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Fret B, Smetcoren AS, De Donder L, Verté D. Preventive Home Visits Among Frail Community-Dwelling Older Adults. The Added Value of Follow-Up Telephone Calls. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:444-457. [PMID: 38491960 DOI: 10.1080/19371918.2024.2325555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
People in need of care and support do not always find appropriate services. This paper aims to explore the content and added value of monthly follow-up telephone calls after preventive home visits. We used both monitoring data and qualitative semi-structured interviews (with older adults, formal and informal caregivers). Results indicate that a majority of older adults (N = 95) received a regular follow-up of four telephone calls. Social connection and involvement were mentioned by all three groups as positive aspects of the program. Although time-consuming, this paper draws attention to the added value of follow-up telephone calls after preventive home visits.
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Affiliation(s)
- Bram Fret
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - An-Sofie Smetcoren
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Liesbeth De Donder
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dominique Verté
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Dicpinigaitis AJ, Khamzina Y, Hall DE, Nassereldine H, Kennedy J, Seymour CW, Schmidt M, Reitz KM, Bowers CA. Adaptation of the Risk Analysis Index for Frailty Assessment Using Diagnostic Codes. JAMA Netw Open 2024; 7:e2413166. [PMID: 38787554 PMCID: PMC11127118 DOI: 10.1001/jamanetworkopen.2024.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/23/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Frailty is associated with adverse outcomes after even minor physiologic stressors. The validated Risk Analysis Index (RAI) quantifies frailty; however, existing methods limit application to in-person interview (clinical RAI) and quality improvement datasets (administrative RAI). Objective To expand the utility of the RAI utility to available International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) administrative data, using the National Inpatient Sample (NIS). Design, Setting, and Participants RAI parameters were systematically adapted to ICD-10-CM codes (RAI-ICD) and were derived (NIS 2019) and validated (NIS 2020). The primary analysis included survey-weighed discharge data among adults undergoing major surgical procedures. Additional external validation occurred by including all operative and nonoperative hospitalizations in the NIS (2020) and in a multihospital health care system (UPMC, 2021-2022). Data analysis was conducted from January to May 2023. Exposures RAI parameters and in-hospital mortality. Main Outcomes and Measures The association of RAI parameters with in-hospital mortality was calculated and weighted using logistic regression, generating an integerized RAI-ICD score. After initial validation, thresholds defining categories of frailty were selected by a full complement of test statistics. Rates of elective admission, length of stay, hospital charges, and in-hospital mortality were compared across frailty categories. C statistics estimated model discrimination. Results RAI-ICD parameters were weighted in the 9 548 206 patients who were hospitalized (mean [SE] age, 55.4 (0.1) years; 3 742 330 male [weighted percentage, 39.2%] and 5 804 431 female [weighted percentage, 60.8%]), modeling in-hospital mortality (2.1%; 95% CI, 2.1%-2.2%) with excellent derivation discrimination (C statistic, 0.810; 95% CI, 0.808-0.813). The 11 RAI-ICD parameters were adapted to 323 ICD-10-CM codes. The operative validation population of 8 113 950 patients (mean [SE] age, 54.4 (0.1) years; 3 148 273 male [weighted percentage, 38.8%] and 4 965 737 female [weighted percentage, 61.2%]; in-hospital mortality, 2.5% [95% CI, 2.4%-2.5%]) mirrored the derivation population. In validation, the weighted and integerized RAI-ICD yielded good to excellent discrimination in the NIS operative sample (C statistic, 0.784; 95% CI, 0.782-0.786), NIS operative and nonoperative sample (C statistic, 0.778; 95% CI, 0.777-0.779), and the UPMC operative and nonoperative sample (C statistic, 0.860; 95% CI, 0.857-0.862). Thresholds defining robust (RAI-ICD <27), normal (RAI-ICD, 27-35), frail (RAI-ICD, 36-45), and very frail (RAI-ICD >45) strata of frailty maximized precision (F1 = 0.33) and sensitivity and specificity (Matthews correlation coefficient = 0.26). Adverse outcomes increased with increasing frailty. Conclusion and Relevance In this cohort study of hospitalized adults, the RAI-ICD was rigorously adapted, derived, and validated. These findings suggest that the RAI-ICD can extend the quantification of frailty to inpatient adult ICD-10-CM-coded patient care datasets.
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Affiliation(s)
- Alis J. Dicpinigaitis
- Department of Neurology, New York Presbyterian–Weill Cornell Medical Center, New York, New York
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico
| | | | - Daniel E. Hall
- Department of Neurology, New York Presbyterian–Weill Cornell Medical Center, New York, New York
- Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Wolff Center, UPMC, Pittsburgh, Pennsylvania
| | - Hasan Nassereldine
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason Kennedy
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher W. Seymour
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Meic Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico
| | - Katherine M. Reitz
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christian A. Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico
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Zhang M, Gao X, Liu M, Gao Z, Sun X, Huang L, Zou T, Guo Y, Chen L, Liu Y, Zhang X, Feng H, Wang Y, Sun Y. Correlation of preoperative frailty with postoperative delirium and one-year mortality in Chinese geriatric patients undergoing noncardiac surgery: Study protocol for a prospective observational cohort study. PLoS One 2024; 19:e0295500. [PMID: 38446754 PMCID: PMC10917300 DOI: 10.1371/journal.pone.0295500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 10/23/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND To Frailty is associated with postoperative delirium (POD) but is rarely assessed in patients undergoing noncardiac surgery. In this study, the correlation between preoperative frailty and POD, one-year mortality will be investigated in noncardiac Chinese geriatric surgery patients. METHODS This study is a prospective, observational, cohort study conducted at a single center with Chinese geriatric patients. Patients who undergo noncardiac surgery and are older than 70 years will be included. A total of 536 noncardiac surgery patients will be recruited from the First Affiliated Hospital of Shandong First Medical University for this study. The Barthel Index (BI) rating will be used to assess the patient's ability to carry out everyday activities on the 1st preoperative day. The modified frailty index (mFI) will be used to assess frailty. Patients in the nonfrailty group will have an mFI < 0.21, and patients in the frailty group will have an mFI ≥ 0.21. The primary outcome is the incidence of POD. Three-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) will be conducted twice daily during the 1st-7th postoperative days, or just before discharge. The secondary outcomes will include one-year mortality, in-hospital cardiopulmonary events, infections, acute renal injury, and cerebrovascular events. DISCUSSION This study will clarify the correlation of preoperative frailty with POD and one-year all-cause mortality in Chinese geriatric patients undergoing noncardiac surgery. Can preoperative frailty predict POD or one-year mortality? In the face of China's serious aging social problems, this result may have important clinical value for the surgical treatment of geriatric patients. TRIAL REGISTRATION This protocol has been registered with ClinicalTrials. Gov on 12 January 2022 (https://clinicaltrials.gov/ct2/show/NCT05189678).
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Affiliation(s)
- Min Zhang
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiaojun Gao
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mengjie Liu
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhongquan Gao
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Xiaxuan Sun
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Linlin Huang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ting Zou
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yongle Guo
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Lina Chen
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yang Liu
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiaoning Zhang
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Hai Feng
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yuelan Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| | - Yongtao Sun
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Howard FD, Green R, Harris J, Ross J, Nicholson C. Understanding the extent to which PROMs and PREMs used with older people with severe frailty capture their multidimensional needs: A scoping review. Palliat Med 2024; 38:184-199. [PMID: 38268061 PMCID: PMC10865766 DOI: 10.1177/02692163231223089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Older people with severe frailty are nearing the end of life but their needs are often unknown and unmet. Systematic ways to capture and measure the needs of this group are required. Patient reported Outcome Measures (PROMs) & Patient reported Experience Measures (PREMs) are possible tools to assist this. AIM To establish whether, and in what ways, the needs of older people living with severe frailty are represented within existing PROMs and PREMs and to examine the extent to which the measures have been validated with this patient group. DESIGN The scoping review follows the method of Arksey and O'Malley. RESULTS Seventeen papers from 9 countries meeting the inclusion criteria and 18 multi-dimensional measures were identified: 17 PROMs, and 1 PROM with PREM elements. Seven out of the 18 measures had evidence of being tested for validity with those with frailty. No measure was developed specifically for a frail population. Using the adapted framework of palliative need, five measures covered all five domains of palliative need (IPOS, ICECAP-SCM, PDI, WHOQOL-BREF, WHOQOL-OLD). The coverage of items within the domains varied between the measures. CONCLUSION Existing PROMs and PREMs are not well designed for what we know about the needs of older people with severe frailty. Future research should firstly focus on adapting and validating the existing measures to ensure they are fit for purpose, and secondly on developing a better understanding of how measures are used to deliver/better person-centred care.
