada;
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH, D-52074 Aachen, Germany;
| | - Rakesh C. Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, Winnipeg, MB R2H 2A6, Canada;
| | - Daniel T. Engelman
- Heart and Vascular Program, Baystate Health, Medical School-Baystate, University of Massachusetts, Springfield, MA 01199, USA;
| | - Andrew G. Day
- KGH Research Institute, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada;
| | - Christian Stoppe
- 3CARE—Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Würzburg, 97080 Würzburg, Germany
- Correspondence: (A.H.); (C.S.)
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Zirves M, Pfaff H. Nursing Home Residents Aged over 80-A Cross-Sectional Analysis on Which Activity Traits Correlate to Positive Affect. Int J Environ Res Public Health 2020; 17:ijerph17249583. [PMID: 33371397 PMCID: PMC7767436 DOI: 10.3390/ijerph17249583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023]
Abstract
Admission to a care facility is assumed to enhance depressive symptoms and dependent behavior in old age. In this context, the relevance of participation in activities that make everyday life in a care facility more pleasant has been pointed out. This study examines if there is a relationship between participation in different activities as well as the frequency of this participation and the positive affect of nursing home residents aged over 80. Data from the unique cross-sectional representative study ‘Quality of life and subjective well-being of the very old in North Rhine-Westphalia’ in Germany (n = 150, aged 90.15 years in average) were used. The data were collected between 08/2017 and 02/2018 using computer-assisted personal interviewing. The variability in and frequency of activity participation functioned as independent, and positive affect as dependent variable. Multiple regression analysis was performed. Residents’ predicted positive affect significantly increased with a higher variability in activity participation. There was no independent effect of frequency in participation. Our findings indicate that there is a significant and positive relationship between participating in a high number of different activities and the overall positive affect of residents aged over 80 years. This does not hold true for the frequency of participation.
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Affiliation(s)
- Melanie Zirves
- Gerontological Research on Well-Being—Graduate School GROW, Faculty of Human Sciences, University of Cologne, 50923 Cologne, Germany
- Correspondence: ; Tel.: +49-0221-470-1177
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine, University of Cologne, 50933 Cologne, Germany;
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Yamashita M, Adachi T, Ono S, Matsumura N, Adachi T, Natsuda K, Hidaka M, Eguchi S. Pancreaticoduodenectomy can be indicated for elderly patients: risk prediction using the estimation of physiologic ability and surgical stress (E-PASS) system. J Hepatobiliary Pancreat Sci 2020; 28:165-173. [PMID: 33058480 DOI: 10.1002/jhbp.840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pancreaticobiliary malignant diseases are primarily treated by surgical resection. However, the surgical indications for elderly patients, especially for pancreaticoduodenectomy (PD), must be carefully considered due to patient compliance. Whether PD can contribute to better prognoses in elderly patients remains unclear. Therefore, we aimed to evaluate the complications, compliance, and survival of elderly and non-elderly patients who underwent PD in our department. METHODS We retrospectively analyzed 282 patients who underwent PD from 2000 to 2017 and divided them into non-elderly (aged ≤ 79 years, n = 238) and elderly (aged ≥ 80 years, n = 44) groups. The estimation of physiologic ability and surgical stress (E-PASS) system was used to evaluate morbidity and mortality using preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS). RESULTS Preoperative risk score was higher in the elderly group than in the non-elderly group, although SSS and CRS were similar. No significant differences were detected in the occurrence of postoperative complications. In the elderly group, CRS was higher in patients with complications than in those without. Long-term outcomes evaluated by overall and disease-specific survival were not significantly different. CONCLUSIONS In the elderly patients, E-PASS especially CRS can predict the occurrence of complications. The safety and prognoses of elderly patients after PD are comparable with those of non-elderly patients.
