1
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Stanbouly D, Stewart SJ, Harris JA, Arce K. Does Alcohol Use Influence Hospitalization Outcomes in Adults Suffering Craniomaxillofacial Fractures From Street Fighting? Craniomaxillofac Trauma Reconstr 2024; 17:132-142. [PMID: 38779398 PMCID: PMC11107825 DOI: 10.1177/19433875231164705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Study Design This retrospective cohort study utilized the National Inpatient Sample (NIS) database for the years 2016-2018. Incidences of street fighting were identified using the corresponding ICD-10 codes. Objective To determine whether alcohol use (measured by blood alcohol content (BAC)) in patients sustaining maxillofacial trauma from hand-to-hand fighting influence hospitalization outcomes. Methods The primary predictor variable was BAC stratified into six categories of increasing magnitude. The primary outcome variable was mean length of hospital stay (days). The secondary outcome variable was total hospital charges (US dollars). Results Our final sample consisted of 3038 craniomaxillofacial fractures. Each additional year in age added +$545 in hospital charges (P < .01). Non-elective admissions added $14 210 in hospital charges (P < .05). Patients admitted in 2018 experienced approximately $7537 more in hospital charges (P < .01). Le Fort fractures (+$61 921; P < .01), mandible fractures (+$13 227, P < .01), and skull base fractures (+$22 170; P < .05) were all independently associated with increased hospital charges. Skull base fractures added +7.6 days to the hospital stay (P < .01) and each additional year in patient age added +.1 days to the length of the hospital stay (P < .01). Conclusions BAC levels did not increase length of stay or hospitalization charges. Le Fort fractures, mandible fractures, and skull base fracture each independently increased hospital charges. This reflects the necessary care (ie, ICU) and treatment (ie, ORIF) of such fractures. Older adults and elderly patients are associated with increased length of stay and hospital charges-they are likely to struggle in navigating the healthcare system and face socioeconomic barriers to discharge.
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Affiliation(s)
- Dani Stanbouly
- Columbia University College of Dental Medicine, New York, NY, USA
| | - Sara J. Stewart
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Kevin Arce
- Division of Oral and Maxillofacial Surgery, Section of Head and Neck Oncologic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
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Smeuninx B, Elhassan YS, Sapey E, Rushton AB, Morgan PT, Korzepa M, Belfield AE, Philp A, Brook MS, Gharahdaghi N, Wilkinson D, Smith K, Atherton PJ, Breen L. A single bout of prior resistance exercise attenuates muscle atrophy and declines in myofibrillar protein synthesis during bed-rest in older men. J Physiol 2023. [PMID: 37856286 DOI: 10.1113/jp285130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Impairments in myofibrillar protein synthesis (MyoPS) during bed rest accelerate skeletal muscle loss in older adults, increasing the risk of adverse secondary health outcomes. We investigated the effect of prior resistance exercise (RE) on MyoPS and muscle morphology during a disuse event in 10 healthy older men (65-80 years). Participants completed a single bout of unilateral leg RE the evening prior to 5 days of in-patient bed-rest. Quadriceps cross-sectional area (CSA) was determined prior to and following bed-rest. Serial muscle biopsies and dual stable isotope tracers were used to determine rates of integrated MyoPS (iMyoPS) over a 7 day habitual 'free-living' phase and the bed-rest phase, and rates of acute postabsorptive and postprandial MyoPS (aMyoPS) at the end of bed rest. Quadriceps CSA at 40%, 60% and 80% of muscle length significantly decreased in exercised (EX) and non-exercised control (CTL) legs with bed-rest. The decline in quadriceps CSA at 40% and 60% of muscle length was attenuated in EX compared with CTL. During bed-rest, iMyoPS rates decreased from habitual values in CTL, but not EX, and were significantly different between legs. Postprandial aMyoPS rates increased above postabsorptive values in EX only. The change in iMyoPS over bed-rest correlated with the change in quadriceps CSA in CTL, but not EX. A single bout of RE attenuated the decline in iMyoPS rates and quadriceps atrophy with 5 days of bed-rest in older men. Further work is required to understand the functional and clinical implications of prior RE in older patient populations. KEY POINTS: Age-related skeletal muscle deterioration, linked to numerous adverse health outcomes, is driven by impairments in muscle protein synthesis that are accelerated during periods of disuse. Resistance exercise can stimulate muscle protein synthesis over several days of recovery and therefore could counteract impairments in this process that occur in the early phase of disuse. In the present study, we demonstrate that the decline in myofibrillar protein synthesis and muscle atrophy over 5 days of bed-rest in older men was attenuated by a single bout of unilateral resistance exercise performed the evening prior to bed-rest. These findings suggest that concise resistance exercise intervention holds the potential to support muscle mass retention in older individuals during short-term disuse, with implications for delaying sarcopenia progression in ageing populations.