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Affiliation(s)
- Faith D Howard
- Department of Health Sciences, University of Surrey, Guildford, UK
| | - Richard Green
- Department of Health Sciences, University of Surrey, Guildford, UK
| | - Jenny Harris
- Department of Health Sciences, University of Surrey, Guildford, UK
| | - Joy Ross
- St Christopher’s Hospice, London, UK
| | - Caroline Nicholson
- Department of Health Sciences, University of Surrey, Guildford, UK
- St Christopher’s Hospice, London, UK
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Thandi M, Wong ST, Price M, Baumbusch J. Perspectives on the representation of frailty in the electronic frailty index. BMC PRIMARY CARE 2024; 25:4. [PMID: 38166753 PMCID: PMC10759446 DOI: 10.1186/s12875-023-02225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Frailty is a state of increased vulnerability from physical, social, and cognitive factors resulting in greater risk of negative health-related outcomes and increased healthcare expenditure. A 36-factor electronic frailty index (eFI) developed in the United Kingdom calculates frailty scores using electronic medical record data. There is currently no standardization of frailty screening in Canadian primary care. In order to implement the eFI in a Canadian context, adaptation of the tool is necessary because frailty is represented by different clinical terminologies in the UK and Canada. In considering the promise of implementing an eFI in British Columbia, Canada, we first looked at the content validation of the 36-factor eFI. Our research question was: Does the eFI represent frailty from the perspectives of primary care clinicians and older adults in British Columbia? METHODS A modified Delphi using three rounds of questionnaires with a panel of 23 experts (five family physicians, five nurse practitioners, five nurses, four allied health professionals, four older adults) reviewed and provided feedback on the 36-factor eFI. These professional groups were chosen because they closely work as interprofessional teams within primary care settings with older adults. Older adults provide real life context and experiences. Questionnaires involved rating the importance of each frailty factor on a 0-10 scale and providing rationale for ratings. Panelists were also given the opportunity to suggest additional factors that ought to be included in the screening tool. Suggested factors were similarly rated in two Delphi rounds. RESULTS Thirty-three of the 36 eFI factors achieved consensus (> 80% of panelists provided a rating of ≥ 8). Factors that did not achieve consensus were hypertension, thyroid disorder and peptic ulcer. These factors were perceived as easily treatable or manageable and/or not considered reflective of frailty on their own. Additional factors suggested by panelists that achieved consensus included: cancer, challenges to healthcare access, chronic pain, communication challenges, fecal incontinence, food insecurity, liver failure/cirrhosis, mental health challenges, medication noncompliance, poverty/financial difficulties, race/ethnic disparity, sedentary/low activity levels, and substance use/misuse. There was a 100% retention rate in each of the three Delphi rounds. CONCLUSIONS AND NEXT STEPS Three key findings emerged from this study: the conceptualization of frailty varied across participants, identification of frailty in community/primary care remains challenging, and social determinants of health affect clinicians' assessments and perceptions of frailty status. This study will inform the next phase of a broader mixed-method sequential study to build a frailty screening tool that could ultimately become a standard of practice for frailty screening in Canadian primary care. Early detection of frailty can help tailor decision making, frame discussions about goals of care, prevent advancement on the frailty trajectory, and ultimately decrease health expenditures, leading to improved patient and system level outcomes.
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Affiliation(s)
- Manpreet Thandi
- School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Morgan Price
- Department of Family Practice, University of British Columbia, David Strangway Building, Suite 300, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Gu Y, Li Z, Dang A, Zhang W, Liu J, Han X, Li Y, Lv N. Obesity, birth weight, and lifestyle factors for frailty: a Mendelian randomization study. Aging (Albany NY) 2023; 15:14066-14085. [PMID: 38095641 PMCID: PMC10756094 DOI: 10.18632/aging.205290] [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: 06/15/2023] [Accepted: 10/17/2023] [Indexed: 12/21/2023]
Abstract
Obesity, birth weight and lifestyle factors have been found associated with the risk of frailty in observational studies, but whether these associations are causal is uncertain. We conducted a two-sample Mendelian randomization study to investigate the associations. Genetic instruments associated with the exposures at the genome-wide significance level (p < 5 × 10-8) were selected from corresponding genome-wide association studies (n = 143,677 to 703,901 individuals). Summary-level data for the frailty index were obtained from the UK Biobank (n = 164,610) and Swedish TwinGene (n = 10,616). The β of the frailty index was 0.15 (p = 3.88 × 10-9) for 1 standard deviation increase in the prevalence of smoking initiation, 0.19 (p = 3.54 × 10-15) for leisure screen time, 0.13 (p = 5.26 × 10-7) for body mass index and 0.13 (p = 1.80 × 10-4) for waist circumference. There was a suggestive association between genetically predicted higher birth weight and moderate-to-vigorous intensity physical activity with the decreased risk of the frailty index. We observed no causal association between genetically predicted age of smoking initiation and alcoholic drinks per week with the frailty index. This study supports the causal roles of smoking initiation, leisure screen time, overall obesity, and abdominal obesity in frailty. The possible association between higher birth weight, proper physical activity and a decreased risk of frailty needs further confirmation.
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Affiliation(s)
- Yingzhen Gu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zuozhi Li
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Aimin Dang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jinxing Liu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaorong Han
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yifan Li
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Naqiang Lv
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Dent E, Hanlon P, Sim M, Jylhävä J, Liu Z, Vetrano DL, Stolz E, Pérez-Zepeda MU, Crabtree DR, Nicholson C, Job J, Ambagtsheer RC, Ward PR, Shi SM, Huynh Q, Hoogendijk EO. Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology. Ageing Res Rev 2023; 91:102082. [PMID: 37797723 DOI: 10.1016/j.arr.2023.102082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/07/2023]
Abstract
Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
| | - Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, University of Tampere, Tampere, Finland
| | - Zuyun Liu
- Second Affiliated Hospital and School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Dirección de Investigación, ciudad de México, Mexico; Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan Edo. de México
| | | | - Caroline Nicholson
- Centre for Health System Reform & Integration, Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Jenny Job
- Centre for Health System Reform & Integration, Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Rachel C Ambagtsheer
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
| | - Paul R Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
| | - Sandra M Shi
- Hinda and Arthur Marcus Institute for Aging, Hebrew Senior Life, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands; Amsterdam Public Health research institute, Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, the Netherlands.
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Carvacho R, Carrasco M, Fernández MB, Miranda-Castillo C. Predictors of Unmet Needs in Chilean Older People with Dependency: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6928. [PMID: 37887666 PMCID: PMC10606872 DOI: 10.3390/ijerph20206928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
Approximately one in five Chilean older adults has some degree of dependency. Limited evidence is available on self-perceived needs in Latin-American older people. The main aim of this study was to identify predictors of unmet needs of dependent older persons without cognitive impairment, considering personal and primary informal caregivers' factors. This cross-sectional study was conducted with a sample of 77 dyads of older people with dependency and their caregivers. A survey was administered, evaluating sociodemographic characteristics, anxious and depressive symptomatology, health-related quality of life, and social support. Older people's self-reported met and unmet needs and caregivers' burden and self-efficacy were also assessed. To determine predictors of unmet needs, a multiple regression analysis was carried out. Most participants had mild to moderate levels of dependency. The most frequent unmet needs were "daytime activities" (33.8%), "company" (23.4%), "benefits" (23.4%), and "psychological distress" (24.7%). Older people's higher level of dependency and anxious symptomatology were predictors of a higher number of unmet needs, with a model whose predictive value was 31%. The high prevalence of anxious symptomatology and its relationship with the presence of unmet needs highlight the importance of making older people's psychological and social needs visible and addressing them promptly.
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Affiliation(s)
- Raffaela Carvacho
- Millennium Institute for Care Research (MICARE), Santiago 8370146, Chile; (R.C.); (M.B.F.)
| | - Marcela Carrasco
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Center for Studies in Age and Aging (Centro de Estudios de Vejez y Envejecimiento CEVE-UC), Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - María Beatriz Fernández
- Millennium Institute for Care Research (MICARE), Santiago 8370146, Chile; (R.C.); (M.B.F.)
- Center for Studies in Age and Aging (Centro de Estudios de Vejez y Envejecimiento CEVE-UC), Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
- Institute of Sociology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - Claudia Miranda-Castillo
- Millennium Institute for Care Research (MICARE), Santiago 8370146, Chile; (R.C.); (M.B.F.)
- Faculty of Nursing, Universidad Andres Bello, Santiago 8370146, Chile
- Millennium Institute for Research in Depression and Personality, Santiago 7820436, Chile
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Devkota R, Cummings G, Hunter KF, Maxwell C, Shrestha S, Dennett L, Hoben M. Factors influencing emotional support of older adults living in the community: a scoping review protocol. Syst Rev 2023; 12:186. [PMID: 37794514 PMCID: PMC10548654 DOI: 10.1186/s13643-023-02346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Emotional support is key to improve older adults' subjective health, and psychological, social and emotional well-being. However, many older adults living in the community lack emotional support, increasing the risk for loneliness, depression, anxiety, potentially avoidable healthcare use and costs, and premature death. Multiple intersecting factors may influence emotional support of older adults in the community, but these are poorly understood. Studies have focused on specific populations (e.g., older adults with depression, cancer). Although relevant, these studies may not capture modifiable factors for the wider and more diverse population of older adults living in the community. Our scoping review will address these important gaps. We will identify and synthesize the evidence on factors that influence emotional support of older adults in the community. METHODS We will use the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews to guide our review process. We will search MEDLINE, EMBASE, APA Psycinfo, CINAHL, Dissertations and Theses Global, and Scopus from inception. We will include studies published in English, examining factors influencing emotional support of older adults residing in community, without restrictions on the study design or year of publication. We will also include gray literature (dissertations and reports). Two independent reviewers will conduct title, abstract, and full-text screening, as well as risk of bias assessment, using validated quality appraisal tools based on study designs. Discrepancies will be resolved by consensus. The primary reviewer will extract the data from all studies, and the second reviewer will check the extractions of all the studies. We will use descriptive statistics and narrative synthesis for analysis. Family/friend caregivers and older adults involved as an advisory group will help with explaining the findings in terms of whether associations observed reflect their experiences and reality. We will analyze the discussion and generate themes, and summarize in a narrative form. DISCUSSION This scoping review may identify factors that could be modified or mitigated to improve emotional support provision for older adults residing in community. The knowledge will inform the development of tailored interventions directed to older adults and their caregivers. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/4TAEB (associated project link: osf.io/6y48t).
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Affiliation(s)
- Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Greta Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Colleen Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
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Son BK, Miura T, Yabu KI, Sumikawa Y, Kim D, Lyu W, Yang Y, Tanaka M, Tanaka T, Yoshizawa Y, Iijima K. The Co-Design/Co-Development and Evaluation of an Online Frailty Check Application for Older Adults: Participatory Action Research with Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6101. [PMID: 37372688 DOI: 10.3390/ijerph20126101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Frailty is an age-related condition characterized by a decline in physical capacity with an increased vulnerability to stressors. During the COVID-19 pandemic, there was considerable progression in frailty in older adults. Therefore, an online frailty check (FC) is required for continuous screening, especially acceptable to older adults. We aimed to co-design/co-develop an online FC application with FC supporters who were facilitators in a pre-existing onsite FC program in the community. It consisted of a self-assessment of sarcopenia and an 11-item questionnaire assessing dietary, physical, and social behaviors. Opinions obtained from FC supporters (median 74.0 years) were categorized and implemented. The usability was assessed using the system usability scale (SUS). For both FC supporters and participants (n = 43), the mean score was 70.2 ± 10.3 points, which implied a "marginally high" acceptability and a "good" adjective range. Multiple regression analysis showed that the SUS score was significantly correlated with onsite-online reliability, even after adjusting for age, sex, education level, and ICT proficiency (b = 0.400, 95% CI: 0.243-1.951, p = 0.013). We also validated the online FC score, which showed a significant association between onsite and online FC scores (R = 0.670, p = 0.001). In conclusion, the online FC application is an acceptable and reliable tool to check frailty for community-dwelling older adults.