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Affiliation(s)
- Mampei Yamashita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinichiro Ono
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naomi Matsumura
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiyuki Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koji Natsuda
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Shrestha NK, Blaskewicz C, Gordon SM, Everett A, Rehm SJ. Safety of Outpatient Parenteral Antimicrobial Therapy in Nonagenarians. Open Forum Infect Dis 2020; 7:ofaa398. [PMID: 33033731 PMCID: PMC7532659 DOI: 10.1093/ofid/ofaa398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/27/2020] [Indexed: 11/14/2022] Open
Abstract
Background Although widely accepted for adults, the safety of outpatient parenteral antimicrobial therapy (OPAT) in very old patients has not been examined. Methods Nonagenarians (age ≥90 years) discharged from the hospital on OPAT over a 5-year period were identified from the Cleveland Clinic OPAT Registry. Three matched controls (<90 years) were selected for each nonagenarian. Times to OPAT-related emergency department (ED) visit and OPAT-related readmission were compared across the 2 groups in multivariable subdistribution proportional hazards competing risks regression models. Incidence of adverse drug events and vascular access complications were compared using negative binomial regression. Results Of 126 nonagenarians and 378 controls, 7 were excluded for various reasons. Among the remaining 497 subjects, 306 (62%) were male, 311 (63%) were treated for cardiovascular or osteoarticular infections, and 363 (73%) were discharged to a residential health care facility. The mean (SD) ages of nonagenarians and controls were 92 (2) and 62 (16) years, respectively. Compared with matched controls, being a nonagenarian was not associated with increased risk of OPAT-related ED visit (hazard ratio [HR], 0.77; 95% CI, 0.33-1.80; P = .55), OPAT-related readmission (HR, 0.78; 95% CI, 0.28-2.16; P = .63), adverse drug event from OPAT medications (incidence rate ratio [IRR], 1.00; 95% CI, 0.43-2.17; P = .99), or vascular access complications (IRR, 0.66; 95% CI, 0.27-1.51; P = .32). Nonagenarians had a higher risk of death overall (HR, 2.64; 95% CI, 1.52-4.58; P < .001), but deaths were not from OPAT complications. Conclusions Compared with younger patients, OPAT in nonagenarians is not associated with higher risk of OPAT-related complications. OPAT can be provided as safely to nonagenarians as to younger patients.
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Affiliation(s)
- Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Steven M Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Angela Everett
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susan J Rehm
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
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Karapinar‐Çarkit F, van den Bemt PM, Sadik M, van Soest B, Knol W, van Hunsel F, van Riet‐Nales DA. Opportunities for changes in the drug product design to enhance medication safety in older people: Evaluation of a national public portal for medication incidents. Br J Clin Pharmacol 2020; 86:1946-1957. [PMID: 32473057 PMCID: PMC7495303 DOI: 10.1111/bcp.14392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/30/2019] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Medication safety requires urgent attention in hospital pharmacy. This study evaluated the medication-related problems/errors as reported to the Dutch medication incident registry and disseminated for information to pharmacists. Through analysis by an expert panel we aimed to better understand which problems could have been mitigated by the drug product design. Additionally, the (wider) implications of the problems for current hospital/clinical practice were discussed. METHODS Items were extracted from the public Portal for Patient Safety. Items were included if relevant for older people and connected with the drug product design and excluded if they should reasonably have been intercepted by compliance to routine controls or well-known professional standards in pharmaceutical care. To explore any underreporting of well-known incidents, it was investigated if different medication-related problems could be observed in a regional hospital practise over a 1-month period. For 6 included items (cases), the implications for hospital/clinical practise were discussed in an expert panel. RESULTS In total, 307 items were identified in the Portal for Patient Safety; all but 14 were excluded. Six cases were added from daily hospital practice. These 20 cases commonly related to confusing product characteristics, packaging issues such as the lack of a single unit package for an oncolytic product, or incorrect or incomplete user instructions. CONCLUSION Medication registries provide important opportunities to evaluate real-world medication-related problems. However, underreporting of well-known problems should be considered. The product design can be used as an (additional) risk mitigation measure to support medication safety in hospital practice.
