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van Liempd S, Bolt S, Verbiest M, Luijkx K. Association between freedom of movement and health of nursing home residents with dementia: an exploratory longitudinal study. BMC Geriatr 2024; 24:192. [PMID: 38408921 PMCID: PMC10898030 DOI: 10.1186/s12877-024-04677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Locked doors remain a common feature of dementia units in nursing homes (NHs) worldwide, despite the growing body of knowledge on the negative effects of restricted freedom on residents. To date, no previous studies have explored the health effects of opening locked NH units, which would allow residents to move freely within the building and enclosed garden. This study examines the association between increased freedom of movement and the health of NH residents with dementia. METHODS This longitudinal, pre-post study involved a natural experiment in which NH residents with dementia (N = 46) moved from a closed to a semi-open location. Data on dimensions of positive health were collected at baseline (T0; one month before the relocation), at one (T1), four (T2) and nine (T3) months after the relocation. Linear mixed models were used to examine changes in positive health over time. RESULTS Cognition, quality of life and agitation scores improved significantly at T1 and T2 compared to the baseline, while mobility scores decreased. At T3, improvements in agitation and quality of life remained significant compared to the baseline. Activities of daily living (ADL) and depression scores were stable over time. CONCLUSIONS Increasing freedom of movement for NH residents with dementia is associated with improved health outcomes, both immediately and over time. These findings add to the growing evidence supporting the benefits of freedom of movement for the overall health of NH residents with dementia.
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Affiliation(s)
- Suzan van Liempd
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Stichting Mijzo, Waalwijk, The Netherlands.
| | - Sascha Bolt
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Marjolein Verbiest
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Katrien Luijkx
- Department of Tranzo, Scientific Centre for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Guthrie DM, Williams N, O'Rourke HM, Orange JB, Phillips N, Pichora-Fuller MK, Savundranayagam MY, Sutradhar R. Development and validation of risk of CPS decline (RCD): a new prediction tool for worsening cognitive performance among home care clients in Canada. BMC Geriatr 2023; 23:792. [PMID: 38041046 PMCID: PMC10693097 DOI: 10.1186/s12877-023-04463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND To develop and validate a prediction tool, or nomogram, for the risk of a decline in cognitive performance based on the interRAI Cognitive Performance Scale (CPS). METHODS Retrospective, population-based, cohort study using Canadian Resident Assessment Instrument for Home Care (RAI-HC) data, collected between 2010 and 2018. Eligible home care clients, aged 18+, with at least two assessments were selected randomly for model derivation (75%) and validation (25%). All clients had a CPS score of zero (intact) or one (borderline intact) on intake into the home care program, out of a possible score of six. All individuals had to remain as home care recipients for the six months observation window in order to be included in the analysis. The primary outcome was any degree of worsening (i.e., increase) on the CPS score within six months. Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of a deterioration in the CPS score. Model performance was assessed on the validation cohort using discrimination and calibration plots. RESULTS We identified 39,292 eligible home care clients, with a median age of 79.0 years, 62.3% were female, 38.8% were married and 38.6% lived alone. On average, 30.3% experienced a worsening on the CPS score within the six-month window (i.e., a change from 0 or 1 to 2, 3, 4, 5, or 6). The final model had good discrimination (c-statistic of 0.65), with excellent calibration. CONCLUSIONS The model accurately predicted the risk of deterioration on the CPS score over six months among home care clients. This type of predictive model may provide useful information to support decisions for home care clinicians who use interRAI data internationally.
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Affiliation(s)
- Dawn M Guthrie
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Nicole Williams
- Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Joseph B Orange
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Natalie Phillips
- Department of Psychology, Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | | | | | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Morris JN, Howard EP, Schachter E, Burney S, Laytham A, Fialova D, Hoogendijk EO, Liperoti R, van Hout HPJ, Vetrano DL. Cognitive Change Among Nursing Home Residents: CogRisk-NH Scale Development to Predict Decline. J Am Med Dir Assoc 2023; 24:1405-1411. [PMID: 37517808 DOI: 10.1016/j.jamda.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Examine cognitive changes over time among nursing home residents and develop a risk model for identifying predictors of cognitive decline. DESIGN Using secondary analysis design with Minimum Data Set data, cognitive status was based on the Cognitive Performance Scale (CPS). SETTING AND PARTICIPANTS Baseline and 7 quarterly follow-up analyses of US and Canadian interRAI data (N = 1,257,832) were completed. METHODS Logistic regression analyses identified predictors of decline to form the CogRisk-NH scale. RESULTS At baseline, about 15% of residents were cognitively intact (CPS = 0), and 11.2% borderline intact (CPS = 1). The remaining more intact, with mild impairment (CPS = 2), included 15.0%. Approximately 59% residents fell into CPS categories 3 to 6 (moderate to severe impairment). Over time, increasing proportions of residents declined: 17.1% at 6 months, 21.6% at 9 months, and 34.0% at 21 months. Baseline CPS score was a strong predictor of decline. Categories 0 to 2 had 3-month decline rates in midteens, and categories 3 to 5 had an average decline rate about 9%. Consequently, a 2-submodel construction was employed-one for CPS categories 0 to 2 and the other for categories 3 to 5. Both models were integrated into a 6-category risk scale (CogRisk-NH). CogRisk-NH scale score distribution had 15.9% in category 1, 26.84% in category 2, and 36.7% in category 3. Three higher-risk categories (ie, 4-6) represented 20.6% of residents. Mean decline rates at the 3-month assessment ranged from 4.4% to 28.3%. Over time, differentiation among risk categories continued: 6.9% to 38.4.% at 6 months, 11.0% to 51.0% at 1 year, and 16.2% to 61.4% at 21 months, providing internal validation of the prediction model. CONCLUSIONS AND IMPLICATIONS Cognitive decline rates were higher among residents in less-impaired CPS categories. CogRisk-NH scale differentiates those with low likelihood of decline from those with moderate likelihood and, finally, much higher likelihood of decline. Knowledge of resident risk for cognitive decline enables allocation of resources targeting amenable factors and potential interventions to mitigate continuing decline.
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Affiliation(s)
- John N Morris
- Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Elizabeth P Howard
- Hebrew SeniorLife, The Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA; Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.
| | | | - Sharran Burney
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Anna Laytham
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Prague, Czech Republic; Department of Geriatrics and Gerontology, 1(st) Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Emiel O Hoogendijk
- Department of General Practice and Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein P J van Hout
- Amsterdam University Medical Center, Departments of General Practice and Medicine for Older Persons, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
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Prognostic Association Between Frailty and Post-Arrest Health Outcomes in Patients Receiving Home Care: A Population-Based Retrospective Cohort Study. Resuscitation 2023; 187:109766. [PMID: 36931455 DOI: 10.1016/j.resuscitation.2023.109766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
AIM To evaluate the association between frailty and post-cardiac arrest survival, functional decline, and cognitive decline, among patients receiving home care METHODS: Frailty was measured using the Clinical Frailty Scale (CFS) and a valid frailty index. We used multivariable logistic regression to measure the association between frailty and post-arrest outcomes after adjusting for age, sex, and arrest setting. Functional independence and cognitive performance were measured using the interRAI ADL Long-Form and Cognitive Performance Scale, respectively. We conducted sub-group analytics of in-hospital and out-of-hospital arrests RESULTS: Our cohort consisted of 7,901 home care clients; most patients arrested out-of-hospital (55.4%) and were 75 years or older (66.3%). Most of the cohort was classified as frail (94.2%), with a CFS score of 5 or greater. The 30-day survival rate was higher for in-hospital (26.6%) than out-of-hospital cardiac arrests (5.2%). Most patients who survived to discharge had declines in post-arrest functional independence (65.8%) and cognitive performance (46.5%). A one-point increase in the CFS decreased the odds of 30-day survival by 8% (aOR=0.92; 95%CI = 0.87-0.97). A 0.1 unit increase in the frailty index reduced 30-day survival odds by 9% (aOR = 0.91; 95%CI = 0.86-0.96). The frailty index was associated with declines in functional independence (OR = 1.16; 95%CI = 1.02-1.31) and cognitive performance (OR = 1.24; 95%CI = 1.09-1.42), while the CFS was not. CONCLUSION Frailty is associated with cardiac arrest survival and post-arrest cognitive and functional status in patients receiving home care. Post-cardiac arrest cognitive and functional status are best predicted using more comprehensive frailty indices.