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Affiliation(s)
- Bo-Kyung Son
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-0033, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takahiro Miura
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Human Augmentation Research Center (HARC), National Institute of Advanced Industrial Science and Technology (AIST), Kashiwa 277-0882, Japan
| | - Ken-Ichiro Yabu
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Research Center for Advanced Science and Technology (RCAST), The University of Tokyo, Tokyo 153-8904, Japan
| | - Yuka Sumikawa
- Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Dongyool Kim
- Department of Agribusiness Management, Faculty of International Agriculture and Food Studies, Tokyo University of Agriculture, Tokyo 156-8502, Japan
| | - Weida Lyu
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yingxue Yang
- Graduate School of Education, The University of Tokyo, Tokyo 113-0033, Japan
| | - Moeko Tanaka
- Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
| | - Yasuyo Yoshizawa
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-0033, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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11
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Yin Z, Ying Y, Li X, Jiang Y, He B, Zheng E, Huang L, Li H, Zhang C, Fu L. Post-discharge care needs of the older people with hospital-associated disability: A longitudinal study. J Clin Nurs 2023; 32:1303-1315. [PMID: 35332590 DOI: 10.1111/jocn.16293] [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: 09/20/2021] [Revised: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the change and associated factors of care needs within 6 months post-discharge in older people with hospital-associated disability, and the relationship between time-varying care needs and physical function. BACKGROUND Older people with hospital-associated disability will have various care needs post-discharge. Understanding their care needs will help to improve their health. However, studies on this population are still limited. DESIGN A longitudinal study. METHODS The older people who met the inclusion and exclusion criteria were selected in 2 tertiary hospitals in Zhejiang Province, China. The questionnaire survey method was used to collect data about socio-demographic characteristics, physical function and care needs. The data of 375 older people who completed follow-up were analysed using logistic regression analysis, generalised estimating equations and generalised additive mixed model. We followed STROBE checklist for reporting the study. RESULTS The care needs of the older people with hospital-associated disability declined unevenly, it decreased rapidly in the first three months, and then flattening out. The percentage of people with care needs in each dimension decreased over time, but daily care and rehabilitation needs were consistently more important. Socio-demographic factors and physical function had different effects on need at different time points, the physical function was the main factor among them. There were non-linear relationships between the physical function and different care needs with different inflection points. CONCLUSION This research revealed change patterns of the care needs of older people with hospital-associated disability post-discharge and the non-linear relationship between physical function and care needs. These findings may help healthcare professionals and caregivers to provide accurate care. RELEVANCE TO CLINICAL PRACTICE The findings can be used to identify effective approaches to address the care needs of older people with hospital-associated disability based on the time of discharge, in conjunction with age, education, and especially physical function, which will promote the justify allocation of nursing resources. What does this paper contribute to the wider global clinical community?
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Affiliation(s)
- Zhiqin Yin
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yisha Ying
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Xiuyue Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yuqi Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Buxin He
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Enjie Zheng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Lili Huang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Hui Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Chunmei Zhang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Liyan Fu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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12
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Li J, Wu D, Li H, Chen J. Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis. Front Public Health 2023; 11:1064846. [PMID: 36815170 PMCID: PMC9939901 DOI: 10.3389/fpubh.2023.1064846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Abstract
Objectives Older populations have a relatively high prevalence of unmet healthcare needs, which can result in poor health status. Moreover, in the coming century, frailty is expected to become one of the most serious global public health challenges. However, there is a lack of clear evidence proving an association between unmet healthcare needs and frailty. This study aimed to assess whether unmet healthcare needs predict the onset of frailty in China. Methods The association between frailty and unmet healthcare needs was explored by analyzing data from the China Health and Retirement Longitudinal Study (CHARLS) using random-effects logistic regression and Cox regression with time-varying exposure. Results At baseline, 7,719 respondents were included in the analysis. Random-effects logistic regression shows that unmet outpatient healthcare needs were associated with increased risk of both contemporaneous (adjusted OR [aOR], 1.17; 95% CI, 1.02-1.35) and lagged (aOR, 1.24; 95% CI, 1.05-1.45) frailty, as were unmet inpatient needs (contemporaneous: aOR, 1.28; 95% CI, 1.00-1.64; lagged: aOR, 1.55; 95% CI, 1.17-2.06). For respondents not classified as frail at baseline (n = 5,392), Cox regression with time-varying exposure shows significant associations of both unmet outpatient needs (adjusted HR, 1.23; 95% CI, 1.05-1.44) and unmet inpatient needs (adjusted HR, 1.48; 95% CI, 1.11-1.99) with increased risk of developing frailty. Conclusions Reducing unmet healthcare needs would be a valuable intervention to decrease frailty risk and promote healthy aging in middle-aged and older populations. It is urgent and essential that the equity and accessibility of the medical insurance and health delivery systems be strengthened.
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Affiliation(s)
- Jun Li
- Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and Technology, Wuhan, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China,*Correspondence: Haomiao Li ✉
| | - Jiangyun Chen
- School of Health Management, Southern Medical University, Guangzhou, China
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13
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Meng Y, Luo Y, Yue J, Nie M, Fan L, Li T, Tong C. The effect of perceived social support on frailty and depression: A multicategorical multiple mediation analysis. Arch Psychiatr Nurs 2022; 40:167-173. [PMID: 36064241 DOI: 10.1016/j.apnu.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/16/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022]
Abstract
The mediating effects of three sources of perceived social support on frailty severity and depression were examined. Conducted in rural China, data on 570 frail older women were studied. Results showed that significant others' support (mainly daughters) (β = 0.177 for frailty score = 3) mediated the relationship between frailty severity and depression, and the 95 % bias-corrected bootstrap confidence intervals did not straddle zero (0.013-0.419), while the mediating effects of family support (mainly sons) and friends support were not observed. Support from daughters contributes to frail mothers' mental health.
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Affiliation(s)
- Yanting Meng
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China; Medical College of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Yang Luo
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China.
| | - Jing Yue
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Min Nie
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Ling Fan
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Ting Li
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Chenxi Tong
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
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14
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Frechman E, Buck HG, Dietrich MS, Maxwell CA. Development of a Planning for Aging and Frailty Questionnaire. Res Gerontol Nurs 2022; 15:239-244. [PMID: 36113008 DOI: 10.3928/19404921-20220830-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a gap in understanding adults' readiness to plan for adaptions across the aging trajectory. The purpose of the current psychometric project was to develop and test the Planning for Aging and Frailty Questionnaire. Clinical experience and extant literature formed the basis for creating items measuring planning for aging. Content validity was established with gerontology and health service research experts. Face validity testing was conducted through two cognitive interviewing and debriefing sessions at a senior center. All survey questions resulted in a content validity index ≥0.80 from experts. Face validity testing involved successful completion of the survey by 12 adults followed by cognitive interviewing/debriefing, resulting in minor changes. The 21-item Planning for Aging and Frailty Questionnaire demonstrates good initial validity and can be used to measure readiness in planning for aging and personal experiences and experiences with others. Further testing with additional usage is warranted. [Research in Gerontological Nursing, 15(5), 239-244.].
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15
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Frechman E, Dietrich MS, Buck HG, Rhoten BA, Maxwell CA. PLAN: Preparing and Living for Aging Now; A descriptive study invesitigating older adults' readiness to plan for aging and frailty. Geriatr Nurs 2022; 47:164-170. [PMID: 35914494 DOI: 10.1016/j.gerinurse.2022.07.008] [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: 05/29/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many older adults want to age in place but do not make plans. Understanding how and under what conditions adults prepare/plan ahead is vital given population aging and increasing frailty. This study examines the stages of change and experiences (personal/others) related to readiness to plan for aging and frailty. METHODS Descriptive cross-sectional. SETTING Community-dwelling. PARTICIPANTS Adults aged 50-80(N = 252). DATA COLLECTION demographics, other characteristics, stages of change, experiences (personal/others) was assessed with survey questions. DATA ANALYSIS frequencies/percentages, McNemar test, Chi-square. RESULTS Among domains, participants' percentages in action/maintenance stages ranged from 28.2% (cognitive) to 68.7% (financial). Participants had increased experience with others across domains rather than self. Older participants (≥ 70) vs. younger (50-69) reported statistically significant greater planning in action/maintenance stages for all domains (p < .05) with the exception of cognitive. DISCUSSION Examining the concept of planning for aging and frailty provides a foundation for future work to develop/test interventions aimed at increasing readiness for aging.
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Affiliation(s)
- Erica Frechman
- Atrium Health 920 Church St N., Concord, NC 28025, United States.
| | - Mary S Dietrich
- Vanderbilt University School of Medicine & School of Nursing, Nashville, TN, United States
| | - Harleah G Buck
- Csomay Center for Gerontological Excellence, University of Iowa College of Nursing, Iowa City, IA, United States
| | - Bethany A Rhoten
- Vanderbilt University School of Nursing, Nashville, TN, United States
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, Nashville, TN, United States
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16
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Abstract
OBJECTIVES Frailty, a multifaceted geriatric condition, is an emerging global health problem. Integrated care models designed to meet the complex needs of the older people with frailty are required. Early identification of innovative models may inform policymakers and other stakeholders of service delivery alternatives they can introduce and locally adapt so as to tackle system fragmentation and lack of coordination. This study used horizon scanning methodologies to systematically search for, prioritise and assess new integrated care models for older people with frailty and investigated experts' views on barriers and facilitators to the adoption of horizon scanning in health services research. METHODS A four-step horizon scanning review was performed. Frailty-specific integrated care models and interventions were identified through a review of published literature supplemented with grey literature searches. Results were filtered and prioritised according to preset criteria. An expert panel focus group session assessed the prioritised models and interventions on innovativeness, impact and potential for implementation. The experts further evaluated horizon scanning for its perceived fruitfulness in aiding decision-making. RESULTS Nine integrated care models and interventions at system level (n=5) and community level (n=4) were summarised and assessed by the expert panel (n=7). Test scores were highest for the Walcheren integrated care model (system-based model) and EuFrailSafe (community-based intervention). The participants stated that horizon scanning as a decision-making tool could aid in assessing knowledge gaps, criticising the status quo and developing new insights. Barriers to adoption of horizon scanning on individual, organisational and wider institutional level were also identified. CONCLUSION Study findings demonstrated that horizon scanning is a potentially valuable tool in the search for innovative service delivery models. Further studies should evaluate how horizon scanning can be institutionalised and effectively used for serving this purpose.