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Affiliation(s)
| | | | - Mariam Sadik
- Department of Clinical PharmacyOLVG hospitalAmsterdamThe Netherlands
| | - Brigit van Soest
- Royal Pharmaceutical Society in the Netherlands (KNMP)The HagueThe Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR)University Medical Centre UtrechtThe Netherlands
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Manckoundia P, Rosay C, Menu D, Nuss V, Mihai AM, Vovelle J, Nuémi G, d’Athis P, Putot A, Barben J. The Prescription of Vitamin K Antagonists in a Very Old Population: A Cross-Sectional Study of 8696 Ambulatory Subjects Aged Over 85 Years. Int J Environ Res Public Health 2020; 17:ijerph17186685. [PMID: 32937847 PMCID: PMC7558265 DOI: 10.3390/ijerph17186685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 01/12/2023]
Abstract
We compared very elderly people taking vitamin K antagonists (VKA) and those not taking VKA (noVKA). Individuals were included in the noVKA group if there was no VKA on their reimbursed prescriptions during the study period. We also compared three subgroups, constituted by VKA type (fluindione, warfarin, or acenocoumarol). We included individuals aged over 85 years, affiliated to Mutualité Sociale Agricole of Burgundy, who were refunded for prescribed VKA in September 2017. The VKA and noVKA groups were compared in terms of demographic conditions, registered chronic diseases (RCD), number of drugs per prescription and cardiovascular medications. The three VKA subgroups were compared for the same items plus laboratory monitoring, novel and refill VKA prescriptions, and prescriber specialty. Of the 8696 included individuals, 1157 (13.30%) were prescribed VKA. Mean age was 90 years. The noVKA group had fewer women (53.67 vs 66.08%), more RCD (93.43 vs. 71.96%) and more drugs per prescription (6.65 vs. 5.18) than the VKA group (all p < 0.01). Except for direct oral anticoagulants and platelet aggregation inhibitors, the VKA group took significantly more cardiovascular medications. The most commonly prescribed VKA was fluindione (59.46%). Mean age was higher in the warfarin (90.42) than in the acenocoumarol (89.83) or fluindione (89.71) subgroups (p < 0.01). No differences were observed for sex (women were predominant) or RCD. 13% of subjects in this population had a VKA prescription. Fluindione was the most commonly prescribed VKA.
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Affiliation(s)
- Patrick Manckoundia
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
- UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy and Franche Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-3-80-29-39-70
| | - Clémentine Rosay
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Didier Menu
- Mutualité Sociale Agricole of Burgundy Franche Comté, 21000 Dijon, France;
| | - Valentine Nuss
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Anca-Maria Mihai
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Jérémie Vovelle
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Gilles Nuémi
- Department of Medical Information, University Hospital, University of Burgundy, 21000 Dijon, France; (G.N.); (P.d.)
| | - Philippe d’Athis
- Department of Medical Information, University Hospital, University of Burgundy, 21000 Dijon, France; (G.N.); (P.d.)
| | - Alain Putot
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
| | - Jérémy Barben
- Hospital of Champmaillot, University Hospital, University of Burgundy, 21000 Dijon, France; (C.R.); (V.N.); (A.-M.M.); (J.V.); (A.P.); (J.B.)
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Rossi G, Cozzi I, Della Starza I, De Novi LA, De Propris MS, Gaeta A, Petrucci L, Pulsoni A, Pulvirenti F, Ascoli V. Human herpesvirus-8-positive primary effusion lymphoma in HIV-negative patients: Single institution case series with a multidisciplinary characterization. Cancer Cytopathol 2020; 129:62-74. [PMID: 32975904 DOI: 10.1002/cncy.22344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary effusion lymphoma (PEL) is a very rare non-Hodgkin lymphoma caused by human herpesvirus-8 (HHV8) that grows in liquid phase within body cavities. The diagnosis of PEL is based on cytology but requires confirmatory ancillary tests. PEL occurs mainly in association with HIV infection. This study describes 9 cases of PEL in HIV-negative patients and compares their characteristics with 10 HIV-associated cases of PEL diagnosed at a single institution in Italy between 1995 and 2019. METHODS Clinical records were reviewed for demographic data, comorbidities, laboratory abnormalities, and outcome. PEL samples were evaluated for cytomorphology, immunophenotype, immunoglobulin (IG)/T cell receptor (TR) rearrangements, and HHV8 and Epstein-Barr virus (EBV) viral loads in effusion supernatants. RESULTS HIV-unrelated PEL occurred in 8 elderly patients (7 men, 1 woman) and 1 young adult with primary antibody deficiency. Cytology revealed HHV8-positive lymphoma cells lacking B/T cell antigens and exhibiting 2 cell patterns (polymorphous or monotonous). IG was clonally rearranged in all cases; aberrant TRG occurred in 2 cases. Effusion supernatants had more than 106 HHV8 DNA copies per mL and variable loads of EBV DNA. Compared with HIV-associated PEL, the HIV-negative cohort was characterized by older age, less frequent association with Kaposi sarcoma and/or multicentric Castleman disease, comparable but less abnormal laboratory parameters, and a nonsignificant survival benefit. PEL cases with low apoptosis were associated with better prognosis. CONCLUSION To the best of our knowledge, our case series of HIV-unrelated PEL is the largest thus far, expands the spectrum of cytological findings, and supports the need for a multidisciplinary approach in the diagnostic workup.