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Merrick E, Shannon K, Neville S, Bail K, Vorster A, Fry M. A cross‐sectional description of the health characteristics of cognitively impaired older adults. Australas J Ageing 2022; 42:241-245. [PMID: 36334060 DOI: 10.1111/ajag.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The analysis presented here describes the care needs of older adults with and without cognitive impairment. To describe the health characteristics of older adults with and without cognitive impairment who receive home care or Aged Residential Care services in New Zealand. METHODS A descriptive analysis of the initial interRAI assessment for adults older than 55 years was undertaken. Data were grouped by level of assessed cognitive impairment. The population proportions for each level of the following scales were calculated: Changes in Health, End-stage Disease, Signs, and Symptoms Scale (CHESS), pain, pressure injury risk, Activities of Daily Living (ADL), depression screening, and body mass index (BMI). RESULTS The analysis included 93,680 assessments. The mean age was 83 years (SD = 8.7) a positive association was observed between age and cognitive impairment (p < 0.01). People with cognitive impairment were less likely to have been recently hospitalised or to have attended ED (p < 0.01). Significant associations with effect sizes ≥3 were observed for cognitive impairment and ADL (p < 0.01, γ = 0.63), pain (p < 0.01, γ = -0.32), and risk of pressure injury (p < 0.01, Cramer's V = 0.271). CONCLUSIONS The results reinforce a need to be alert to the differential care needs of older adults with moderate/severe cognitive impairment. The findings may act as a trigger for practitioners to focus assessment on aspects of care that, due to context, may otherwise be underassessed or untreated.
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Affiliation(s)
- Eamon Merrick
- School of Clinical Science Auckland University of Technology Auckland New Zealand
| | - Kay Shannon
- School of Clinical Science Auckland University of Technology Auckland New Zealand
| | - Stephen Neville
- Department of Nursing Auckland University of Technology Auckland New Zealand
| | - Kasia Bail
- Department of Nursing University of Canberra Canberra Australian Capital Territory Australia
| | - Anja Vorster
- Department of Biostatistics, Faculty of Health and Environmental Sciences Auckland University of Technology Auckland New Zealand
| | - Margaret Fry
- Nursing School, Faculty of Medicine and Health University of Technology Sydney Sydney New South Wales Australia
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Peel NM, Jones LV, Berg K, Gray LC. Validation of a Falls Risk Screening Tool Derived From InterRAI Acute Care Assessment. J Patient Saf 2021; 17:e1152-e1156. [PMID: 29360675 DOI: 10.1097/pts.0000000000000462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to develop and validate a falls risk screening tool derived from interRAI Acute Care (AC) Assessment. METHODS For derivation and validation, two prospective cohorts were recruited from AC hospitals in Australia. The derivation cohort comprised 1418 patients from 11 hospitals. In the validation cohort, 393 patients were recruited from four hospitals. The interRAI AC tool was used to collect comprehensive geriatric assessment data at admission. In-hospital falls were documented from medical records. A falls risk score was calculated using logistic regression. Predictive ability was compared with St. Thomas Risk Assessment Tool In Falling elderlY (STRATIFY), using area under curve (AUC). The validation cohort provided external validity. RESULTS Complete data in the derivation cohort were available for 1288 patients (91%), with 75 (5.8%) having an in-hospital fall. The derived interRAI AC falls risk score (range = 0-6) had significantly better predictive ability (AUC = 0.70, 95% confidence interval [CI] = 0.63-0.76) compared with St. Thomas Risk Assessment Tool In Falling elderlY (AUC = 0.64, 95% CI = 0.58-0.70) (P = 0.033). At a cut point of three, 54 of 75 falls were correctly predicted by the falls risk score derived from interRAI AC (sensitivity = 0.72 [95% CI = 0.60-0.82] and specificity = 0.60 [95% CI = 0.57-0.62]). The falls risk score performed similarly in the validation cohort. CONCLUSIONS The falls risk tool developed from interRAI AC is a valid measure to screen for in-hospital falls. Reduction in assessment burden without loss of fidelity can be achieved through integrating the risk screener within the interRAI hospital system, which automatically triggers protocols for falls prevention based on identified risk.
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Affiliation(s)
- Nancye May Peel
- From the Centre for Research in Geriatric Medicine, Faculty of Medicine, The University of Queensland
| | - Lee Vanessa Jones
- Research Methods Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Ontario, Canada
| | - Leonard Charles Gray
- From the Centre for Research in Geriatric Medicine, Faculty of Medicine, The University of Queensland
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Corsonello A, Soraci L, Di Rosa M, Bustacchini S, Bonfigli AR, Lisa R, Liperoti R, Tettamanti M, Cherubini A, Antonicelli R, Pelliccioni G, Postacchini D, Lattanzio F. Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital. J Am Med Dir Assoc 2021; 23:499-506.e1. [PMID: 34384766 DOI: 10.1016/j.jamda.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals. DESIGN A prospective multicenter observational study. SETTING AND PARTICIPANTS Our series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project. METHODS After signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell's C-index and categorical Net Reclassification Index (NRI). RESULTS Functional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy [C-index 0.66, 95% confidence interval (CI) 0.65-0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53-0.56), and Charlson score (C-index 0.58, 95% CI 0.56-0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14-0.31) or Charlson score (NRI 0.13, 95% CI 0.03-0.20) to functional cluster model slightly improved the accuracy of prediction. CONCLUSIONS AND IMPLICATIONS Functional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals' needs and to design tailored preventive interventions.
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Affiliation(s)
- Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy; Unit of Geriatric Medicine, IRCSS INRCA, Cosenza, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCSS INRCA, Cosenza, Italy.
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | | | | | | | - Rosa Liperoti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Tettamanti
- Geriatric Epidemiology Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | | | - Demetrio Postacchini
- Geriatrics Operative Unit, Italian National Research Centre on Aging (IRCCS INRCA), Fermo, Italy
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Performance of the Cognitive Performance Scale of the Resident Assessment Instrument (interRAI) for Detecting Dementia amongst Older Adults in the Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136708. [PMID: 34206380 PMCID: PMC8297343 DOI: 10.3390/ijerph18136708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022]
Abstract
The Cognitive Performance Scale (CPS) in the widely used interRAI suite of instruments is of interest to clinicians and policy makers as a potential screening mechanism for detecting dementia. However, there has been little evaluation of the CPS in home care settings. This retrospective diagnostic study included 134 older adults (age ≥ 65) who were discharged from two acute psychogeriatric inpatient units or assessed in two memory clinics. The reference test was a diagnosis of clinical dementia, and the index test was interRAI CPS measured within 90 days of discharge. The overall accuracy of the CPS was good, with an area under the Receiver Operating Characteristic curve of 0.82 (95% CI = 0.75–0.89). The optimal cut point was 1/2, coinciding with the recommended cut point, with good sensitivity (0.90, 95% CI = 0.81–0.96) but poor specificity (0.60, 95% CI = 0.46–0.72). Positive predictive value improved from 0.72 (95% CI = 0.66–0.78) to 0.89 (95% CI = 0.75–0.96) when using a cut point of 2/3 instead of 1/2. If the results of the present study are replicated with more generalisable interRAI samples, older adults with a CPS of 3 or above, but without a formal diagnosis of dementia, should be referred for further cognitive assessment.