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Affiliation(s)
- Ashwanee A Kjelsnes
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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17
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Prevalence and determinants of care needs among older people in Ghana. PLoS One 2022; 17:e0263965. [PMID: 35167602 PMCID: PMC8846497 DOI: 10.1371/journal.pone.0263965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Given the longevity noticed among older people in Ghana, and the potential occurrence of functional disability in later years of life, it has become essential to understand their care needs. This study examined the care needs in daily tasks and associated factors in Ghana, following the World Health Organisation International Classification of Functioning, Disability and Health framework.
Materials and methods
A cross-sectional survey was conducted among a sample of 400 older people from Komfo Anokye Teaching Hospital in Southern Ghana. Care need was assessed by one question; “Do you regularly need help with daily tasks because of long-term illness, disability, or frailty?” Multivariate logistic regression was used to test the association between care need and independent variables based on the WHO-ICF conceptual framework.
Results
Majority of the sample (81%), particularly women (54%) reported needing care in daily tasks. Per the WHO-ICF conceptual framework, functional disability—activity variable, (OR = 1.07 95%CI: 1.05–1.09, p<0.001), and absence of government support—an environmental factor, (OR = 3.96 95%CI: 1.90–8.25, p<0.001) were associated with care need.
Conclusions
The high prevalence of care needs among older people may offer an indication that majority of older people in Ghana could benefit from long-term care services. Functional disability and the absence of government support are the major issues that need to be prioritised in addressing the increased demand for care related to performing daily tasks among older people in Ghana.
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Werner C, Wolf-Belala N, Nerz C, Abel B, Braun T, Grüneberg C, Thiel C, Büchele G, Muche R, Hendlmeier I, Schäufele M, Dams J, König HH, Bauer JM, Denkinger M, Rapp K. A multifactorial interdisciplinary intervention to prevent functional and mobility decline for more participation in (pre-)frail community-dwelling older adults (PromeTheus): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2022; 22:124. [PMID: 35164686 PMCID: PMC8842871 DOI: 10.1186/s12877-022-02783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Age-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dwelling older adults are, however, often not yet established and implemented in routine practice. Research on the feasibility, implementation, and (cost-)effectiveness of multifactorial, interdisciplinary intervention programs that take advantage of available services of healthcare providers is also limited. The main aim of this study is to evaluate the effectiveness of such an intervention program (PromeTheus) to prevent functional and mobility decline for more participation in community-dwelling (pre-)frail older adults. Methods The study is designed as a three-center, randomized controlled trial with a 12-month intervention period. Four hundred community-dwelling (pre-)frail (Clinical Frailty Scale score 4–6) older adults (≥70 years) will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will receive the PromeTheus program consisting of obligatory home-based physical exercises (Weight-bearing Exercise for Better Balance) accompanied by physiotherapists and facultative counseling services (person-environment-fit, coping with everyday life, nutrition, group-based activities) delivered via existing healthcare structures (e.g., social workers, nutritionists). The CG will receive usual care and a one-time counseling session on recommendations for physical activity and nutrition. Primary outcomes assessed at months 6 and 12 are the function component of the Late-Life Function and Disability Instrument and the University of Alabama at Birmingham Life-Space Assessment. Secondary outcomes are disability, physical capacity and activity, frailty, nutritional status, falls, fear of falling, health status, and psychosocial components. Process and economic evaluations are also conducted. Primary statistical analyses will be based on the intention-to-treat principle. Discussion Compared to usual care, the PromeTheus program is expected to result in higher function and mobility, greater independence and lower need for care, and more participation. As the PromeTheus program draws on existing German healthcare structures, its large-scale translation and delivery will be feasible, if evidence of (cost-)effectiveness and successful implementation can be demonstrated. Trial registration German Clinical Trials Register, . Registered on March 11, 2021.
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Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | | | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Bastian Abel
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Reiner Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ingrid Hendlmeier
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Martina Schäufele
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Denkinger
- Institute for Geriatric Research, Ulm University, Ulm, Germany.,Agaplesion Bethesda Clinic, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
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Lette M, Stoop A, Nijpels G, Baan C, de Bruin S, van Hout H. Safety risks among frail older people living at home in the Netherlands - A cross-sectional study in a routine primary care sample. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e469-e477. [PMID: 33201562 PMCID: PMC9292903 DOI: 10.1111/hsc.13230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 08/28/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
Frail older people face a range of problems and risks that could undermine their ability to live safely at home. A comprehensive overview of these risks, from a multidimensional perspective, is currently lacking. This study aims to examine the prevalence of risks in multiple domains of life among frail older people living at home. We used cross-sectional data from 824 people aged 65 years and older, who received a comprehensive geriatric assessment (the interRAI Home Care [interRAI-HC]) between 2014 and 2018, as part of routine care from 25 general practices in the region of West-Friesland, the Netherlands. The interRAI-HC identifies amenable risks related to people's clinical conditions, functioning, lifestyle and behaviour, and social and physical environment. Descriptive statistics were used to examine population characteristics (age, gender, marital status, living arrangements and presence of chronic conditions) and prevalence of risks. Most common risks were related to people's clinical conditions (i.e cardio-respiratory health, urinary incontinence, pain), functioning (i.e. limitations in instrumental activities of daily living and mood) and social environment (i.e. limitations in informal care and social functioning). More than 80% of frail older people faced multiple risks, and often on multiple domains of life simultaneously. People experiencing multiple risks per person, and on multiple domains simultaneously, were more often widowed and living alone. The multidimensional character of risks among frail older people living at home implies that an integrated approach to care, comprising both health and social care, is necessary. Insight in the prevalence of these risks can give direction to care allocation decisions.
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Affiliation(s)
- Manon Lette
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- SIGRAAmsterdamThee Netherlands
| | - Annerieke Stoop
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
| | - Caroline Baan
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Simone de Bruin
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Hein van Hout
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
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20
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Kinematic characteristics during gait in frail older women identified by principal component analysis. Sci Rep 2022; 12:1676. [PMID: 35102162 PMCID: PMC8803892 DOI: 10.1038/s41598-022-04801-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
Frailty is associated with gait variability in several quantitative parameters, including high stride time variability. However, the associations between joint kinematics during walking and increased gait variability with frailty remain unclear. In the current study, principal component analysis was used to identify the key joint kinematics characteristics of gait related to frailty. We analyzed whole kinematic waveforms during the entire gait cycle obtained from the pelvis and lower limb joint angle in 30 older women (frail/prefrail: 15 participants; non-frail: 15 participants). Principal component analysis was conducted using a 60 × 1224 input matrix constructed from participants’ time-normalized pelvic and lower-limb-joint angles along three axes (each leg of 30 participants, 51 time points, four angles, three axes, and two variables). Statistical analyses revealed that only principal component vectors 6 and 9 were related to frailty. Recombining the joint kinematics corresponding to these principal component vectors revealed that frail older women tended to exhibit greater variability of knee- and ankle-joint angles in the sagittal plane while walking compared with non-frail older women. We concluded that greater variability of knee- and ankle-joint angles in the sagittal plane are joint kinematic characteristics of gait related to frailty.
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21
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Liu PJ, Wang A, Schwab-Reese LM, Stratton SK. Elder Mistreatment Victims during the COVID-19 Pandemic: Administrative Data from San Francisco Adult Protective Services. JOURNAL OF FAMILY VIOLENCE 2022; 37:1027-1040. [PMID: 34413572 PMCID: PMC8363489 DOI: 10.1007/s10896-021-00305-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 05/05/2023]
Abstract
This study examined elder mistreatment victims' experiences at the beginning of the COVID-19 pandemic, focusing on their COVID-19 awareness and unmet needs. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews with clients or collaterals (client's family, trusted other, or service provider) to inquire about clients' awareness of COVID-19 and unmet needs. Nine-hundred-and-thirty-four (71%) of 1,313 APS' past clients or their collaterals were interviewed, with 741 (79%) responding positively to COVID-19-awareness questions, and 697 (75%) having no unmet needs. Binary logistic regression with Firth adjusted maximum likelihood estimation method revealed that older persons (p < .05), self-neglectors (p < .05), and victims of neglect (p < .05) were less aware of COVID-19. Unmet needs varied by mistreatment type. Victims of isolation were more likely to have medical needs (p < .05), while victims of emotional abuse were more likely to report loneliness (p < .001). Case notes reflected clients who were well-prepared for the pandemic, versus those who required additional assistance to follow preventative measures of the COVID-19 pandemic to stay home. Although the majority of San Francisco APS' past clients experienced no unmet needs at the beginning of the COVID-19 pandemic, the prolonged length and intensity of the pandemic could have exacerbated this vulnerable group's situation. Collaboration between service providers is key in assisting victims experiencing unmet needs to live safely in a public health crisis, especially underserved victims of specific ethnic backgrounds.