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Affiliation(s)
- Giovanni Rossi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Ilaria Cozzi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.,GIMEMA Foundation, Rome, Italy
| | - Lucia Anna De Novi
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Aurelia Gaeta
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Luigi Petrucci
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Federica Pulvirenti
- Department of Infectious Diseases and Internal Medicine, Sapienza University, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
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Ono T, Wada H, Ishikawa H, Tamamura H, Tokumaru S. Proton beam therapy is a safe and effective treatment in elderly patients with esophageal squamous cell carcinoma. Thorac Cancer 2020; 11:2170-2177. [PMID: 32510875 PMCID: PMC7396394 DOI: 10.1111/1759-7714.13524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/27/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022] Open
Abstract
Background There are many elderly patients with esophageal squamous cell carcinoma (ESCC). However, there are currently few articles regarding the clinical outcome following proton beam therapy in these patients. The purpose of this study was to evaluate the clinical results of proton beam therapy in elderly patients with ESCC. Methods Between January 2009 and December 2013, patients aged ≥75 years who underwent proton beam therapy were examined using multi‐institutional data from Japan. Results There were 38 inoperable patients (70.4%) and 16 operable patients (29.6%). More than 40% of patients had stage III/IV ESCC. The five‐year overall and cancer‐specific survival rates were 56.2% and 71.7%, respectively. Performance status was the only factor that significantly influenced overall survival during the multivariate analysis. The five‐year local control rate was 61.8%, and local recurrence occurred within 13 months in 82.4% of patients,. There was no grade 3 or higher toxicity, excluding three patients with grade 3 esophageal ulcers. Conclusions In conclusion, proton beam therapy may become an alternative treatment with lower toxicity in elderly patients with ESCC, compared to surgery or conventional X‐ray radiotherapy. This includes inoperable patients. Key points Significant findings of the study Proton beam therapy was a safe and effective treatment for elderly patients with esophageal squamous cell carcinoma (ESCC) including inoperable patients. What this study adds Proton beam therapy may be a safer treatment choice for elderly patients with ESCC compared to conventional X‐ray radiotherapy.
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Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, QST Hospital, Chiba, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Ibaraki, Japan
| | - Hiroyasu Tamamura
- Department of Radiation Oncology, Proton Therapy Center, Fukui Prefectural Hospital, Fukui-ken, Japan
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno City, Japan
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Clerencia-Sierra M, Ioakeim-Skoufa I, Poblador-Plou B, González-Rubio F, Aza-Pascual-Salcedo M, Machón M, Gimeno-Miguel A, Prados-Torres A. Do Centenarians Die Healthier than Younger Elders? A Comparative Epidemiological Study in Spain. J Clin Med 2020; 9:jcm9051563. [PMID: 32455809 PMCID: PMC7291259 DOI: 10.3390/jcm9051563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
This study aims to describe the clinical course, drug use, and health services use characteristics during the last year of life of elders who die being centenarians and to identify key aspects differentiating them from elders who die at an earlier age, with a particular focus on sex differences. We conducted an observational, population-based study in the EpiChron Cohort (Aragón, Spain). The population was stratified by sex and into three age sub-populations (80-89, 90-99, and ≥100 years), and their characteristics were described and compared. Multimorbidity was the rule in our elders, affecting up to 3 in 4 centenarians and 9 in 10 octogenarians and nonagenarians. Polypharmacy was also observed in half of the centenarian population and in most of the younger elders. Risk factors for cardiovascular disease (i.e., hypertension, dyslipidaemia, diabetes), cerebrovascular disease and dementia were amongst the most common chronic conditions in all age groups, whereas the gastroprotective drugs and antithrombotic agents were the most dispensed drugs. Centenarians presented in general lower morbidity and treatment burden and lower use of both primary and hospital healthcare services than octogenarians and nonagenarians, suggesting a better health status. Sex-differences in their clinical characteristics were more striking in octogenarians and tended to decrease with age.