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Affiliation(s)
- Benoit Smeuninx
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Cellular & Molecular Metabolism Laboratory, Monash University, Melbourne, Victoria, Australia
| | - Yasir S Elhassan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alison B Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Paul T Morgan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Marie Korzepa
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Archie E Belfield
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Philp
- Centre for Healthy Ageing, Centenary Institute, Camperdown, New South Wales, Australia
| | - Matthew S Brook
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
- MRC-ARUK Centre of Excellence for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK
| | - Nima Gharahdaghi
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
- MRC-ARUK Centre of Excellence for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK
| | - Daniel Wilkinson
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
- MRC-ARUK Centre of Excellence for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK
| | - Kenneth Smith
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
- MRC-ARUK Centre of Excellence for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK
| | - Philip J Atherton
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
- MRC-ARUK Centre of Excellence for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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3
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Huang Q, Li J, Huang N, Xia X, Qiu Y, Zhong Z, Lin Z, Huang X, Zhang D, Huang F. Clinical characteristics and outcomes of antibiotic-associated encephalopathy in patients with end-stage kidney disease. Ren Fail 2022; 44:1708-1716. [PMID: 36259485 PMCID: PMC9586608 DOI: 10.1080/0886022x.2022.2134025] [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] [Indexed: 11/15/2022] Open
Abstract
Objective End-stage kidney disease (ESKD) patients have a higher risk of antibiotic-associated encephalopathy (AAE) than other patients. We aimed to evaluate the prevalence, risk factors and outcomes of AAE in ESKD patients. Method A retrospective study of ESKD patients treated with intravenous antibiotics in our hospital from Jan. 1, 2006, to Dec. 31, 2015 was performed. AAE was diagnosed by the modified Delphi method. Control individuals were randomly selected from the remaining patients who did not exhibit neurologic symptoms. Logistic regression analysis was used to identify risk factors for AAE as well as the association between AAE and outcome. Result A total of 2104 patients were included in the study. The prevalence of AAE in our study was 4.4% (92/2104). The multivariate logistic regression analysis revealed that anuria (OR = 8.04, 95% CI: 4.13–15.65, p < 0.001), history of central nervous system disorder (OR = 3.03, 95% CI: 1.21–7.56, p = 0.018) and hypoalbuminemia (OR= 1.87, 95% CI: 1.01–3.47, p = 0.046) were independent factors associated with AAE in ESKD patients. After adjustment for confounders, AAE was associated with composite outcomes of in-hospital mortality and treatment withdrawal (OR = 4.36, 95% CI: 2.09–9.10, p < 0.001). Conclusion The prevalence of AAE was 4.4% in ESKD patients and varied among different antibiotics. Anuria, history of central nervous system disorder and hypoalbuminemia were associated with AAE in ESKD patients. AAE is associated with worse outcomes in ESKD patients.