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Ruangritchankul S, Peel NM, Hanjani LS, Gray LC. Drug related problems in older adults living with dementia. PLoS One 2020; 15:e0236830. [PMID: 32735592 PMCID: PMC7394402 DOI: 10.1371/journal.pone.0236830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.
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Affiliation(s)
- Sirasa Ruangritchankul
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nancye M. Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Di Rosa M, D’Alia S, Guarasci F, Soraci L, Pierpaoli E, Lenci F, Ricci M, Onder G, Volpato S, Ruggiero C, Cherubini A, Corsonello A, Lattanzio F. Cognitive Impairment, Chronic Kidney Disease, and 1-Year Mortality in Older Patients Discharged from Acute Care Hospital. J Clin Med 2020; 9:E2202. [PMID: 32664677 PMCID: PMC7408778 DOI: 10.3390/jcm9072202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/01/2023] Open
Abstract
The prognostic interaction between chronic kidney disease (CKD) and cognitive impairment is still to be elucidated. We investigated the potential interaction of overall cognitive impairment or defective constructional praxis and CKD in predicting 1-year mortality among 646 older patients discharged from hospital. The estimated glomerular filtration rate (eGFR) was calculated using the Berlin Initiative Study (BIS) equation. Cognitive impairment was assessed by the Mini Mental State Exam (MMSE) and defective constructional praxis was ascertained by the inherent MMSE item. The study outcome was 1-year mortality. Statistical analysis was carried out using Cox regression. After adjusting for potential confounders, the co-occurrence of eGFR <30 and overall cognitive impairment (Hazard Ratio (HR) = 3.12, 95% Confidence Interval (CI) = 1.26-7.77) and defective constructional praxis (HR = 2.50, 95% CI = 1.08-5.77) were associated with the outcome. No significant prognostic interaction of eGFR < 30 with either overall cognitive impairment (HR = 1.99, 95% CI = 0.38-10.3) or constructional apraxia (HR = 1.68, 95% CI = 0.33-8.50) was detectable, while only cognitive deficits were found significantly associated with the outcome in the interaction models (HR = 3.12, 95% CI = 1.45-6.71 for overall cognitive impairment and HR = 2.16, 95% CI = 1.05-4.45 for constructional apraxia). Overall cognitive impairment and defective constructional praxis may be associated with increased risk of 1-year mortality among older hospitalized patients with severe CKD. However, no significant prognostic interaction between CKD and cognitive impairment could be observed.
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Affiliation(s)
- Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Sonia D’Alia
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Francesco Guarasci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
| | - Luca Soraci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Elisa Pierpaoli
- Advanced Technology Center for Aging Research, Scientific Technological Area, IRCCS INRCA, 60124 Ancona, Italy;
| | - Federica Lenci
- Unit of Nephrology and Dialysis, IRCCS INRCA, 60124 Ancona, Italy; (F.L.); (M.R.)
| | - Maddalena Ricci
- Unit of Nephrology and Dialysis, IRCCS INRCA, 60124 Ancona, Italy; (F.L.); (M.R.)
| | - Graziano Onder
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, 06132 Perugia, Italy;
| | - Antonio Cherubini
- Geriatria Accettazione Geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, 60124 Ancona, Italy;
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124 Ancona, Italy; (M.D.R.); (S.D.A.); (F.G.); (A.C.)
- Unit of Geriatric Medicine, IRCSS INRCA, 60124 Ancona, Italy
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11
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Ruangritchankul S, Peel NM, Shafiee Hanjani L, Gray LC. The Changes in Medication Prescribing Among the Older People with Cognitive Impairment in the Acute Care Setting. Clin Interv Aging 2020; 15:865-876. [PMID: 32606626 PMCID: PMC7292256 DOI: 10.2147/cia.s252432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Most older people with cognitive impairment usually have multiple comorbidities. In the last decade, the guidelines for the management of chronic diseases have been changed, leading to changes in the patterns of medication prescribing and in the prevalence of drug-related problems (DRPs). The main objectives were to explore the changes in medication use and in the prevalence of polypharmacy (PP), the use of potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) among older hospitalized adults with cognitive impairment in a 5-year period. PATIENTS AND METHODS Older hospitalized patients with cognitive impairment diagnosed by cognitive performance scale (CPS) score of 2 or more at tertiary hospital in Brisbane, Australia in 2009 and 2015 to 2016 were enrolled. Prescribed medication use, and exposures to PP, PIM and/or DDI were evaluated at two time points. The associated factors with patients exposed to >1 criteria of PP, PIM or DDI were analyzed by using logistic regression analyses. RESULTS The median number of prescribed medications was not significantly different between the two periods. The number of medications use as dermatological agents and analgesics substantially increased over 5 years. In contrast, there was a decrease in prescription of drugs for acid-related disorders, drugs used in diabetes, and mineral supplements. Most of the participants were exposed to at least one of PP, PIM or DDI. In multivariate regression analysis, the presence of diabetes diagnosis was a risk factor associated with increased exposure to >1 criteria of PP, PIM or DDI. CONCLUSION The patterns of many prescribed medications use have altered in a 5-year period. The present study confirms that the majority of older adults with cognitive impairment admitted in an acute care setting are prone to PP, PIM and DDI. Comprehensive medication reviews should be undertaken in clinical care of older patients with cognitive impairment.
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Affiliation(s)
- Sirasa Ruangritchankul
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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12
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Pierpaoli E, Fabi K, Lenci FF, Ricci M, Di Rosa M, Onder G, Volpato S, Ruggiero C, Cherubini A, Corsonello A, Lattanzio F. Kidney function and cognitive impairment among older hospitalized patients: a comparison of four glomerular filtration rate equations. Aging Clin Exp Res 2020; 32:841-850. [PMID: 31732959 DOI: 10.1007/s40520-019-01405-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between the estimated glomerular filtration rate (eGFR) and cognitive impairment may change as a function of the equation used. We aimed at investigating the association between four different eGFR equations and cognitive impairment among older hospitalized patients. METHODS Our series consisted of 795 older patients consecutively admitted to 7 geriatric and internal medicine acute care wards. The eGFR was calculated by Chronic Kidney Disease Epidemiologic Collaboration (CKD-EPI), Cockcroft-Gault (CG), Berlin Initiative Study (BIS) and Full Age Spectrum (FAS) equations. Study outcomes were total Mini Mental State Examination (MMSE) < 24 and sub-scores related to orientation to time, orientation to space, registration, calculation, three words recall, language and constructional praxis. Statistical analysis was carried out by logistic or Poisson regressions when appropriate. The accuracy of eGFR equations in identifying cognitive outcomes was investigated by calculating the area (AUC) under the receiver operating characteristic (ROC) curve for each equation. RESULTS After adjusting for potential confounders, eGFR < 30 was significantly associated with MMSE < 24 only with CKD-EPI equation (OR 2.03, 95% CI 1.04-3.96). eGFR < 30 was significantly associated with constructional apraxia with all study equations (CKD-EPI: OR 3.62, 95% CI 1.73-7.56; BIS: OR 2.86, 95% CI 1.31-6.26; FAS: OR 2.83, 95% CI 1.44-5.56; CG: OR 2.08, 95% CI 1.09-3.99). The accuracy of eGFR < 30 in identifying patients with defective constructional praxis was poor with all (BIS: AUC 0.54, 95% CI 0.52-0.55; CKD-EPI: AUC 0.55, 95% CI 0.53-0.57; CG: AUC 0.58, 95% CI 0.55-0.61; FAS: AUC 0.56, 95% CI 0.54-0.58). CONCLUSIONS Constructional apraxia may characterize the cognitive profile of older patients with severe CKD. The accuracy in identifying patients with constructional apraxia is only fair, and studies including other biomarkers of kidney function are needed.