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Affiliation(s)
- Mercedes Clerencia-Sierra
- Aragon Health Service (SALUD), EpiChron Research Group, 50009 Zaragoza, Spain; (M.C.-S.); (F.G.-R.); (M.A.-P.-S.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28222 Madrid, Spain; (B.P.-P.); (M.M.); (A.P.-T.)
| | | | - Beatriz Poblador-Plou
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28222 Madrid, Spain; (B.P.-P.); (M.M.); (A.P.-T.)
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Francisca González-Rubio
- Aragon Health Service (SALUD), EpiChron Research Group, 50009 Zaragoza, Spain; (M.C.-S.); (F.G.-R.); (M.A.-P.-S.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28222 Madrid, Spain; (B.P.-P.); (M.M.); (A.P.-T.)
| | - Mercedes Aza-Pascual-Salcedo
- Aragon Health Service (SALUD), EpiChron Research Group, 50009 Zaragoza, Spain; (M.C.-S.); (F.G.-R.); (M.A.-P.-S.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28222 Madrid, Spain; (B.P.-P.); (M.M.); (A.P.-T.)
| | - Mónica Machón
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28222 Madrid, Spain; (B.P.-P.); (M.M.); (A.P.-T.)
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, 20014 San Sebastián, Spain
- Instituto de Investigación en Servicios de Salud Kronikgune, 48902 Barakaldo, Spain
| | - Antonio Gimeno-Miguel
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28222 Madrid, Spain; (B.P.-P.); (M.M.); (A.P.-T.)
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Correspondence: ; Tel.: +34-976-765-500
| | - Alexandra Prados-Torres
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 28222 Madrid, Spain; (B.P.-P.); (M.M.); (A.P.-T.)
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain
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Mittal VS, Wu B, Song J, Milentijevic D, Ashton V, Mahajan D. Healthcare resource utilization and costs among nonvalvular atrial fibrillation patients initiating rivaroxaban or warfarin in skilled nursing facilities: a retrospective cohort study. Curr Med Res Opin 2020; 36:529-536. [PMID: 31858841 DOI: 10.1080/03007995.2019.1706464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Atrial fibrillation (AF) is present in up to 17% of patients in skilled nursing facilities (SNFs). This study compared healthcare resource utilization (HRU) and costs between AF patients initiating rivaroxaban or warfarin in SNFs.Methods: Using de-identified claims from Optum Clinformatics Extended Data Mart (1 January 2013 to 31 December 2017), this retrospective cohort study indexed AF patients with first SNF admission during which rivaroxaban or warfarin was initiated within 3 days of admission. To adjust for selection bias, inverse probability of treatment weighting (IPTW) was applied for baseline characteristics. Logistic regression and generalized linear models were used to compare HRU and costs.Results: 519 rivaroxaban and 1129 warfarin patients met inclusion criteria. After IPTW, the cohorts were well balanced for baseline characteristics. The average length of index SNF stay was 32.07 and 37.44 days for rivaroxaban and warfarin patients, respectively. During SNF stay, rivaroxaban patients had 27% lower odds of hospitalization (p < .0001), 2.7 fewer international normalized ratio (INR) tests per-patient-per-month (PPPM; p < .001), and 2.3 fewer pathology/laboratory encounters PPPM (p < .0001) than warfarin patients. All-cause healthcare costs were $2638 lower with rivaroxaban versus warfarin (p < .0001) during the index SNF stay, with lower medical costs (p < .0001) but higher pharmacy costs (p < .0001). Total all-cause healthcare costs 100 days post-index SNF were $8746 lower with rivaroxaban versus warfarin (p < .0001).Conclusions: In the SNF setting, AF patients treated with rivaroxaban had 5-day shorter length of stay, lower HRU, and lower all-cause total and medical costs compared to warfarin, despite higher treatment costs. These findings may help inform clinical decision-making to reduce economic burden.