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Affiliation(s)
- Qingxiu Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.,Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Jianbo Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Naya Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xi Xia
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Zhong Zhong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Zhenchuan Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.,Department of Nephrology, Kidney and Urology Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xiaowen Huang
- Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Dihua Zhang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
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Hayes C, Manning M, Condon B, Griffin AC, FitzGerald C, Shanahan E, O'Connor M, Glynn L, Robinson K, Galvin R. Effectiveness of community-based multidisciplinary integrated care for older people: a protocol for a systematic review. BMJ Open 2022; 12:e063454. [PMID: 36410816 PMCID: PMC9680188 DOI: 10.1136/bmjopen-2022-063454] [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: 11/23/2022] Open
Abstract
INTRODUCTION The increasing number of older adults with multiple complex care needs has placed increased pressure on healthcare systems internationally to reorientate healthcare delivery. For many older adults, their first point of contact with the health service is with their general practitioner (GP) and GP participation with integrated care models is the foundation of a population-based approach. A knowledge gap remains in relation to the effectiveness of GP participation in community-based integrated health and social care approaches for older adults. This systematic review aims to examine the effectiveness of multidisciplinary-integrated care for community-dwelling older adults with GP participation. METHODS AND ANALYSIS This systematic review will include randomised controlled trials (RCTs), quasi and cluster RCTs focusing on integrated care interventions for community-dwelling older adults by multidisciplinary teams including health and social care professionals and GPs. The databases PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE will be searched. The primary outcome measure will be functional status. Secondary outcomes will include: primary healthcare utilisation, secondary healthcare utilisation, participant satisfaction with care, health-related quality of life, nursing home admission and mortality. The methodological quality of the studies will be assessed using the Cochrane Risk of Bias Tool V.2. The elements of care integration will be mapped in the individual studies using the Rainbow Model of Integrated Care taxonomy. A meta-analysis will be completed, depending on the uniformity of the data. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess the certainty of evidence. ETHICS AND DISSEMINATION Formal ethical approval is not required as all data included are anonymous secondary data. Scientific outputs will be presented at relevant conferences and in collaboration with our public and patient involvement stakeholder panel of older adults at the Ageing Research Centre at the University of Limerick. PROSPERO REGISTRATION NUMBER CRD42022309744.
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Affiliation(s)
- Christina Hayes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Public and Patient Involvement (PPI) Research Unit, University of Limerick, Limerick, Ireland
| | - Brian Condon
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Christina Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Christine FitzGerald
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- HRB, Primary Care Clinical Trials Network, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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5
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Gallego-González E, Mayordomo-Cava J, Vidán MT, Valadés-Malagón MI, Serra-Rexach JA, Ortiz-Alonso J. Functional trajectories associated with acute illness and hospitalization in oldest old patients: Impact on mortality. Front Physiol 2022; 13:937115. [PMID: 36187794 PMCID: PMC9515786 DOI: 10.3389/fphys.2022.937115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The literature pays low attention to functional changes during acute illness in older patients. Our main objectives were to separately describe the different functional changes occurring before and after hospital admission in oldest old medical patients, to investigate their association with mortality, and identify predictors associated with in-hospital failure to recover function.Methods: Secondary analysis of data from a prospective cohort study conducted in a tertiary teaching hospital. The study followed the STROBE criteria. The sample included 604 consecutive patients aged 65 or older hospitalized for acute illness, discharged alive, and not fully dependent at baseline. Activities of daily living measured at baseline, admission, and discharge were used to classify patients into four functional trajectories depending on whether they decline or remain stable between baseline and admission (prehospital) and whether they decline, remain stable, or recover baseline function between admission and discharge (in-hospital). Multivariate models were used to test the association between functional trajectories with mortality, and predictors for in-hospital recovery.Results: Functional trajectories were: “stable-stable” (18%); “decline-recovery” (18%); “decline-no recovery” (53%); “in-hospital decline” (11%). Prehospital decline occurred in 75% and 64% were discharged with worse function than baseline. “In-hospital decline” and “decline-no recovery” trajectories were independently associated with higher 6- and 12-month mortality. Extent of prehospital decline and dementia were predictors of failure to in-hospital recovery.Conclusion: In acutely ill older people, differentiating between prehospital and in-hospital functional changes has prognostic implications. Lack of functional regain at discharge is associated with higher mortality at 6- and 12-months.