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Affiliation(s)
- Elisa Pierpaoli
- Advanced Technology Center for Aging Research, Scientific Technological Area, IRCCS INRCA, Ancona, Italy
| | - Katia Fabi
- Unit of Neurology, IRCCS INRCA, Ancona, Italy
| | | | | | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Via Santa Margherita 5, 60124, Ancona, Italy.
| | - Graziano Onder
- Department of Cardiovascular and endocrine-metabolic diseases, and aging, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Volpato
- Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Carmelinda Ruggiero
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Via Santa Margherita 5, 60124, Ancona, Italy
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Shafiee Hanjani L, Hubbard RE, Freeman CR, Gray LC, Scott IA, Peel NM. Medication use and cognitive impairment among residents of aged care facilities. Intern Med J 2020; 51:520-532. [PMID: 32092243 DOI: 10.1111/imj.14804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Potentially inappropriate polypharmacy is common in residential aged care facilities (RACF). This is of particular concern among people with cognitive impairment who, compared with cognitively intact residents, are potentially more sensitive to the adverse effects of medications. AIM To compare the patterns of medication prescribing of RACF residents based on cognitive status. METHODS De-identified data collected during telehealth-mediated geriatric consultations with 720 permanent RACF residents were analysed. Residents were categorised into cognitively intact, mild to moderate impairment and severe impairment groups using the interRAI Cognitive Performance Scale. The number of all regular and when-required medications used in the past 3 days, the level of exposure to anti-cholinergic/sedative medications and potentially inappropriate medications and the use of preventive and symptom control medications were compared across the groups. RESULTS The median number of medications was 10 (interquartile range (IQR) 8-14). Cognitively intact residents were receiving significantly more medications (median (IQR) 13 (10-16)) than those with mild to moderate (10 (7-13)) or severe (9 (7-12)) cognitive impairment (P < 0.001). Overall, 82% of residents received at least one anti-cholinergic/sedative medication and 26.9% were exposed to one or more potentially inappropriate medications, although the proportions of those receiving such medications were not significantly different across the groups. Of 7658 medications residents were taking daily, 21.3% and 11.7% were classified as symptom control and preventive medications respectively with no significant difference among the groups in their use. CONCLUSION Our findings highlight the need for optimising prescribing in RACF residents, with particular attention to medications with anti-cholinergic effects.
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Affiliation(s)
- Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher R Freeman
- Centre for Optimising Pharmacy Practice-based Excellence in Research, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian A Scott
- PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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14
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Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
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Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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15
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Peel NM, Hornby-Turner YC, Henderson A, Hubbard RE, Gray LC. Prevalence and Impact of Functional and Psychosocial Problems in Hospitalized Adults: A Prospective Cohort Study. J Am Med Dir Assoc 2019; 20:1294-1299.e1. [DOI: 10.1016/j.jamda.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/28/2019] [Accepted: 03/17/2019] [Indexed: 10/26/2022]
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Hwang AB, Boes S, Nyffeler T, Schuepfer G. Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. PLoS One 2019; 14:e0219569. [PMID: 31344048 PMCID: PMC6657852 DOI: 10.1371/journal.pone.0219569] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION As the population ages, Alzheimer's disease and other subtypes of dementia are becoming increasingly prevalent. However, in recent years, diagnosis has often been delayed or not made at all. Thus, improving the rate of diagnosis has become an integral part of national dementia strategies. Although screening for dementia remains controversial, the case is strong for screening for dementia and other forms of cognitive impairment in hospital inpatients. For this reason, the objective of this systematic review was to provide clinicians, who wish to implement screening, an up-to-date choice of cognitive tests with the most extensive evidence base for the use in elective hospital inpatients. METHODS For this systematic review, PubMed, PsycINFO and Cochrane Library were searched by using a multi-concept search strategy. The databases were accessed on April 10, 2019. All cross-sectional studies that utilized brief, multi-domain cognitive tests as index test and a reference standard diagnosis of dementia or mild cognitive impairment as comparator were included. Only studies conducted in the hospital setting, sampling from unselected, elective inpatients older than 64 were considered. RESULTS Six studies met the inclusion criteria, with a total of 2112 participants. Diagnostic accuracy data for the Six-Item Cognitive Impairment Test, Cognitive Performance Scale, Clock-Drawing Test, Mini-Mental Status Examination, and Time & Change test were extracted and descriptively analyzed. Clinical and methodological heterogeneity between the studies precluded performing a meta-analysis. DISCUSSION This review found only a small number of instruments and was not able to recommend a single best instrument for use in a hospital setting. Although it was not possible to estimate the pooled operating characteristics, the included description of instrument characteristics, the descriptive analysis of performance measures, and the critical evaluation of the reporting studies may contribute to clinician's choice of the screening instrument that fits best their purpose.
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Affiliation(s)
- Aljoscha Benjamin Hwang
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Thomas Nyffeler
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Guido Schuepfer
- Staff Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
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17
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Gray LC, Beattie E, Boscart VM, Henderson A, Hornby-Turner YC, Hubbard RE, Wood S, Peel NM. Development and Testing of the interRAI Acute Care: A Standardized Assessment Administered by Nurses for Patients Admitted to Acute Care. Health Serv Insights 2018; 11:1178632918818836. [PMID: 30618486 PMCID: PMC6299328 DOI: 10.1177/1178632918818836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Underpinning standards for developing comprehensive care in hospital is the need to identify, early in the admission process, functional and psychosocial issues which affect patient outcomes. Despite the value of comprehensive assessment of patients on admission, the process is often sub-optimal due to a lack of standardized assessment practices. This project aimed to develop a concise, integrated assessment for patients admitted to acute care and test its psychometric properties. Methods: Two international expert panels of clinicians and health scientists collaborated to establish design parameters. Using clinical observations and a variety of derivative applications sourced from the interRAI research collaborative repository, the panels constructed a draft instrument to examine feasibility, resource requirements, and inter-rater reliability. Field testing was conducted in Australia and Canada. Next, the system was revised to its final form, the interRAI Acute Care, after feedback and review from international interRAI members. Results: Constructed using 56 items, the interRAI Acute Care required a median of 15 minutes to complete. Inter-rater reliability tested on 130 paired assessments was substantial to almost perfect for 78% of the clinical items and moderate for the remaining 22% of items. A subset of 30 items from the admission assessment comprised the discharge assessment. Discussion: The interRAI Acute Care has been shown to be an efficient nursing assessment instrument with good psychometric properties. Implementation in a digital environment will enable documentation and care planning to comply with standards for quality of care in the general adult hospital population.