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Affiliation(s)
- V Simon Mittal
- Advanced Health Institute and LTC Professionals, Bloomington, MN, USA
| | - Bingcao Wu
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Ji Song
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Dheeraj Mahajan
- University of Illinois at Chicago and Advocate Illinois Masonic Medical Center, Melrose Park, IL, USA
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Dalin DA, Vermehren C, Jensen AK, Unkerskov J, Andersen JT. Systematic Medication Review in General Practice by an Interdisciplinary Team: A thorough but Laborious Method to Address Polypharmacy among Elderly Patients. Pharmacy (Basel) 2020; 8:pharmacy8020057. [PMID: 32244439 PMCID: PMC7356921 DOI: 10.3390/pharmacy8020057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/05/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
Polypharmacy increases the risk of hospitalization but may be reduced by medication review. The study objective is to describe and evaluate a method for conducting medication review in general practice by an interdisciplinary medication team of pharmacists and physicians—in this case conducted by a team from the Department of Clinical Pharmacology—based on information concerning medication, diagnosis, relevant laboratory data and medical history supplied by the general practitioner. We discussed the medication review with the patients’ general practitioners and received feedback from them regarding acceptance rates of the recommended changes. Ninety-four patients with a total of 1471 prescriptions were included. A medication change was recommended for nearly half of the prescriptions (48%); at least one change of medication was recommended for all patients. The acceptance rate for recommended medication changes was 55%, corresponding to a mean of 4.2 accepted recommendations per patient. For 18% of all 1471 prescriptions, the general practitioner agreed either to discontinue (stop the medication completely) or reduce the dose of the medication. This method is thorough, but since it requires several healthcare professionals, it is rather time-consuming. There is a need to support medication review in general practice, but although this method may be too time consuming in most cases, it may nevertheless prove to be a useful tool managing the most complicated patients.
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Affiliation(s)
- Dagmar Abelone Dalin
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg, Copenhagen DK-2400, Denmark
- Correspondence: ; Tel.: +45-38-66-53-37
| | - Charlotte Vermehren
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg, Copenhagen DK-2400, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | | | - Janne Unkerskov
- Quality in General Practice in the Capital Region of Denmark (KAP-H), DK-3400 Hillerød, Denmark
| | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg, Copenhagen DK-2400, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
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Niimura H, Eguchi Y, Kida H, Suzuki K, Takayama M, Mimura M. Sociopsychological characteristics of late nonagenarians in Japan: the protocol of the Arakawa 95+ study. Psychogeriatrics 2020; 20:50-58. [PMID: 31083794 DOI: 10.1111/psyg.12457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/12/2018] [Revised: 03/06/2019] [Accepted: 03/19/2019] [Indexed: 01/07/2023]
Abstract
AIM The aim of this study was to examine sociopsychological characteristics of the oldest old in Japan. We conducted a baseline survey of a community-based cohort of persons aged 95 or older. METHODS Participants were aged 95+ years and resided in Arakawa Ward in Tokyo on 1 January 2016. We mailed a questionnaire to these individuals to assess their physical, mental, and social status. Subsequently, if respondents agreed, we conducted in-home interviews and examined their physical and cognitive function. Also, we mailed non-respondents a simplified version of full questionnaire. Additionally, we examined the basic registered data of the study population and the status of their Long-term Care Insurance. Data at baseline and 1-year follow-up were compared. RESULTS With regard to Long-term Care Insurance, 423 residents aged 95+ years (78.0%) were on long-term care level, 35 (6.5%) were on support level, and 84 (15.5%) did not require support. At the 1-year follow-up, 275 (50.7%) had the same care level, 107 (19.7%) required a greater level of care, and 131 had died (annual death rate: 24.2%). Compared to the simplified questionnaire group (n = 128) and the full questionnaire-only group (n = 14), a higher proportion of respondents who had completed the full questionnaire and had in-home interviews (n = 26) were men, lived only with a spouse, had higher activities of daily living, and reported more positive feelings and well-being. CONCLUSIONS In the late nonagenarian population, the annual death rate was high, and care needs increased rapidly. However, some persons maintained the same care level or even showed improvement and successful ageing.