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Affiliation(s)
- Pi-Ju Liu
- School of Nursing and Center on Aging and the Life Course, Purdue University, 502 North University Street, West Lafayette, IN 47907 USA
| | - Aining Wang
- Department of Statistics, Purdue University, West Lafayette, USA
| | | | - Sara K. Stratton
- Department of Aging and Adult Services, San Francisco Adult Protective Services, San Francisco, USA
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22
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Older Adults' Demand for Integrated Care and Its Influencing Factors: A Scoping Review. Int J Integr Care 2021; 21:28. [PMID: 34963757 PMCID: PMC8663746 DOI: 10.5334/ijic.5946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Integration has become a major concern for governments, healthcare and aged care systems in many countries. However, the research on and implementation of integrated care in China started relatively late, and there is no review on the needs of older adults with regard to integrated care and the influencing factors. Therefore, this paper aims to provide a scoping review by searching, evaluating, and summarizing the Chinese and international literature on the need for and the factors influencing integrated care for older people. In addition, this review highlights evidence of the gap between China and the world in integrated care. Methods: Using a framework proposed by Arksey and O’Malley, a systematic search of 12 domestic and international databases was conducted. Of the 890 original studies retrieved, those that met the established inclusion criteria were screened and scored using the Ekman quality assessment tool. The qualitative description method was used to summarize the demand for integrated care for older adults and the influencing factors. Results: A total of 49 papers were included. These studies were from eleven countries on five continents (most commonly China and the US) and were mostly cross-sectional quantitative studies that surveyed the integrated care needs of older people living in homes/communities or long-term care facilities. The analysis shows that existing research on the integrated care needs of older people in China adopts a single perspective and is inadequate and unsystematic in its assessment; the integrated care needs of older adults and the factors influencing them are multifaceted; and both in China and internationally, the community-home care scenario most consistently meets the needs and expectations of older adults. Conclusion: Although there is no uniform definition of integrated care in China or abroad and each country has its own national definition and system of integrated care, there are certain commonalities regarding the needs of older adults and the factors that influence them across countries. Our research reveals a gap between China and the international community in terms of integrated care.
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Stein J, Löbner M, Pabst A, Riedel-Heller SG. Unmet needs of the oldest old primary care patients with common somatic and psychiatric disorders-A psychometric evaluation. Int J Methods Psychiatr Res 2021; 30:e1872. [PMID: 33835615 PMCID: PMC8412221 DOI: 10.1002/mpr.1872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Unmet needs are common in older patients and should be assessed via suitable instruments. The adapted German version of the Camberwell Assessment of Need for the Elderly (CANE) represents an often used tool to determine the needs in older individuals. Evidence on the psychometric properties of the CANE is still pending. METHODS A sample of 231 patients with common somatic and psychiatric diseases were interviewed about their needs including their caring relatives and general practitioners (GPs). Frequencies of unmet needs were evaluated across the different perspectives. Interrater agreement, convergent and discriminant validity were evaluated. RESULTS On average, psychiatric patients reported more unmet needs than somatic patients, particularly regarding to psychological distress and behavior. The interrater agreement was higher in the somatic subgroup than in the psychiatric subgroup, and higher between patients and relatives compared to patients and GPs. Evidence for construct validity was reported. CONCLUSIONS Patients with common somatic and psychiatric disorders report specific unmet needs that should be considered in healthcare. Moderate to good psychometric characteristics were found for the CANE. The use of valid instruments to record needs in health and nursing care can be useful and represents an important starting point for targeted interventions and effective treatment.
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Affiliation(s)
- Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
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24
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Blanco-Reina E, Aguilar-Cano L, García-Merino MR, Ocaña-Riola R, Valdellós J, Bellido-Estévez I, Ariza-Zafra G. Assessing Prevalence and Factors Related to Frailty in Community-Dwelling Older Adults: A Multinomial Logistic Analysis. J Clin Med 2021; 10:jcm10163576. [PMID: 34441873 PMCID: PMC8397006 DOI: 10.3390/jcm10163576] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient’s susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the impact of frailty in different settings. The main aim of this study is to determine the prevalence of Fried’s frailty phenotype among community-dwelling older people and to analyse the factors associated with frailty. In this research study, 582 persons aged 65 years or more participated in this cross-sectional study that was conducted at primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional and comprehensive drug therapy data were compiled. The relationship between the independent variables and the different states of frailty was analysed by using a multinomial logistic regression model. Frailty was present in 24.1% of the study sample (95% CI = 20.7–27.6) of whom 54.3% were found to be pre-frail and 21.6% were non-frail. The study variable most strongly associated with frailty was the female gender (OR = 20.54, 95% CI = 9.10–46.3). Other factors found to be associated with the state of frailty included age, dependence for the instrumental activities of daily living (IADL), polymedication, osteoarticular pathology and psychopathology. This study confirms the high prevalence of frailty among community-dwelling older people. Frailty may be associated with many factors. Some of these associated factors may be preventable or modifiable and, thus, provide clinically relevant targets for intervention. This is particularly the case for depressive symptoms, the clinical control of osteoarthritis and the use of polypharmacy.
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Affiliation(s)
- Encarnación Blanco-Reina
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
- Correspondence: ; Tel.: +34-952136648
| | - Lorena Aguilar-Cano
- Physical Medicine and Rehabilitation Department, Hospital Regional Universitario, 29010 Málaga, Spain;
| | | | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18011 Granada, Spain
| | - Jenifer Valdellós
- Health District of Málaga-Guadalhorce, 29009 Málaga, Spain; (M.R.G.-M.); (J.V.)
| | - Inmaculada Bellido-Estévez
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
| | - Gabriel Ariza-Zafra
- Geriatrics Department, Complejo Hospitalario Universitario, 02006 Albacete, Spain;
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25
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Inacio MC, Lang C, Bray SCE, Visvanathan R, Whitehead C, Griffith EC, Evans K, Corlis M, Wesselingh S. Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort. Intern Med J 2021; 51:712-724. [PMID: 32359019 PMCID: PMC8251748 DOI: 10.1111/imj.14871] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022]
Abstract
Background Understanding the health profile, service and medicine use of Australians in the aged care sector will help inform appropriate service provision for our ageing population. Aims To examine the 2006–2015 trends in (i) comorbidities and frailty of individuals accessing aged care, and (ii) health services, medicine use and mortality after entry into long‐term care. Methods Cross‐sectional and population‐based trend analyses were conducted using the Registry of Senior Australians. Results From 2006 to 2015, 509 944 individuals accessed permanent residential care, 206 394 home care, 283 014 respite and 124 943 transition care. Over this time, the proportion of individuals accessing permanent residential care with high frailty scores (≥0.3) increased (19.7–49.7%), as did the proportion with 5–9 comorbidities (46.4–54.5%), with similar trends observed for those accessing other services. The median number of medicines dispensed in the year after entering permanent residential care increased from 9 (interquartile range (IQR) 6–12) to 10 (IQR 7–14), while remaining stable in home care (2006: 9, IQR 5–12, 2015: 9, IQR 6–13). Short‐term (within 100 days) mortality in those accessing permanent care was higher in 2006 (15.6%, 95% CI 15.2–16.0) than 2015 (14.6%, 95% CI 14.3–14.9). Longer term (101–1095 days, 2006: 44.3%, 95% CI 43.7–45.0, 2015: 46.4%, 95% CI 45.8–46.9) mortality was higher in 2015 compared to 2006. Mortality in individuals accessing home care did not change. Conclusion The health of older Australians accessing aged care programmes has declined while frailty increased, with an increasing use of medicine and worse long‐term mortality in some. Funding and care models need to adapt to this changing profile.
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Affiliation(s)
- Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sarah C E Bray
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Geriatrics Training and Research with Aged Care Centre, University of Adelaide, Adelaide, South Australia, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged Care and Palliative Care, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.,Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth C Griffith
- Clinical Research, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Megan Corlis
- Research and Development, Helping Hand Aged Care, Adelaide, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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26
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Farrés-Godayol P, Jerez-Roig J, Minobes-Molina E, Yildirim M, Goutan-Roura E, Coll-Planas L, Escribà-Salvans A, Molas-Tuneu M, Moreno-Martin P, Rierola-Fochs S, Rierola-Colomer S, Romero-Mas M, Torres-Moreno M, Naudó-Molist J, Bezerra de Souza DL, Booth J, Skelton DA, Giné-Garriga M. Urinary incontinence and sedentary behaviour in nursing home residents in Osona, Catalonia: protocol for the OsoNaH project, a multicentre observational study. BMJ Open 2021; 11:e041152. [PMID: 33879481 PMCID: PMC8061864 DOI: 10.1136/bmjopen-2020-041152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/14/2021] [Accepted: 03/24/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Several studies have shown that physical activity (PA) levels and sedentary behaviour (SB) are independent risk factors for many health-related issues. However, there is scarce evidence supporting the relationship between SB and urinary incontinence (UI) in community-dwelling older adults, and no information on any possible association in institutionalised older adults. Stage I of this project has the main objective of determining the prevalence of UI and its associated factors in nursing home (NH) residents, as well as analysing the association between UI (and its types) and SB. Stage II aims to investigate the incidence and predictive factors of functional and continence decline, falls, hospitalisations, mortality and the impact of the COVID-19 pandemic among NH residents. METHODS AND ANALYSIS Stage I is an observational, multicentre, cross-sectional study with mixed methodology that aims to explore the current status of several health-related outcomes in NH residents of Osona (Barcelona, Spain). The prevalence ratio will be used as an association measure and multivariate analysis will be undertaken using Poisson regression with robust variance. Stage II is a 2-year longitudinal study that aims to analyse functional and continence decline, incidence of falls, hospitalisations, mortality and the impact of the COVID-19 pandemic on these outcomes. A survival analysis using the actuarial method for functional decline and continence, evaluated every 6 months, and the Kaplan-Meier method for falls, hospitalisations and deaths, and Cox regression for multivariate analysis will be undertaken. ETHICS AND DISSEMINATION The study received the following approvals: University of Vic - Central University of Catalonia Ethics and Research Committee (92/2019 and 109/2020), Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (FORES) (code 2020118/PR249). Study results will be disseminated at conferences, meetings and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04297904.