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Affiliation(s)
- Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Veronique M Boscart
- Schlegel Centre for Advancing Seniors Care, Conestoga College, Kitchener, ON, Canada
| | - Amanda Henderson
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yvonne C Hornby-Turner
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Susan Wood
- Quality and Patient Safety, Canterbury and West Coast District Health Boards, Christchurch, New Zealand
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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18
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Betini RSD, Hirdes JP, Curtin-Telegdi N, Gammage L, Vansickle J, Poss J, Heckman G. Development and validation of a screener based on interRAI assessments to measure informal caregiver wellbeing in the community. BMC Geriatr 2018; 18:310. [PMID: 30545318 PMCID: PMC6293658 DOI: 10.1186/s12877-018-0986-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/20/2018] [Indexed: 12/04/2022] Open
Abstract
Background Informal caregivers are invaluable partners of the health care system. However, their caring responsibilities often affect their psychological wellbeing and ability to continue in their role. It is of paramount importance to easily identify caregivers that would benefit from immediate assistance. Methods In this nonexperimental cohort study, a cross-sectional analysis was conducted among 362 informal caregivers (mean age 64.1 years, SD ± 13.1) caring for persons with high care needs (mean age 78.6 years, SD ± 15.0). Caregivers were interviewed using an interRAI-based self-reported survey with 82 items covering characteristics of caregivers including key aspects of wellbeing. A factor analysis identified items in the caregiver survey dealing with subjective wellbeing that were compared against other wellbeing measures. A screener, called Caregiver Wellbeing Index (CWBI), consisting of four items with response scores ranging from 0 to 2 was created. The CWBI was validated in a follow-up study in which 1020 screeners were completed by informal caregivers of home care clients. Clinical assessments of the care recipients (n = 262) and information on long-term care home (LTCH) admission (n = 176) were linked to the screener dataset. The association between the CWBI scores and caregiver and care recipient characteristics were assessed using logistic regression models and chi-square tests. The reliability of CWBI was also measured. Results The CWBI scores ranging from zero to eight were split in four ‘wellbeing’ levels (excellent, good, fair, poor). In the validation study, fair/poor psychological wellbeing was strongly associated with caregiver reports of inability to continue in their role; conflict with family; or feelings of distress, anger, or depression (P < 0.0001). Caregivers caring for a care recipient that presented changes in behavior, cognition, and mood were more likely to present fair/poor wellbeing (P < 0.0001). Additionally, caregivers with high CWBI scores (poor wellbeing) were also more likely to provide care for someone who was admitted to a LTCH (OR 3.52, CI 1.32–9.34) after controlling for care recipient and caregiver characteristics. The Cronbach alpha value 0.89 indicated high reliability. Conclusion The CWBI is a valid screener that can easily identify caregivers that might benefit from further assessment and interventions.
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Affiliation(s)
- Raquel S D Betini
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - John P Hirdes
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Nancy Curtin-Telegdi
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Lisa Gammage
- Nucleus Independent Living, Oakville, ON, L6H 6P5, Canada
| | - Jennifer Vansickle
- Hamilton Niagara Haldimand Brant Local Health Integration Network, Hamilton, ON, L8J 0G5, Canada
| | - Jeff Poss
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - George Heckman
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.,Schlegel Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
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Jordan J, Crowe M, Gillon D, McCall C, Frampton C, Jamieson H. Reduced Pain Reports With Increasing Cognitive Impairment in Older Persons in New Zealand. Am J Alzheimers Dis Other Demen 2018; 33:463-470. [PMID: 29716389 PMCID: PMC10852435 DOI: 10.1177/1533317518772685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Conflicting findings prevail about pain in older persons with cognitive impairment. There is evidence of changed pain perception; however, pain is also underrecognized. Pain and cognitive impairment were examined in a national cohort of older persons assessed using the Home Care International Residential Assessment Instrument (interRAI-HC). METHODS Participants were 41 459 aged 65+ years receiving a mandated needs assessment to access publicly funded services. InterRAI-HC pain severity and Cognitive Performance Scale analyses covaried for age, gender, and ethnicity. RESULTS Milder pain prevalence increased with age, whereas daily severe-excruciating pain prevalence decreased with age. Daily severe-excruciating pain was reported by 18% of cognitively intact individuals decreasing to 8% in the severe cognitive impairment group. This relationship remained after covarying for age, sex, and ethnicity. Differences among dementia subtypes were found. CONCLUSION Although severe pain reports decrease with increasing age and cognitive impairment, more nuanced research covarying for dementia severity and subtype is required.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Deborah Gillon
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Cate McCall
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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20
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Martinez-Ruiz A, Huang Y, Gee S, Jamieson H, Cheung G. Individual risk factors for possible undetected dementia amongst community-dwelling older people in New Zealand. DEMENTIA 2018; 19:750-765. [PMID: 29989431 DOI: 10.1177/1471301218786277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is general acknowledgement of the importance of early diagnosis of dementia, yet there are still high rates of undetected dementia internationally. The aim of this cross-sectional study was to determine the sociodemographic characteristics associated with possible undetected dementia in a large sample of community-dwelling older New Zealanders. The sample consisted of older people (age ≥ 65) who had received the homecare version of the international Residential Home Care Assessment version 9.1 over a two-year period and who were screened positive for possible dementia on the international Residential Assessment’s Cognitive Performance Scale. People with possible alternative explanations for impaired cognitive performance such as depression and other neurological conditions were excluded from analysis. The 5202 eligible individuals were categorized into two groups: (1) those with a recorded diagnosis of dementia (64%) and (2) those without a recorded diagnosis of dementia (i.e. possible undetected dementia group) (36%). Logistic regression was used to evaluate the association between individual characteristics and possible undetected dementia. Significant risk factors for being in the possible undetected dementia group included Asian ethnicity, living alone, not having participated in long-standing social activities recently, major life stressors, and limited accessibility of their house. The knowledge gained from this study could enable targeting of services and resources for the groups at risk of undetected dementia to have a more equitable access to early diagnosis.
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Affiliation(s)
- Adrian Martinez-Ruiz
- National Institute of Geriatrics of Mexico, México.,University of Auckland, New Zealand
| | - Ying Huang
- University of Auckland, New Zealand.,University of Auckland, New Zealand
| | - Susan Gee
- Canterbury District Health Board, New Zealand.,University of Auckland, New Zealand
| | - Hamish Jamieson
- University of Otago, New Zealand.,University of Auckland, New Zealand
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Psychometric Evaluation of the interRAI Child and Youth Mental Health Disruptive/Aggression Behaviour Scale (DABS) and Hyperactive/Distraction Scale (HDS). Child Psychiatry Hum Dev 2018; 49:279-289. [PMID: 28791517 DOI: 10.1007/s10578-017-0751-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The present study aims to validate the interRAI Child and Youth Mental Health (interRAI ChYMH), Disruptive/Aggression Behaviour Scale (DABS) and Hyperactive/Distraction Scale (HDS). Data were collected from children/youth aged 4-18 (N = 3464) across 39 mental health agencies in Ontario, Canada. Unrestricted factor analysis using polychoric correlation matrices and Samejima's graded item response theory (IRT) parameterizations were conducted for both measures. Scores on the HDS and DABS were also compared amongst children/youth diagnosed with attention-deficit hyperactivity disorder (ADHD) and disruptive behaviour disorder (DBD) respectively using DSM-IV criteria. Results from the factor analysis and IRT analysis demonstrated good measurement properties. Using a receiver operating characteristics curve, the area under the curve (AUC) for the HDS and DABS is 0.79 and 0.75 for a diagnosis of ADHD and DBD respectively. Overall, converging results suggest that the interRAI HDS and DABS may serve as effective measures that detect externalizing mental health indicators.