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Affiliation(s)
- Hidehito Niimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Eguchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hisashi Kida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kouta Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Midori Takayama
- Department of Foreign Language and Liberal Arts, Keio University School of Science and Technology, Yokohama, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Dumbuya A, Gomes AF, Marchini L, Zeng E, Comnick CL, Melo SLS. Bone changes in the temporomandibular joints of older adults: A cone-beam computed tomography study. Spec Care Dentist 2019; 40:84-89. [PMID: 31799710 DOI: 10.1111/scd.12441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/31/2019] [Revised: 11/05/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022]
Abstract
AIMS To assess the prevalence of degenerative bone changes in the temporomandibular joint (TMJ) of older adults using cone-beam computed tomography (CBCT), and to verify possible associations between these findings and patient health history. METHODS CBCT scans comprising both TMJs were acquired for 137 patients aged 65+, regardless of TMD status. Images were assessed by two oral radiologists and evaluated for the presence of flattening, erosion, sclerosis, subchondral cysts, and osteophytes in the TMJ bony components, and self-reported patient systemic health histories were retrieved from records. RESULTS There were 59 males, and the mean age was 73.35 ± 6.28. A total of 31.4% had bone changes in both TMJs, and 65.7% had bone changes in at least one side. Bone changes were more prevalent in females, with subchondral cysts (63.3%) and osteophytes (60%) the most common findings. There was a higher prevalence of osteoporosis/osteopenia (38.5%) and connective tissue disorders (39.8%) in patients with TMJ bone changes than in those with normal TMJs. CONCLUSION Degenerative bone changes of TMJ were prevalent among older adults, and females were more affected. There was a greater prevalence of osteoporosis/osteopenia and connective tissue disorders in patients with TMJ bone changes than in subjects with normal TMJs.
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Affiliation(s)
- Aminata Dumbuya
- The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| | | | - Leonardo Marchini
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa
| | - Erliang Zeng
- Department of Preventive & Community Dentistry, Division of Biostatistics and Computational Biology, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa.,Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa
| | - Carissa L Comnick
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Saulo L Sousa Melo
- Department of Integrative Biomedical and Diagnostic Sciences, School of Dentistry, Oregon Health and Science University, Portland, Oregon
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Mendonça N, Kingston A, Granic A, Jagger C. Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study. Age Ageing 2019; 49:32-38. [PMID: 31711099 PMCID: PMC6939283 DOI: 10.1093/ageing/afz142] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To examine the association of protein intake with frailty progression in very old adults. Design The Newcastle 85+ study, a prospective longitudinal study of people aged 85 years old in Northeast England and followed over 5 years. Setting and Participants 668 community-dwelling older adults (59% women) at baseline, with complete dietary assessment and Fried frailty status (FFS). Measures Dietary intake was estimated with 2 × 24-h multiple pass recalls at baseline. FFS was based on five criteria: shrinking, physical endurance/energy, low physical activity, weakness and slow walking speed and was available at baseline and 1.5, 3 and 5 years. The contribution of protein intake (g/kg adjusted body weight/day [g/kg aBW/d]) to transitions to and from FFS (robust, pre-frail and frail) and to death over 5 years was examined by multi-state models. Results Increase in one unit of protein intake (g/kg aBW/d) decreased the likelihood of transitioning from pre-frail to frail after adjusting for age, sex, education and multimorbidity (hazard ratios [HR]: 0.44, 95% confidence interval [CI]: 0.25–0.77) but not for the other transitions. Reductions in incident frailty were equally present in individuals with protein intake ≥0.8 (HR: 0.60, 95% CI: 0.43–0.84) and ≥1 g/kg aBW/d (HR: 0.63, 95% CI: 0.44–0.90) from 85 to 90 years. This relationship was attenuated after adjustment for energy intake, but the direction of the association remained the same (e.g. g/kg aBW/d model: HR: 0.71, 95% CI: 0.36–1.41). Conclusion High protein intake, partly mediated by energy intake, may delay incident frailty in very old adults. Frailty prevention strategies in this age group should consider adequate provision of protein and energy.