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Affiliation(s)
- Eva Gallego-González
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Hospital Universitario HM Montepríncipe, Madrid, Spain
- *Correspondence: Jennifer Mayordomo-Cava,
| | - María T. Vidán
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | | | - José A. Serra-Rexach
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Ortiz-Alonso
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
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6
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Deardorff WJ, Jing B, Jeon SY, Boscardin WJ, Lee AK, Fung KZ, Lee SJ. Do functional status and Medicare claims data improve the predictive accuracy of an electronic health record mortality index? Findings from a national Veterans Affairs cohort. BMC Geriatr 2022; 22:434. [PMID: 35585537 PMCID: PMC9118715 DOI: 10.1186/s12877-022-03126-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Electronic health record (EHR) prediction models may be easier to use in busy clinical settings since EHR data can be auto-populated into models. This study assessed whether adding functional status and/or Medicare claims data (which are often not available in EHRs) improves the accuracy of a previously developed Veterans Affairs (VA) EHR-based mortality index. Methods This was a retrospective cohort study of veterans aged 75 years and older enrolled in VA primary care clinics followed from January 2014 to April 2020 (n = 62,014). We randomly split participants into development (n = 49,612) and validation (n = 12,402) cohorts. The primary outcome was all-cause mortality. We performed logistic regression with backward stepwise selection to develop a 100-predictor base model using 854 EHR candidate variables, including demographics, laboratory values, medications, healthcare utilization, diagnosis codes, and vitals. We incorporated functional measures in a base + function model by adding activities of daily living (range 0-5) and instrumental activities of daily living (range 0-7) scores. Medicare data, including healthcare utilization (e.g., emergency department visits, hospitalizations) and diagnosis codes, were incorporated in a base + Medicare model. A base + function + Medicare model included all data elements. We assessed model performance with the c-statistic, reclassification metrics, fraction of new information provided, and calibration plots. Results In the overall cohort, mean age was 82.6 years and 98.6% were male. At the end of follow-up, 30,263 participants (48.8%) had died. The base model c-statistic was 0.809 (95% CI 0.805-0.812) in the development cohort and 0.804 (95% CI 0.796-0.812) in the validation cohort. Validation cohort c-statistics for the base + function, base + Medicare, and base + function + Medicare models were 0.809 (95% CI 0.801-0.816), 0.811 (95% CI 0.803-0.818), and 0.814 (95% CI 0.807-0.822), respectively. Adding functional status and Medicare data resulted in similarly small improvements among other model performance measures. All models showed excellent calibration. Conclusions Incorporation of functional status and Medicare data into a VA EHR-based mortality index led to small but likely clinically insignificant improvements in model performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03126-z.
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Affiliation(s)
- William James Deardorff
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, San Francisco, CA, 94158, USA.
| | - Bocheng Jing
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, San Francisco, CA, 94158, USA
| | - Sun Y Jeon
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, San Francisco, CA, 94158, USA
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, San Francisco, CA, 94158, USA
| | - Alexandra K Lee
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, San Francisco, CA, 94158, USA
| | - Kathy Z Fung
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Sei J Lee
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
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Effects on clients' daily functioning and common features of reablement interventions: a systematic literature review. Eur J Ageing 2022; 19:903-929. [PMID: 36692753 PMCID: PMC9729664 DOI: 10.1007/s10433-022-00693-3] [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] [Accepted: 03/03/2022] [Indexed: 01/26/2023] Open
Abstract
This systematic review aimed to provide an overview of reablement interventions according to the recently published ReAble definition and their effect on Activities of Daily Living (ADL). In addition, the most common and promising features of these reablement interventions were identified. Four electronic bibliographic databases were searched. Articles were included when published between 2002 and 2020, which described a Randomised or Clinical Controlled Trial of a reablement intervention matching the criteria of the ReAble definition, and had ADL functioning as an outcome. Snowball sampling and expert completion were used to detect additional publications. Two researchers screened and extracted the identified articles and assessed methodological quality; discrepancies were resolved by discussion and arbitration by a third researcher. Twenty relevant studies from eight countries were included. Ten of these studies were effective in improving ADL functioning. Identifying promising features was challenging as an equal amount of effective and non-effective interventions were included, content descriptions were often lacking, and study quality was moderate to low. However, there are indications that the use of more diverse interdisciplinary teams, a standardised assessment and goal-setting method and four or more intervention components (i.e. ADL-training, physical and/or functional exercise, education, management of functional disorders) can improve daily functioning. No conclusions could be drawn concerning the effectiveness on ADL functioning. The common elements identified can provide guidance when developing reablement programmes. Intervention protocols and process evaluations should be published more often using reporting guidelines. Collecting additional data from reablement experts could help to unpack the black box of reablement.