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Gagliardi C, Corsonello A, Di Rosa M, Fabbietti P, Cherubini A, Mercante O, Mazzei B, Postacchini D, Deales A, Bustacchini S, Lattanzio F. Preadmission Functional Decline Predicts Functional Improvement Among Older Patients Admitted to Acute Care Hospital. J Gerontol A Biol Sci Med Sci 2017; 73:1363-1369. [DOI: 10.1093/gerona/glx211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cristina Gagliardi
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Andrea Corsonello
- Italian National Research Center on Aging (INRCA), Research Hospital of Cosenza, Italy
| | - Mirko Di Rosa
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Paolo Fabbietti
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Antonio Cherubini
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Oriano Mercante
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Bruno Mazzei
- Italian National Research Center on Aging (INRCA), Research Hospital of Cosenza, Italy
| | - Demetrio Postacchini
- Italian National Research Center on Aging (INRCA), Research Hospital of Fermo, Italy
| | - Alberto Deales
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Silvia Bustacchini
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
| | - Fabrizia Lattanzio
- Italian National Research Center on Aging (INRCA), Research Hospital of Ancona and Scientific Direction, Italy
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Martin-Khan MG, Edwards H, Wootton R, Counsell SR, Varghese P, Lim WK, Darzins P, Dakin L, Klein K, Gray LC. Reliability of an Online Geriatric Assessment Procedure Using the interRAI Acute Care Assessment System. J Am Geriatr Soc 2017; 65:2029-2036. [PMID: 28832897 DOI: 10.1111/jgs.14895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine whether geriatric triage decisions made using a comprehensive geriatric assessment (CGA) performed online are less reliable than face-to-face (FTF) decisions. DESIGN Multisite noninferiority prospective cohort study. Two specialist geriatricians assessed individuals sequentially referred for an acute care geriatric consultation. Participants were allocated to one FTF assessment and an additional assessment (FTF or online (OL)), creating two groups-two FTF (FTF-FTF, n = 81) or online and FTF (OL-FTF, n = 85). SETTING Three acute care public hospitals in two Australian states. PARTICIPANTS Admitted individuals referred for CGA. INTERVENTION Nurse-administered CGA, based on the interRAI Acute Care assessment system accessed online and other online clinical data such as pathology results and imaging enabling geriatricians to review participants' information and provide input into their care from a distance. MEASUREMENTS The primary decision subjected to this analysis was referral for permanent residential care. Geriatricians also recorded recommendations for referrals and variations for medication management and judgment regarding prognosis at discharge and after 3 months. RESULTS Overall percentage agreement was 88% (n = 71) for the FTF-FTF group and 91% (n = 77) for the OL-FTF group. The difference in agreement between the FTF-FTF and OL-FTF groups was -3%, indicating that there was no difference between the methods of assessment. Judgements made regarding diagnoses of geriatric syndromes, medication management, and prognosis (with regard to hospital outcome and location at 3 months) were found to be equally reliable in each mode of consultation. CONCLUSION Geriatric assessment performed online using a nurse-administered structured CGA system was no less reliable than conventional assessment in making clinical triage decisions.
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Affiliation(s)
- Melinda G Martin-Khan
- Centre for Research in Geriatric Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Centre for Online Health, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Helen Edwards
- Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Richard Wootton
- The University of Queensland, Woolloongabba, Queensland, Australia
| | - Steven R Counsell
- Center for Aging Research and Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Paul Varghese
- Princess Alexandra Hospital, Queensland Health, Woolloongabba, Brisbane, Queensland, Australia
| | - Wen Kwang Lim
- @Age, Melbourne Health, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Research Centre, Northern Health, Epping, Victoria, Australia
| | - Peteris Darzins
- Eastern Health Clinical School, Eastern Health, Box Hill, Victoria, Australia.,Geriatric Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lucy Dakin
- Ipswich Hospital, West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Kerenaftali Klein
- Clinical Trials and Biostatistics Centre, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Leonard C Gray
- Centre for Research in Geriatric Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Centre for Online Health, The University of Queensland, Woolloongabba, Queensland, Australia
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Tanuseputro P, Hsu A, Kuluski K, Chalifoux M, Donskov M, Beach S, Walker P. Level of Need, Divertibility, and Outcomes of Newly Admitted Nursing Home Residents. J Am Med Dir Assoc 2017; 18:616-623. [PMID: 28377155 DOI: 10.1016/j.jamda.2017.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. DESIGN Retrospective cohort study. SETTING A total of 640 publicly funded nursing homes (also known as long-term care facilities) in Ontario, Canada. PARTICIPANTS All newly admitted residents between January 1, 2010 and March 1, 2012. MEASUREMENTS We categorized residents into 36 groups based on different levels of (1) cognitive impairment, (2) difficulty in activities of daily living (ADL), (3) difficulty in instrumental ADLs, and (4) whether or not they had a caregiver at home. Residents were then categorized as having low, intermediate, or high needs; applying results from previous "Balance of Care" studies, we also captured the proportion who could have been cost-effectively diverted into the community. We then contrasted the characteristics of residents across the needs and divertible groupings, and compared 4 outcomes among these groups: hospital admissions, emergency department visits, mortality, and return to home. RESULTS A population-level cohort of 64,105 incident admissions was captured. About two-thirds had great difficulty performing ADLs (65%) and had mild to severe cognitive impairment (66%); over 90% had great difficulty with instrumental ADLs. Just less than 50% of the new admissions were considered to be residents with high care needs (cognitively impaired with great ADL difficulty), while only 4.5% (2880 residents) had low care needs (cognition and ADL intact). Those with dementia (71.0%) and previous stroke (21.5%) were over-represented in the high needs group. Those that cannot be divertible to anywhere else but an institution with 24 hour nursing care comprised 41.3% (n = 26,502) of residents. Only 5.4% (n = 3483), based on community resources available, could potentially be cost-effectively diverted to the community. Those at higher needs experienced higher rates of mortality, higher total cost across all health sectors, and lower rates of return to home. CONCLUSIONS The majority of those admitted into nursing homes have high levels of need (driven largely by dementia and stroke) and could not have their needs met cost-effectively elsewhere, suggesting that the system is at capacity. Caring for the long-term care needs of the aging population should consider the balance of investments in institution and community settings.
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Affiliation(s)
- Peter Tanuseputro
- Bruyère Research Institute, Bruyère Center of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada.
| | - Amy Hsu
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Kerry Kuluski
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mathieu Chalifoux
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Population Health and Primary Care, Ottawa, Ontario, Canada
| | - Melissa Donskov
- Bruyère Research Institute, Bruyère Center of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada
| | - Sarah Beach
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Peter Walker
- Bruyère Research Institute, Bruyère Center of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada
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Simultaneous temporal trends in dementia incidence and prevalence, 2005-2013: a population-based retrospective cohort study in Saskatchewan, Canada. Int Psychogeriatr 2016; 28:1643-58. [PMID: 27352934 DOI: 10.1017/s1041610216000818] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006 to 2012/2013 to: (1) examine simultaneous temporal trends in annual age- and sex-specific dementia incidence and prevalence among individuals aged 45 and older, and (2) stratify the changes in incidence over time by database of identification. METHODS Using a population-based retrospective cohort study design, data were extracted from seven provincial administrative health databases linked by a unique anonymized identification number. Individuals 45 years and older at first identification of dementia between April 1, 2005 and March 31, 2013 were included, based on case definition criteria met within any one of four administrative health databases (hospital, physician, prescription drug, and long-term care). RESULTS Between 2005/2006 and 2012/2013, the 12-month age-standardized incidence rate of dementia declined significantly by 11.07% and the 12-month age-standardized prevalence increased significantly by 30.54%. The number of incident cases decreased from 3,389 to 3,270 and the number of prevalent cases increased from 8,795 to 13,012. Incidence rate reductions were observed in every database of identification. CONCLUSIONS We observed a simultaneous trend of decreasing incidence and increasing prevalence of dementia over a relatively short 8-year time period from 2005/2006 to 2012/2013. These trends indicate that the average survival time of dementia is lengthening. Continued observation of these time trends is warranted given the short study period.
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Kuluski K, Gandhi S, Diong C, Steele Gray C, Bronskill SE. Patterns of community follow-up, subsequent health service use and survival among young and mid-life adults discharged from chronic care hospitals: a retrospective cohort study. BMC Health Serv Res 2016; 16:382. [PMID: 27522347 PMCID: PMC4983410 DOI: 10.1186/s12913-016-1631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite the demand for rehabilitation and chronic care services across the life course, policy and care strategies tend to focus on older adults and overlook medically complex younger adult populations. This study examined young and mid-life adults discharged from tertiary chronic care hospitals in order to describe their health service use and to examine the association between patterns of timely community follow-up, and subsequent health outcomes. METHODS This population-based retrospective cohort study used linked administrative data to identify 1,906 individuals aged 18-64 years and discharged alive from tertiary chronic care hospitals in Ontario, Canada between April 1, 2005 and March 31, 2006. Multivariate Cox proportional hazard models were used to examine the effect of community follow-up within 7 days of discharge (home care and/or a primary care physician visit or neither) on time to first hospitalization and emergency department (ED) visit. Five-year survival was examined using Kaplan-Meier survival curves. RESULTS The cohort had a high prevalence of multi-morbidity and use of hospital, emergency services and physician services was high in the year following discharge. Most individuals received follow-up care from a primary care physician and/or home care within 7 days of discharge while 30 % received neither. Within 1 year of discharge, 18 % of individuals died. Among those who survived, time to acute care hospitalization in the year following discharge was significantly longer among those who received both a home care and a physician follow-up visit compared to those who received neither. No significant associations were found between community follow-up and ED visits within 1 year. CONCLUSIONS Immediate community follow-up may reduce subsequent use of acute care services. Future research should determine why some individuals, who would likely benefit from services, are not receiving them including barriers to access.