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Affiliation(s)
- Nuno Mendonça
- Institute for Ageing, Faculty of Medical Sciences, Newcastle University, NE2 4AX, UK
- EpiDoC Unit, CHRC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL),1050 082, Portugal
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, NE4 5PL, UK
| | - Andrew Kingston
- Institute for Ageing, Faculty of Medical Sciences, Newcastle University, NE2 4AX, UK
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, NE4 5PL, UK
| | - Antoneta Granic
- AGE Research Group, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, NE2 4HH, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, NE4 5PL, UK
| | - Carol Jagger
- Institute for Ageing, Faculty of Medical Sciences, Newcastle University, NE2 4AX, UK
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, NE4 5PL, UK
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Ambagtsheer RC, Thompson MQ, Archibald MM, Casey MG, Schultz TJ. Diagnostic test accuracy of self-reported screening instruments in identifying frailty in community-dwelling older people: A systematic review. Geriatr Gerontol Int 2019; 20:14-24. [PMID: 31729157 DOI: 10.1111/ggi.13810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/02/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 12/28/2022]
Abstract
Against a backdrop of aging populations worldwide, it has become increasingly important to identify frailty screening instruments suitable for community settings. Self-reported and/or administered instruments might offer significant simplicity and efficiency advantages over clinician-administered instruments, but their comparative diagnostic test accuracy has yet to be systematically examined. The aim of this systematic review was to determine the diagnostic test accuracy of self-reported and/or self-administered frailty screening instruments against two widely accepted frailty reference standards (the frailty phenotype and the Frailty Index) within community-dwelling older adult populations. We carried out a systematic search of the Embase, CINAHL, MEDLINE, PubMed, Web of Science, PEDro, PsycINFO, ProQuest Dissertations, Open Grey and GreyLit databases up to April 2017 (with an updated search carried out over May-July 2018) to identify studies reporting comparison of self-reported and/or self-administered frailty screening instruments against an appropriate reference standard, with a minimum sensitivity threshold of 80% and specificity threshold of 60%. We identified 24 studies that met our selection criteria. Four self-reported screening instruments across three studies met minimum sensitivity and specificity thresholds. However, in most cases, study design considerations limited the reliability and generalizability of the results. Additionally, meta-analysis was not carried out, because no more than three studies were available for any of the unique combinations of index tests and reference standards. Although the present study has shown that a number of self-reported frailty screening instruments reported sensitivity and specificity within a desirable range for community application, additional diagnostic test accuracy studies are required. Geriatr Gerontol Int 2020; 20: 14-24.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
| | - Mark Q Thompson
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia
| | - Mandy M Archibald
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - Timothy J Schultz
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia.,The Center for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Center of Excellence, Adelaide, South Australia, Australia
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Ten Koppel M, Onwuteaka-Philipsen BD, Van den Block L, Deliens L, Gambassi G, Heymans MW, Kylänen M, Oosterveld-Vlug MG, Pasman HRW, Payne S, Smets T, Szczerbińska K, Twisk JW, van der Steen JT, Mammarella F, Mercuri M, Pivodic L, Pac A, Rossi P, Segat I, Sowerby E, Stodolska A, van Hout H, Wichmann A, Adang E, Andreasen P, Finne-Soveri H, Collingridge Moore D, Froggatt K, Kijowska V, Van Den Noortgate N, Vernooij-Dassen M. Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE). Palliat Med 2019; 33:1176-1188. [PMID: 31258004 DOI: 10.1177/0269216319861229] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. AIM To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. DESIGN Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. SETTING/PARTICIPANTS Nurses or care assistants who are most involved in care for the resident. RESULTS We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%-Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%-the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. CONCLUSION The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.
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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.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Giovanni Gambassi
- Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mariska G Oosterveld-Vlug
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jos Wr Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Salinero-Fort MA, Mostaza-Prieto JM, Lahoz-Rallo C, Vicente Díez JI, Cárdenas-Valladolid J. Population-based cross-sectional study of 11 645 Spanish nonagenarians with type 2 diabetes mellitus: cardiovascular profile, cardiovascular preventive therapies, achievement goals and sex differences. BMJ Open 2019; 9:e030344. [PMID: 31542750 PMCID: PMC6756452 DOI: 10.1136/bmjopen-2019-030344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences. DESIGN AND SETTING A cross-sectional population study of 11 645 persons aged ≥90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin-angiotensin system blockers and statins had been prescribed for overt cardiovascular disease. RESULTS The prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females. CONCLUSION Our study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ≥90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.
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Affiliation(s)
- Miguel Angel Salinero-Fort
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Grupo de Envejecimiento y Fragilidad de las personas mayores, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ), Madrid, Spain
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain
| | | | | | | | - Juan Cárdenas-Valladolid
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain
- Dirección Técnica de Sistemas de Información. Gerencia Asistencial de Atención Primaria, Comunidad de Madrid Servicio Madrileno de Salud, Madrid, Spain
- Enfermería, Universidad Alfonso X El Sabio, Villanueva de la Canada, Spain
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