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Kallen MA, Brown HE, Hatton JR, Doyle WA, Murphy R, Elliott R, Gutierrez MA, Catherwood EL, Pitman HP, Liu VX, Gershon RC. New complementary perspectives for inpatient physical function assessment: matched clinician-report and patient-report short form measures from the PROMIS adult physical function item bank. Qual Life Res 2022; 31:2201-2212. [PMID: 35258805 PMCID: PMC9188510 DOI: 10.1007/s11136-022-03089-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose
To develop two item content-matched, precise, score-level targeted inpatient physical function (PF) short form (SF) measures: one clinician-reported, one patient-reported. Items were derived from PROMIS PF bank content; scores are reported on the PROMIS PF T-score metric.
Methods
The PROMIS PF item bank was reviewed for content measuring lower-level PF status (T-scores 10–50) with high item set score-level reliability (≥ 0.90). Selected patient-reported (PR) items were also edited to function as clinician-reported (CR) items. Items were reviewed by clinicians and field tested; responses were assessed for meeting PROMIS measure development standards. New CR and PR items were calibrated using patient responses to the original PROMIS PF items as anchoring data. SFs were constructed, based on content and precision.
Results
Nine PROMIS PF items were candidates for CR and PR inpatient PF assessment; three new items were written to extend content coverage. An inpatient sample (N = 515; 55.1% female; mean age = 66.2 years) completed 12 PR items and was assessed by physical therapists (using 12 CR items). Analyses indicated item sets met expected measure development standards. Twelve new CR and three new PR items were linked to the PROMIS PF metric (raw score r = 0.73 and 0.90, respectively). A 5-item CR SF measure was constructed; score-level reliabilities were ≥ 0.90 for T-scores 13–45. A 5-item PR SF measure was assembled, mirroring CR SF content.
Conclusions
Two item content-matched SFs have been developed for clinician and patient reporting and are an effective, efficient means of assessing inpatient PF and offer complementary perspectives.
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Affiliation(s)
- Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Heather E Brown
- Kaiser Permanente, Kaiser Foundation Hospitals and Health Plan, Oakland, CA, USA
| | | | | | - Ryan Murphy
- The Permanente Medical Group, Oakland, CA, USA
| | | | | | | | | | - Vincent X Liu
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Vrettos I, Voukelatou P, Panayiotou S, Kyvetos A, Tsigkri A, Makrilakis K, Sfikakis PP, Niakas D. Factors Associated With Mortality in Elderly Hospitalized Patients at Admission. Cureus 2022; 14:e22709. [PMID: 35386138 PMCID: PMC8967403 DOI: 10.7759/cureus.22709] [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] [Accepted: 02/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Several factors have been associated with mortality prediction among older inpatients. The objective of this study was to assess the factors associated with mortality in hospitalized elderly patients. Methods A total of 353 consecutively admitted elderly patients (47.9% women), with a median age of 83 years (interquartile range 75.00-88.00), were enrolled in the study and patient characteristics were recorded. Comorbidities were assessed using Charlson Comorbidity Index (CCI), activities of daily living by Barthel Index (BI), frailty was assessed using the Clinical Frailty Scale (CFS), cognition by Global Deterioration Scale (GDS) and symptom severity at admission by quick Sequential Organ Function Assessment (qSOFA) score. CFS, GDS and BI were estimated for the premorbid patients’ status. Parametric and non-parametric tests and binary logistic regression analysis were applied to identify the factors associated with mortality. A receiver operating characteristic (ROC) curve was used to analyse the prognostic value of CFS and qSOFA. Results In total, 55 patients (15.6%) died during hospitalization. In regression analysis, the factors associated with mortality were the qSOFA score at admission (p=0.001, odds ratio [OR]=1.895, 95% confidence interval [CI] 1.282-2.802) and the premorbid CFS score (p=0.001, OR=1.549, 95% CI 1.1204-1.994). The classifiers both have almost similar area under the curve (AUC) scores, with CFS performing slightly better. More specifically, both CFS (AUC 0.79, 95% CI 0.73-0.85, p=0.001) and qSOFA (AUC 0.75, 95% CI 0.67-0.83, p<0.001) showed almost the same accuracy for predicting inpatients’ mortality. Conclusion This study strengthens the perception of premorbid frailty and disease severity at admission as factors closely related to mortality in hospitalized elderly patients. Simple measures such as CFS and qSOFA score may help identify, in the emergency department, elderly patients at risk, in order to provide timely interventions.