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Affiliation(s)
- Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
| | - Sima Gandhi
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
| | - Christina Diong
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital Site), 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
| | - Susan E. Bronskill
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3 M6 Canada
- Institute for Clinical Evaluative Sciences, G123, 2075 Bayview Avenue, Toronto, ON M4N 3 M5 Canada
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27
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Creavin ST, Wisniewski S, Noel‐Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev 2016; 2016:CD011145. [PMID: 26760674 PMCID: PMC8812342 DOI: 10.1002/14651858.cd011145.pub2] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia. OBJECTIVES To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia. SEARCH METHODS We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall. SELECTION CRITERIA We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating. DATA COLLECTION AND ANALYSIS At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method. MAIN RESULTS We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data. AUTHORS' CONCLUSIONS The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.
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Affiliation(s)
- Sam T Creavin
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Susanna Wisniewski
- Cochrane Dementia and Cognitive Improvement Group, Oxford UniversityOxfordUK
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineRoom 4401c (4th Floor)John Radcliffe Hospital, HeadingtonOxfordUKOX3 9DU
| | - Clare M Trevelyan
- Avon and Wiltshire Mental Health Partnership NHS TrustMedical EducationWoodland View, Brentry LaneBristolUKBS10 6NB
| | - Thomas Hampton
- Frimley Health NHS Foundation TrustENTFrimley Park HospitalPortsmouth RoadFrimley, CamberleySurreyUKGU16 7UJ
| | - Dane Rayment
- Avon and Wiltshire Partnership NHS TrustOlder Adult PsychiatryJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Victoria M Thom
- Avon & Wiltshire Mental Health Partnership NHS TrustForensic PsychiatryFromeside, Blackberry Hill HospitalBristolUKBS16 1EG
| | | | - Hosam Elhamoui
- Somerset Partnership NHS TrustPsychiatry91 Comeytrowe LaneTauntonSomersetUKTA1 5QG
| | - Rowena Milligan
- Mansion House SurgeryGeneral PracticeAbbey StreetStoneStaffordshireUKST15 0WA
| | - Anish S Patel
- Avon and Wiltshire Mental Health Partnership NHS TrustNBT Acute Mental Health Liaison TeamDonal Early HouseSouthmead HospitalBristolUKBS10 5NB
| | - Demitra V Tsivos
- North Bristol NHS TrustNeuropsychologySouthmead HospitalBristolUKBS10 5NB
| | - Tracey Wing
- Taunton and Somerset NHS trustCare of Elderly/ITU/A+EBristolUKBS1 3DH
| | - Emma Phillips
- 2gether NHS Foundation TrustCharlton Lane HospitalCheltenhamGloucestershireUKGL53 9DZ
| | - Sophie M Kellman
- Avon and Wiltshire Mental Health Partnership NHS TrustJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Hannah L Shackleton
- NHS ScotlandNHS Forth ValleyFalkirk Community Hospital, Majors LoanFalkirkUK
| | | | - Bethany E Neale
- RCGP Severn FacultyGeneral PracticeDeanery HouseBristolUKBA16 1GW
| | | | - Sarah Cullum
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
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Morris JN, Howard EP, Steel K, Perlman C, Fries BE, Garms-Homolová V, Henrard JC, Hirdes JP, Ljunggren G, Gray L, Szczerbińska K. Updating the Cognitive Performance Scale. J Geriatr Psychiatry Neurol 2016; 29:47-55. [PMID: 26251111 DOI: 10.1177/0891988715598231] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/24/2015] [Indexed: 01/10/2023]
Abstract
This study presents the first update of the Cognitive Performance Scale (CPS) in 20 years. Its goals are 3-fold: extend category options; characterize how the new scale variant tracks with the Mini-Mental State Examination; and present a series of associative findings. Secondary analysis of data from 3733 older adults from 8 countries was completed. Examination of scale dimensions using older and new items was completed using a forward-entry stepwise regression. The revised scale was validated by examining the scale's distribution with a self-reported dementia diagnosis, functional problems, living status, and distress measures. Cognitive Performance Scale 2 extends the measurement metric from a range of 0 to 6 for the original CPS, to 0 to 8. Relating CPS2 to other measures of function, living status, and distress showed that changes in these external measures correspond with increased challenges in cognitive performance. Cognitive Performance Scale 2 enables repeated assessments, sensitive to detect changes particularly in early levels of cognitive decline.
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Affiliation(s)
- John N Morris
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | | | - Knight Steel
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Christopher Perlman
- School of Public Health and Health System, University of Waterloo, Waterloo, Ontario, Canada
| | - Brant E Fries
- Institute of Gerontology and Geriatric Research, Education and Clinical Center, Ann Arbor VA Healthcare Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Jean-Claude Henrard
- Versailles-Saint Quentin, En Yvelines (UVSQ) University, Laboratoire Santé, Environment Vieillissement, Paris, France
| | - John P Hirdes
- Ontario Home Care Research and Knowledge Exchange Chair, University of Waterloo, Waterloo, Ontario, Canada
| | - Gunnar Ljunggren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Public Healthcare Services Committee Administration, Stockholm County Council, Stockholm, Sweden
| | - Len Gray
- Centre for Research in Geriatric Medicine, Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, at The Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Kraków, Poland
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29
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Kosteniuk JG, Morgan DG, O'Connell ME, Kirk A, Crossley M, Teare GF, Stewart NJ, Bello-Haas VD, Forbes DA, Innes A, Quail JM. Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study. BMC Geriatr 2015; 15:73. [PMID: 26135912 PMCID: PMC4489119 DOI: 10.1186/s12877-015-0075-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/16/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Determining the epidemiology of dementia among the population as a whole in specific jurisdictions - including the long-term care population-is essential to providing appropriate care. The objectives of this study were to use linked administrative databases in the province of Saskatchewan to determine the 12-month incidence and prevalence of dementia for the 2012/13 period (1) among individuals aged 45 and older in the province of Saskatchewan, (2) according to age group and sex, and (3) according to diagnosis code and other case definition criteria. METHODS We used a population-based retrospective cohort study design and extracted data from 10 provincial health databases linked by a unique health services number. The cohort included individuals 45 years and older at first identification of dementia between April 1, 2001 and March 31, 2013 based on case definitions met within any one of four administrative health databases (Hospital Discharge Abstracts, Physician Service Claims, Prescription Drug, and RAI-MDS, i.e., Long-term Care). RESULTS A total of 3,270 incident cases of dementia (7.28 per 1,000 PAR) and 13,012 prevalent cases (28.16 per 1,000 PAR) were identified during 2012/13. This study found the incidence rate increased by 2.8 to 5.1 times and the prevalence rate increased by 2.6 to 4.6 times every 10 years after 45 years of age. Overall, the age-standardised incidence rate was significantly lower among females than males (7.04 vs. 7.65 per 1,000 PAR) and the age-standardised prevalence rate was significantly higher among females than males (28.92 vs. 26.53 per 1,000 PAR). Over one-quarter (28 %) of all incident cases were admitted to long-term care before a diagnosis was formally recorded in physician or hospital data, and nearly two-thirds of these cases were identified at admission with impairment at the moderate to very severe level or a disease category of Alzheimer's disease/other dementia. CONCLUSIONS Linking multiple sources of registry data contributes to our understanding of the epidemiology of dementia across multiple segments of the population, inclusive of individuals residing in long-term care. This information is foundational for public awareness and policy recommendations, health promotion and prevention strategies, appropriate health resource planning, and research priorities.