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Affiliation(s)
- Pau Farrés-Godayol
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Eduard Minobes-Molina
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Meltem Yildirim
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Ester Goutan-Roura
- Research group on Tissue Repair and Regeneration Laboratory (TR2Lab), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Laura Coll-Planas
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Escribà-Salvans
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Miriam Molas-Tuneu
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Pau Moreno-Martin
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Sandra Rierola-Fochs
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Sergi Rierola-Colomer
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Montse Romero-Mas
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Miriam Torres-Moreno
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Jordi Naudó-Molist
- Research group on Mental Health and Social Innovation (SAMIS), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Dyego Leandro Bezerra de Souza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Joanne Booth
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
- Faculty of Health Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
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Carvacho R, Carrasco M, Lorca MBF, Miranda-Castillo C. Met and unmet needs of dependent older people according to the Camberwell Assessment of Need for the Elderly (CANE): A scoping review. Rev Esp Geriatr Gerontol 2021; 56:225-235. [PMID: 33888307 DOI: 10.1016/j.regg.2021.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
In order to address the complexity of needs of dependent older people, multidimensional and person-centered needs assessment is required. The objective of this review is to describe met and unmet needs of dependent older people, living in the community or in institutions, and the factors associated with those needs. Selection criteria included papers about need asessment which employed the Camberwell Assesment of Need for the Elderly (CANE). A search through MEDLINE, SCOPUS, WOS and CINHAL databases was carried out. Twenty-one articles were finally included. Unmet needs were found more frequently in psychosocial areas (mainly in "company", "daytime activities" and "psychological distress") and in institutionalized population. In addition, unmet needs were often associated with depressive symptoms, dependency, and caregiver burden. Discrepancies between self-reported needs and needs perceived by formal and informal caregivers were identified. It is important that professionals and caregivers try to make visible the perspective of older people and their psychological and social needs, particularly when the person is dependent, depressed or cognitively impaired.
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Affiliation(s)
- Raffaela Carvacho
- Pontificia Universidad Católica de Chile, School of Psychology, Santiago, Chile; Millennium Institute for Caregiving Research, Santiago, Chile
| | - Marcela Carrasco
- Pontificia Universidad Católica de Chile, Faculty of Medicine, Santiago, Chile; UC Center for Studies in Age and Ageing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Beatriz Fernández Lorca
- Pontificia Universidad Católica de Chile, Institute of Sociology, Santiago, Chile; Millennium Institute for Caregiving Research, Santiago, Chile; UC Center for Studies in Age and Ageing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Miranda-Castillo
- Universidad Andres Bello, Faculty of Nursing, Santiago, Chile; Millennium Institute for Caregiving Research, Santiago, Chile; Millennium Institute for Research in Depression and Personality, Santiago, Chile.
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Unmet care needs in the oldest old with social loss experiences: results of a representative survey. BMC Geriatr 2020; 20:416. [PMID: 33081693 PMCID: PMC7576733 DOI: 10.1186/s12877-020-01822-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background Loss experiences such as the loss of a spouse, a close relative or significant others become more likely in old age and may be strongly related to specific unmet health care needs. These unmet needs may often remain undetected and undertreated followed by a negative impact on well-being and social role functioning. The present study aims at exploring the relationship between loss experiences and specific unmet care needs in old age. Methods As part of the study „Need assessment in the oldest old: application, psychometric examination and establishment of the German version of the Camberwell Assessment of Need for the Elderly (CANE)”, the adapted German version of the CANE was used in a population-representative telephone survey in a sample of 988 individuals aged 75+ years. Loss experiences within the last 12 months were assessed within the structured telephone survey. Descriptive and interferential statistical analyses were run in order to examine the association between loss experiences and occurring unmet care needs. Results Overall, 29.7% of the oldest old reported at least one social loss with other relatives losses being the most frequent (12.5%), followed by non-family losses (10.7%). A significant relationship between loss experiences and a higher number of unmet care needs was observed, especially for close family losses. Other risk factors for unmet care needs were age, marital status, depression, social support and morbidity. Conclusions This study provides, for the first time in Germany, data on the association between loss experiences and unmet needs. These findings may substantially contribute to the development of loss-specific interventions, effective treatment and health care planning for the bereaved elderly.
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Eating Alone at Each Meal and Associated Health Status among Community-Dwelling Japanese Elderly Living with Others: A Cross-Sectional Analysis of the KAGUYA Study. Nutrients 2020; 12:nu12092805. [PMID: 32933170 PMCID: PMC7551543 DOI: 10.3390/nu12092805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022] Open
Abstract
This cross-sectional study investigated the association between eating alone at each meal and health status, including functional capacity among community-dwelling Japanese elderly living with others. A self-administered questionnaire was mailed to all 8004 residents aged 65 or older, residing in the same Japanese town in March 2016. Eating alone was assessed by first asking whether participants ate three separate meals each day (i.e., breakfast, lunch, and dinner), and those who answered affirmatively were then asked how many people were usually present at each meal. Health status was assessed in terms of subjective health, medical history, care needs, body mass index, depression, and functional capacity. Data from 2809 respondents were analyzed. Those who reported not being in good subjective health and a history of hypertension were significantly more likely to eat alone at breakfast (odds ratio 1.27; 95% confidence interval 1.01–1.61, and 1.26; 1.06–1.49). Depressive symptoms and many subscales of functional capacity were also significantly associated with eating alone at breakfast, lunch, and dinner (p < 0.05). Many health status indicators were related to eating alone at each meal, especially breakfast.
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Hoogendijk EO, Smit AP, van Dam C, Schuster NA, de Breij S, Holwerda TJ, Huisman M, Dent E, Andrew MK. Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life. J Am Geriatr Soc 2020; 68:2587-2593. [PMID: 32700319 PMCID: PMC7689758 DOI: 10.1111/jgs.16716] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Frailty, loneliness, and social isolation are all associated with adverse outcomes in older adults, but little is known about their combined impact on mortality. DESIGN Prospective cohort study. SETTING The Longitudinal Aging Study Amsterdam. PARTICIPANTS Community-dwelling older adults aged 65 and older (n = 1,427). MEASUREMENTS Frailty was measured with the frailty phenotype (Fried criteria). Loneliness was assessed with the De Jong Gierveld Loneliness Scale. Social isolation was operationalized using information on partner status, social support, and network size. Two categorical variables were created, for each possible combination regarding frailty and loneliness (FL) and frailty and social isolation (FS), respectively. Mortality was monitored over a period of 22 years (1995-2017). Survival curves and Cox proportional hazard models were used to study the effects of the FL and FS combinations on mortality. Analyses were adjusted for sociodemographic factors, depression, chronic diseases, and smoking. RESULTS Frailty prevalence was 13%, and 5.9% of the sample were frail and lonely, and 6.2% frail and socially isolated. In fully adjusted models, older adults who were only frail had a higher risk of mortality compared with people without any of the conditions (hazard ratio [HR] range = 1.40-1.48; P < .01). However, the highest risk of mortality was observed in people with a combined presence of frailty and loneliness or social isolation (HRFL = 1.83; 95% confidence interval [CI] = 1.42-2.37; HRFS = 1.77; 95% CI = 1.36-2.30). Sensitivity analyses using a frailty index based on the deficit accumulation approach instead of the frailty phenotype showed similar results, confirming the robustness of our findings. CONCLUSION Frail older adults are at increased risk of mortality, but this risk is even higher for those who are also lonely or socially isolated. To optimize well-being and health outcomes in physically frail older adults, targeted interventions focusing on both subjective and objective social vulnerability are needed.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Annelot P Smit
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Carmen van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Noah A Schuster
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Sascha de Breij
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Tjalling J Holwerda
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.,Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Souza GAD, Giacomin KC, Firmo JOA. Care for frail older adults in the community: an integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.190134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to identify scientific evidence regarding the care of frail older adults in the community, from the perspective of the older adults themselves. Method: a descriptive, integrative review study was performed. The search for articles was carried out in the Medline, Lilacs, Web of Science, Scopus and SciELO databases. The inclusion criteria were complete available articles; published between 2014 and 2019; written in Portuguese, English, Spanish or French; which had older adults as participants. Results: four categories of analysis emerged from the results: frailty from the perspective of frail older adults; priorities from the perspective of the older adults; the older adults’ perspectives on care by services; and interpersonal relationships in the care of frail older adults. The perception of the older adults has specific characteristics, has maintaining their independence as a focus of care, signals the need to maintain interpersonal relationships, improve communication, and for actions of health education and people-centered services. Conclusion: these points demand the attention of care providers and policy services to improve care delivery and provide actions that are welcomed by this public.
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Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet 2019; 394:1376-1386. [PMID: 31609229 DOI: 10.1016/s0140-6736(19)31785-4] [Citation(s) in RCA: 641] [Impact Index Per Article: 128.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 12/13/2022]
Abstract
Frailty is a complex age-related clinical condition characterised by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors. Because of the heterogeneity of frailty in clinical presentation, it is important to have effective strategies for the delivery of care that range across the continuum of frailty severity. In clinical practice, we should do what works, starting with frailty screening, case identification, and management of frailty. This process is unarguably difficult given the absence of an adequate evidence base for individual and health-system interventions to manage frailty. We advocate change towards individually tailored interventions that preserve an individual's independence, physical function, and cognition. This change can be addressed by promoting the recognition of frailty, furthering advancements in evidence-based treatment options, and identifying cost-effective care delivery strategies.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, Adelaide, SA, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | | | - Howard Bergman
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Jean Woo
- Department of Medicine, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology and Global Brain Health Institute, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet 2019; 394:1365-1375. [PMID: 31609228 DOI: 10.1016/s0140-6736(19)31786-6] [Citation(s) in RCA: 1224] [Impact Index Per Article: 244.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/18/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022]
Abstract
Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, location VU University Medical Center, Amsterdam, Netherlands.
| | - Jonathan Afilalo
- Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Graziano Onder
- Fondazione Policlinico Universitario A Gemelli IRCCS and Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
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Stoop A, Lette M, van Gils PF, Nijpels G, Baan CA, de Bruin SR. Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e549-e566. [PMID: 31225946 PMCID: PMC6852049 DOI: 10.1111/hsc.12793] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person-centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006-2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty-seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty-one different CGAs were identified, of which the EASYcare instrument, RAI-HC/RAI-CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person-centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter-)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.