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Affiliation(s)
- Julie G Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, PO Box 23, 104 Clinic Place, Saskatoon, S7N 2Z4, SK, Canada.
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Andrew Kirk
- Division of Neurology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Margaret Crossley
- Department of Psychology (Professor Emerita), University of Saskatchewan, Saskatoon, SK, Canada.
| | - Gary F Teare
- Saskatchewan Health Quality Council, Saskatoon, SK, Canada.
| | - Norma J Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
| | | | - Dorothy A Forbes
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
| | - Anthea Innes
- Bournemouth University Dementia Institute, Bournemouth University, Dorset, UK.
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30
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Resident Assessment Instrument in der Schweiz. Z Gerontol Geriatr 2015; 48:114-20. [DOI: 10.1007/s00391-015-0864-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 10/24/2022]
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Peel NM, Chan KW, Hubbard RE. Outcomes of cognitively impaired older people in Transition Care. Australas J Ageing 2014; 34:53-7. [PMID: 25420587 DOI: 10.1111/ajag.12168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The benefits of Transition Care Programs (TCPs) for patients with cognitive impairment are not well established. This study aimed to investigate the impact of TCP on patients according to their cognitive status. METHODS In this prospective cohort study, 351 patients were comprehensively assessed at TCP admission using the interRAI Home Care instrument and divided into two groups based on scores on the Cognitive Performance Scale. RESULTS Of 346 patients assessed for cognition, 242 (69.9%) were considered cognitively intact, and 104 (30.1%) were classified as cognitively impaired (Cognitive Performance Scale ≥ 2). There were no significant differences in TCP outcomes between the two groups, including community living at six months (P = 0.1), hospital readmission rates (P = 0.6), or achievement of TCP goals (P = 0.3). CONCLUSIONS Cognitively intact and cognitively impaired patients have similar outcomes post-TCP. Older patients should not be refused Transition Care based on the presence of cognitive impairment.
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Affiliation(s)
- Nancye May Peel
- Centre for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Runganga M, Peel NM, Hubbard RE. Multiple medication use in older patients in post-acute transitional care: a prospective cohort study. Clin Interv Aging 2014; 9:1453-62. [PMID: 25214773 PMCID: PMC4158998 DOI: 10.2147/cia.s64105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Older adults with a range of comorbidities are often prescribed multiple medications, which may impact on their function and cognition and increase the potential for drug interactions and adverse events. Aims This study investigated the extent of polypharmacy and potentially inappropriate medications in patients receiving post-discharge transitional home care and explored the associations of polypharmacy with patient characteristics, functional outcomes, and frailty. Methods A prospective observational study was conducted of 351 patients discharged home from hospital with support from six Transition Care Program (TCP) sites in two states of Australia. A comprehensive geriatric assessment was conducted at TCP admission and discharge using the interRAI Home Care assessment tool, with frailty measured using an index of 57 accumulated deficits. Medications from hospital discharge summaries were coded using the World Health Organization Anatomical Therapeutic Chemical Classification System. Results Polypharmacy (5–9 drugs) was observed in 46.7% and hyperpolypharmacy (≥10 drugs) in 39.2% of patients. Increasing numbers of medications were associated with greater number of comorbid conditions, a higher prevalence of diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, dizziness, and dyspnea and increased frailty. At discharge from the program, the non-polypharmacy group (<5 drugs) had improved outcomes in Activities of Daily Living, Instrumental Activities of Daily Living and fewer falls, which was mediated because of lower levels of frailty. The commonest drugs were analgesics (56.8%) and antiulcer drugs (52.7%). The commonest potentially inappropriate medications were tertiary tricyclic antidepressants. Conclusion Polypharmacy is common in older patients discharged from hospital. It is associated with frailty, falls, and poor functional outcomes. Efforts should be made to encourage regular medication reviews and rationalization of medications as part of discharge planning. Whether careful deprescribing improves outcomes in frail patients should be the focus of randomized trials.
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Affiliation(s)
- Maureen Runganga
- The Prince Charles Hospital, Chermside, QLD, Australia ; Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, QLD, Australia
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, QLD, Australia
| | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, QLD, Australia ; Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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Abstract
BACKGROUND As the population ages, it is increasingly important to use effective short cognitive tests for suspected dementia. We aimed to review systematically brief cognitive tests for suspected dementia and report on their validation in different settings, to help clinicians choose rapid and appropriate tests. METHODS Electronic search for face-to-face sensitive and specific cognitive tests for people with suspected dementia, taking ≤ 20 minutes, providing quantitative psychometric data. RESULTS 22 tests fitted criteria. Mini-Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT) had good psychometric properties in primary care. In the secondary care settings, MMSE has considerable data but lacks sensitivity. 6-Item Cognitive Impairment Test (6CIT), Brief Alzheimer's Screen, HVLT, and 7 Minute Screen have good properties for detecting dementia but need further validation. Addenbrooke's Cognitive Examination (ACE) and Montreal Cognitive Assessment are effective to detect dementia with Parkinson's disease and Addenbrooke's Cognitive Examination-Revised (ACE-R) is useful for all dementias when shorter tests are inconclusive. Rowland Universal Dementia Assessment scale (RUDAS) is useful when literacy is low. Tests such as Test for Early Detection of Dementia, Test Your Memory, Cognitive Assessment Screening Test (CAST) and the recently developed ACE-III show promise but need validation in different settings, populations, and dementia subtypes. Validation of tests such as 6CIT, Abbreviated Mental Test is also needed for dementia screening in acute hospital settings. CONCLUSIONS Practitioners should use tests as appropriate to the setting and individual patient. More validation of available tests is needed rather than development of new ones.
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Pereira EEB, Souza ABFD, Carneiro SR, Sarges EDSNF. Funcionalidade global de idosos hospitalizados. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2014. [DOI: 10.1590/s1809-98232014000100016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objetivo: Identificar a funcionalidade global de idosos submetidos a internação, correlacionando o desempenho para as atividades de vida diária básicas (ABVD) e instrumentais (AIVD) com os principais sistemas funcionais (cognição, humor, mobilidade e comunicação). Métodos: Trata-se de estudo observacional transversal e analítico com a participação de 94 idosos internados em uma clínica médica. Os instrumentos utilizados foram: Escala de Katz, Escala de Lawton & Brody, Miniexame do Estado Mental (MEEM), Escala de Depressão Geriátrica 15 (GDS-15), Teste Timed Up and Go (TUG) e a Avaliação Funcional das Habilidades de Comunicação da Associação Americana de Fonoaudiologia (ASHA FACS). Resultados: Foram avaliados 94 idosos, cuja maioria apresentava algum grau de dependência para ABVD (61,71%) e para AIVD (52,13%). Nos sistemas funcionais, a autonomia mostrou-se preservada, com desempenho médio de 18,14 pontos no MEEM, e de 4,43 pontos na GDS-15; e a independência, alterada, por desempenho médio de 21,82 segundos no TUG, classificando-os com uma mobilidade regular, e de 5,27 pontos na ASHA FACS, considerando-os com a necessidade de auxílio moderado nessa função. Evidenciou-se moderada e significativa associação entre o desempenho para as ABVDs e AIVDs com quase todos os sistemas funcionais. Conclusão: A população estudada apresentou funcionalidade global alterada, devido a algum grau de dependência para as ABVDs e AIVDs, com autonomia preservada e independência prejudicada. As correlações evidenciaram que com o decréscimo dos principais sistemas funcionais, ocorreu declínio da funcionalidade global.
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