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Affiliation(s)
- Annerieke Stoop
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Manon Lette
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Paul F. van Gils
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | - Giel Nijpels
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Caroline A. Baan
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Simone R. de Bruin
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
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Kelly G, Mrengqwa L, Geffen L. "They don't care about us": older people's experiences of primary healthcare in Cape Town, South Africa. BMC Geriatr 2019; 19:98. [PMID: 30947709 PMCID: PMC6449977 DOI: 10.1186/s12877-019-1116-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/24/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As older people age, they have different health needs compared to younger people. South African elder care policy places a strong emphasis on ageing in community rather than institutional settings, but the primary healthcare system is not geared to address the health needs of older people living in community settings. METHODS This paper presents findings of nine focus groups conducted with community-dwelling older adults in three areas (high, medium and low-income) in Cape Town, South Africa over 2 months in 2017. These discussions addressed primary health services available to older persons, their ability to access these services and their expectations and experiences of care. RESULTS Findings showed that while participants in the high-income area had few challenges accessing quality care or support services, services available in lower-income areas were much less responsive and participants displayed low trust in the healthcare system, feeling that their needs were overlooked. Participants who experienced poor doctor-patient communication often failed to comply with treatment, while those who experienced patient-centered communication, either through the private sector or NGO-public sector partnerships had better perceptions of care. CONCLUSIONS Older persons' complex health needs cannot be adequately addressed by a process-driven approach to care. Supporting patient-centered communication and care may help health workers to understand older persons health needs and improve patient understanding, trust and co-operation. This paper suggests the importance of community support services in enhancing health access and developing systems that enable healthcare providers to better understand and respond to older persons' needs in resource-constrained settings.
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Affiliation(s)
- Gabrielle Kelly
- Samson Institute for Ageing Research, University of Cape Town, 234 Upper Buitenkant St, Cape Town, 8001 South Africa
| | - Lindeka Mrengqwa
- Samson Institute for Ageing Research, University of Cape Town, 234 Upper Buitenkant St, Cape Town, 8001 South Africa
| | - Leon Geffen
- Samson Institute for Ageing Research, University of Cape Town, 234 Upper Buitenkant St, Cape Town, 8001 South Africa
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Stein J, Liegert P, Dorow M, König HH, Riedel-Heller SG. Unmet health care needs in old age and their association with depression - results of a population-representative survey. J Affect Disord 2019; 245:998-1006. [PMID: 30699886 DOI: 10.1016/j.jad.2018.11.096] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/09/2018] [Accepted: 11/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the demographic changes, unmet health care needs are expected to increase in the elderly population. The aim of this study was to analyse the distribution of met and unmet needs and their association with depression in old age. METHODS Based on a population-representative telephone survey of the elderly population aged 75 + years and older, a sample of 845 individuals was assessed via structured clinical interviews. Data on unmet needs were collected via the adapted German version of the Camberwell Assessment of Need for the Elderly (CANE). Descriptive and interferential statistical analyses were run. RESULTS Most frequently, unmet needs were reported in the CANE sections memory, physical health and mobility. Significant differences with regard to age and gender were observed. Further, regression analyses revealed that unmet needs were significantly associated with depression. LIMITATIONS Data on unmet needs were only assessed from the participants' perspectives. The cross-sectional design of the study does not allow drawing conclusions on causality of results. CONCLUSION This study provides, for the first time in Germany, population-representative data on unmet health care needs in the oldest old and represents an important starting point in the field of health and social care as well as the development of tailored treatment and interventions in old age.
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Affiliation(s)
- Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany.
| | - Paula Liegert
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany
| | - Marie Dorow
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig 04103, Germany
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Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23:771-787. [PMID: 31641726 PMCID: PMC6800406 DOI: 10.1007/s12603-019-1273-z] [Citation(s) in RCA: 417] [Impact Index Per Article: 83.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. METHODS These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.
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Affiliation(s)
- E Dent
- E. Dent, Torrens University Australia, Adelaide, Australia,
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Dent E, van Gaans D. Improving health care accessibility for older adults with frailty: the role of Geographical Information Systems. Aging Clin Exp Res 2018; 30:1257-1258. [PMID: 29302795 DOI: 10.1007/s40520-017-0884-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
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Hermsen LAH, Hoogendijk EO, van der Wouden JC, Smalbrugge M, Leone SS, van der Horst HE, Dekker J. Self-perceived care needs in older adults with joint pain and comorbidity. Aging Clin Exp Res 2018; 30:449-455. [PMID: 28688079 PMCID: PMC5911275 DOI: 10.1007/s40520-017-0795-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/26/2017] [Indexed: 12/03/2022]
Abstract
Background The aim of this study was to explore self-perceived care needs and determinants of identified needs in older adults with joint pain and comorbidity. Methods This is a cross-sectional study using baseline data from a cohort study of older adults in the Netherlands (≥65 years) with joint pain and comorbidity (n = 407). We used the Camberwell Assessment of Need for the Elderly (CANE) to assess self-perceived care needs. Regression analyses were conducted to examine the associations between needs and sociodemographic factors (age, gender, partner status and educational level), physical factors (pain intensity, comorbidity, frailty and physical functioning) and psychosocial factors (anxiety, depression and social support). Results Older adults with joint pain and comorbidity reported on average 4.0 care needs out of 13 CANE items, of which 0.3 were unmet. High levels of environmental and physical needs were reported, such as needs with regard to physical illness (91%), household (61%) and mobility/falls (53%). However, most of these needs were met. Only few people reported psychosocial needs, but a large proportion of these needs was unmet, especially regarding company (66.7%) and daytime activities (37%). Psychosocial needs were more often present in frail participants (OR 2.40, 95% CI 1.25–4.61), and those with less perceived social support (OR 1.05, 95% CI 1.01–1.08) and more depressive symptoms (OR 1.17, 95% CI 1.07–1.26). Discussion/Conclusions Unmet needs are mainly present in the psychosocial domain. Specific attention targeted at these unmet needs may improve psychosocial well-being of older adults with joint pain and comorbidity.
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Affiliation(s)
- Lotte A H Hermsen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Stephanie S Leone
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Public Mental Health, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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van den Brink AMA, Gerritsen DL, de Valk MMH, Mulder AT, Oude Voshaar RC, Koopmans RTCM. What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study. Int J Nurs Stud 2018. [PMID: 29524680 DOI: 10.1016/j.ijnurstu.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Aging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs. METHODS Cross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents' and nursing staff's perceptions. Descriptive and multivariate regression analyses were conducted. RESULTS Residents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n = 2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n = 1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated 'no need' regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs. CONCLUSIONS Systematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable.
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Affiliation(s)
- Anne M A van den Brink
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda M H de Valk
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands.
| | - Astrid T Mulder
- Gelre Hospital, Department of Geriatrics, Postbus 9014, 7300 DS, Apeldoorn, The Netherlands.
| | - Richard C Oude Voshaar
- University Medical Center Groningen, University of Groningen, University Center for Psychiatry and Interdisciplinary Center for Psychopathology of Emotion Regulation, Postbus 30.001, 9700 RB, Groningen, The Netherlands.
| | - Raymond T C M Koopmans
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
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A brief assessment unravels unmet needs of older people in primary care: a mixed-methods evaluation of the SPICE tool in Portugal. Prim Health Care Res Dev 2018; 19:637-643. [PMID: 29352821 DOI: 10.1017/s1463423617000950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Assessments of need may contribute to identifying health problems associated with functional deterioration in older people. A shorter version of the Camberwell Assessment of Need for the Elderly was developed for routine use in primary care, focusing on five domains: Senses, Physical ability, Incontinence, Cognition, and Emotional distress (SPICE). We aimed to explore its usefulness and feasibility in primary care.We selected a consecutive sample of 51 community-dwelling older adults. The SPICE interview was completed by GPs and patients, with perceptions about its use in primary care being explored.Needs were identified in 38 patients. Unmet needs corresponded to 7% of needs overall. 'Emotional distress' was the most frequent unmet need. SPICE helped to identify undisclosed needs, was well accepted and its importance in clinical evaluation recognised by GPs and patients, despite concerns about time constraints. Facilitating strategies are needed to improve the feasibility of these assessments in primary care.
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Gregory A, Mackintosh S, Kumar S, Grech C. Visibility and meanings of partnership in health care for older people who need support to live at home. Scand J Caring Sci 2017; 32:1027-1037. [DOI: 10.1111/scs.12545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Gregory
- University of South Australia; Adelaide SA Australia
| | | | | | - Carol Grech
- University of South Australia; Adelaide SA Australia
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Abstract
ABSTRACTUnderstanding the nature and extent of unmet need for social care among older people is a critical policy priority in the United Kingdom and beyond, as national governments juggle the provision of adequate social care for a growing older population with competing funding priorities. Several factors can heighten the experience of unmet need among older people, for instance their family environment, and their health and socio-economic status. This paper contributes empirical evidence on the patterns of unmet need for social care among older people in England today, focusing on the individual characteristics associated with experiencing unmet need in relation to mobility tasks, activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The results show that about 55 per cent of older individuals with an ADL difficulty had unmet need, compared to 24 per cent of those with an IADL difficulty and 80 per cent of those with a mobility difficulty. Characteristics reflecting greater vulnerability were more strongly associated with the risk of experiencing unmet need for ADLs, and such vulnerability was greater for particular ADLs (e.g. bathing), and for a higher number of ADLs. The findings reaffirm the complexity of conceptualising and empirically investigating unmet need in later life, and add to our understanding of the challenges of providing adequate and appropriate social care to older people.
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Dury S, De Roeck E, Duppen D, Fret B, Hoeyberghs L, Lambotte D, Van der Elst M, van der Vorst A, Schols J, Kempen G, Rixt Zijlstra GA, De Lepeleire J, Schoenmakers B, Kardol T, De Witte N, Verté D, De Donder L, De Deyn PP, Engelborghs S, Smetcoren AS, Dierckx E. Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics. Aging Ment Health 2017; 21:1031-1039. [PMID: 27267783 DOI: 10.1080/13607863.2016.1193120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards. METHODS Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately. RESULTS The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected. DISCUSSION This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.
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Affiliation(s)
- Sarah Dury
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Ellen De Roeck
- b Laboratory of Neurochemistry and Behavior , University of Antwerp , Antwerp , Belgium.,c Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Brussels , Belgium
| | - Daan Duppen
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Bram Fret
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Lieve Hoeyberghs
- d Faculty of Education, Health and Social Work , University College Ghent , Gent , Belgium
| | - Deborah Lambotte
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Michaël Van der Elst
- e Department of General Practice , Catholic University of Leuven , Leuven , Belgium
| | - Anne van der Vorst
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Jos Schols
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.,g Department of General Practice, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Gertrudis Kempen
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - G A Rixt Zijlstra
- f Department of Health Services Research, CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Jan De Lepeleire
- h Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Birgitte Schoenmakers
- h Department of Public Health and Primary Care , University of Leuven , Leuven , Belgium
| | - Tinie Kardol
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Nico De Witte
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium.,d Faculty of Education, Health and Social Work , University College Ghent , Gent , Belgium
| | - Dominique Verté
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Liesbeth De Donder
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Peter Paul De Deyn
- b Laboratory of Neurochemistry and Behavior , University of Antwerp , Antwerp , Belgium
| | | | - An-Sofie Smetcoren
- a Department of Educational Sciences , Vrije Universiteit Brussel , Brussels , Belgium
| | - Eva Dierckx
- c Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Brussels , Belgium
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Lette M, Stoop A, Lemmens LC, Buist Y, Baan CA, de Bruin SR. Improving early detection initiatives: a qualitative study exploring perspectives of older people and professionals. BMC Geriatr 2017. [PMID: 28645251 PMCID: PMC5482941 DOI: 10.1186/s12877-017-0521-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background A wide range of initiatives on early detection and intervention have been developed to proactively identify problems related to health and wellbeing in (frail) older people, with the aim of supporting them to live independently for as long as possible. Nevertheless, it remains unclear what the best way is to design such initiatives and how older people’s needs and preferences can be best addressed. This study aimed to address this gap in the literature by exploring: 1) older people’s perspectives on health and living environment in relation to living independently at home; 2) older people’s needs and preferences in relation to initiating and receiving care and support; and 3) professionals’ views on what would be necessary to enable the alignment of early detection initiatives with older people’s own needs and preferences. Methods In this qualitative study, we conducted semi-structured interviews with 36 older people and 19 professionals in proactive elderly care. Data were analysed using the framework analysis method. Results From the interviews with older people important themes in relation to health and living environment emerged, such as maintaining independence, appropriate housing, social relationships, a supporting network and a sense of purpose and autonomy. Older people preferred to remain self-sufficient, and they would rather not ask for help for psychological or social problems. However, the interviews also highlighted that they were not always able or willing to anticipate future needs, which can hinder early detection or early intervention. At the same time, professionals indicated that older people tend to over-estimate their self-reliance and therefore advocated for early detection and intervention, including social and psychological issues. Conclusion Older people have a broad range of needs in different domains of life. Discrepancies exist between older people and professionals with regard to their views on timing and scope of early detection initiatives. This study aimed to reveal starting-points for better alignment between initiatives and older people’s needs and preferences. Such starting points may support policy makers and care professionals involved in early detection initiatives to make more informed decisions. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0521-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manon Lette
- Amsterdam Public Health research institute, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands. .,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Annerieke Stoop
- Amsterdam Public Health research institute, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands.,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Scientific Center for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Lidwien C Lemmens
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Yvette Buist
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Scientific Center for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Simone R de Bruin
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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van Rijn M, Suijker JJ, Bol W, Hoff E, Ter Riet G, de Rooij SE, Moll van Charante EP, Buurman BM. Comprehensive geriatric assessment: recognition of identified geriatric conditions by community-dwelling older persons. Age Ageing 2016; 45:894-899. [PMID: 27614077 DOI: 10.1093/ageing/afw157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES to study (i) the prevalence of geriatric conditions in community-dwelling older persons at increased risk of functional decline and (ii) the extent to which older persons recognise comprehensive geriatric assessment (CGA)-identified conditions as relevant problems. METHODS trained registered nurses conducted a CGA in 934 out of 1209 older persons at increased risk of functional decline participating in the intervention arm of a randomised trial in the Netherlands. After screening for 32 geriatric conditions, participants were asked which of the identified geriatric conditions they recognised as relevant problems. RESULTS at baseline, the median age of participants was 82.9 years (interquartile range (IQR) 77.3-87.3 years). The median number of identified geriatric conditions per participant was 8 (IQR 6-11). The median number of geriatric conditions that were recognised was 1 (IQR 0-2). Functional dependency and (increased risk of) alcohol and drug dependency were the most commonly identified conditions. Pain was the most widely recognised problem. CONCLUSION CGA identified many geriatric conditions, of which few were recognised as a problem by the person involved. Further study is needed to better understand how older persons interact with identified geriatric conditions, in terms of perceived relevance. This may yield a more efficient CGA and further improve a patient-centred approach.
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Affiliation(s)
- Marjon van Rijn
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jacqueline J Suijker
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - Wietske Bol
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Eva Hoff
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
- University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Ferreira AR, Dias CC, Fernandes L. Needs in Nursing Homes and Their Relation with Cognitive and Functional Decline, Behavioral and Psychological Symptoms. Front Aging Neurosci 2016; 8:72. [PMID: 27148044 PMCID: PMC4838629 DOI: 10.3389/fnagi.2016.00072] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 03/28/2016] [Indexed: 11/13/2022] Open
Abstract
Unmet needs are becoming acknowledged as better predictors of the worst prognostic outcomes than common measures of functional or cognitive decline. Their accurate assessment is a pivotal component of effective care delivery, particularly in institutionalized care where little is known about the needs of its residents, many of whom suffer from dementia and show complex needs. The aims of this study were to describe the needs of an institutionalized sample and to analyze its relationship with demographic and clinical characteristics. A cross-sectional study was conducted with a sample from three nursing homes. All residents were assessed with a comprehensive protocol that included Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Neuropsychiatric Inventory (NPI) and Adults and Older Adults Functional Inventory (IAFAI). To identify needs, the Camberwell Assessment of Need for the Elderly (CANE) was used. The final sample included 175 residents with a mean age of 81 standard deviation (SD = 10) years. From these, 58.7% presented cognitive deficit (MMSE) and 45.2% depressive symptoms (GDS). Statistically significant negative correlations were found between MMSE score and met (r s = -0.425), unmet (r s = -0.369) and global needs (r s = -0.565). Data also showed significant correlations between depressive symptoms and unmet (r s = 0.683) and global needs (r s = 0.407), and between behavioral and psychological symptoms (BPSD) and unmet (r s = 0.181) and global needs (r s = 0.254). Finally, significant correlations between functional impairment and met (r s = 0.642), unmet (r s = 0.505) and global needs (r s = 0.796) were also found. These results suggest that in this sample, more unmet needs are associated with the worst outcomes measured. This is consistent with previous findings and seems to demonstrate that the needs of those institutionalized elderly remain under-diagnosed and untreated.
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Affiliation(s)
- Ana Rita Ferreira
- Department of Health Information and Decision Sciences (CIDES), PhD Program in Clinical and Health Services Research (PDICSS), Faculty of Medicine, University of Porto Porto, Portugal
| | - Cláudia Camila Dias
- Department of Health Information and Decision Sciences (CIDES), Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto Porto, Portugal
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, Center for Health Technology and Services Research (CINTESIS), University of Porto, Clinic of Psychiatry and Mental Health, CHSJ Porto, Portugal
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Stein J, Pabst A, Weyerer S, Werle J, Maier W, Heilmann K, Scherer M, Stark A, Kaduszkiewicz H, Wiese B, Mamone S, König HH, Bock JO, Riedel-Heller SG. The assessment of met and unmet care needs in the oldest old with and without depression using the Camberwell Assessment of Need for the Elderly (CANE): Results of the AgeMooDe study. J Affect Disord 2016; 193:309-17. [PMID: 26774519 DOI: 10.1016/j.jad.2015.12.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/03/2015] [Accepted: 12/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression belongs to the most common mental disorders in late life and will lead to a significant increase of treatment and health care needs in the future. The Camberwell Assessment of Need for the Elderly (CANE) evaluates met and unmet care needs in older individuals. Reports on needs of the elderly with depression are currently lacking. The aim of the present study was to identify met and unmet needs in older primary care patients with and without depression using the German-language version of the CANE. Furthermore, the association between unmet needs and depression ought to be explored. METHODS As part of the study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)", a sample of 1179 primary care patients aged 75 years and older was assessed. Descriptive and inferential statistics as well as logistic regression analyses were conducted. RESULTS This study, for the first time in Germany, provides data on the distribution of met and unmet needs in depressive and non-depressive older primary care patients. As a main result, unmet needs were significantly associated with depression; other risk factors identified were gender, institutionalization, care by relatives and impaired functional status. LIMITATIONS The conclusions about directions and causality of associations between the variables are limited due to the cross-sectional design. CONCLUSIONS The study results provide an important contribution to generate a solid base for an effective and good-quality health and social care as well as to an appropriate allocation of health care resources in the elderly population.
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Affiliation(s)
- Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Katharina Heilmann
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Silke Mamone
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
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Hoogendijk EO, van der Horst HE, van de Ven PM, Twisk JWR, Deeg DJH, Frijters DHM, van Leeuwen KM, van Campen JPCM, Nijpels G, Jansen APD, van Hout HPJ. Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial. Eur J Intern Med 2016; 28:43-51. [PMID: 26597341 DOI: 10.1016/j.ejim.2015.10.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults. METHODS A 24-month stepped wedge cluster randomized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practices in the Netherlands, and included 1147 frail older adults. The intervention consisted of a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Reassessment occurred every six months. Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams. Complex patients were reviewed in multidisciplinary consultations. The primary outcome was quality of life (SF-12). Secondary outcomes were health-related quality of life, functional limitations, self-rated health, psychological wellbeing, social functioning and hospitalizations. RESULTS Intention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes. Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18months (B=-0.25, 95%CI=-0.43 to -0.06, p=0.007), but this effect was not statistically significant after correction for multiple comparisons. CONCLUSION The GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population. TRIAL REGISTRATION The Netherlands National Trial Register NTR2160.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, France; Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Henriëtte E van der Horst
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Peter M van de Ven
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Dorly J H Deeg
- Department of Epidemiology & Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Dinnus H M Frijters
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Karen M van Leeuwen
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Health Sciences, EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University, Amsterdam, The Netherlands.
| | - Jos P C M van Campen
- Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
| | - Giel Nijpels
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Aaltje P D Jansen
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Hein P J van Hout
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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50
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Hoogendijk EO, Suanet B, Dent E, Deeg DJ, Aartsen MJ. Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam. Maturitas 2016; 83:45-50. [DOI: 10.1016/j.maturitas.2015.09.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 09/14/2015] [Indexed: 11/16/2022]
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