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10
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Sands LP, Do Q, Du P, Pruchno R. Peritraumatic Stress From a Disaster Increases Risk for Onset of Chronic Diseases Among Older Adults. Innov Aging 2022; 6:igab052. [PMID: 34993355 PMCID: PMC8720044 DOI: 10.1093/geroni/igab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure. Research Design and Methods We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane. Results We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks. Discussion and Implications Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.
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Affiliation(s)
- Laura P Sands
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
| | - Quyen Do
- Department of Statistics, Virginia Tech, Blacksburg, Virginia,USA
| | - Pang Du
- Department of Statistics, Virginia Tech, Blacksburg, Virginia,USA
| | - Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
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11
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Junek ML, Jones A, Heckman G, Demers C, Griffith LE, Costa AP. The predictive utility of functional status at discharge: a population-level cohort analysis. BMC Geriatr 2022; 22:8. [PMID: 34979946 PMCID: PMC8722185 DOI: 10.1186/s12877-021-02652-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes. Methods In this population-based retrospective cohort study, Adults 65+ discharged from an acute hospitalization between 4 November 2008 and 18 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) re-presentation, hospital readmission, long term care facility (LTCF) admission or wait listing (‘LTCF readiness’), and death at 180 days from discharge. Results A total of 80 020 discharges were included. 38 928 (48.6%) re-presented to the ED, 24 222 (30.3%) were re-admitted, 5 037 (6.3%) were LTCF ready, and 9 047 (11.3%) died at 180 days. Beyond age, diminished functional status at discharge was the factor most associated with LTCF readiness (adjusted Odds Ratio [OR] 4.11 for those who are completely dependent for activities of daily living compared to those who are independent; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission. Conclusion Routinely collected functional status at discharge meaningfully improves the prediction of long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and planning for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02652-6.
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Affiliation(s)
- Mats L Junek
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - George Heckman
- Schlegel Research Institute on Aging, Waterloo, Ontario, Canada.,University of Waterloo, School of Public Health and Health Systems, Waterloo, Ontario, Canada
| | - Catherine Demers
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Schlegel Research Institute on Aging, Waterloo, Ontario, Canada.,McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
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12
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St John PD, Swift AU, Tate RB. Patterns of Functional Impairment over Time Amongst Older Men-the Manitoba Follow-up Study. Can Geriatr J 2021; 24:144-150. [PMID: 34079608 PMCID: PMC8137456 DOI: 10.5770/cgj.24.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background To determine the incidence and prevalence patterns of activity of daily living (ADL) impairments in ageing men. Methods 3,983 men were enrolled in the Manitoba Follow-up Study (MFUS) cohort study in 1948. From 1996 onwards, functional status was measured. We classified basic (BADL) and instrumental (IADL) into mutually exclusive categories as a time dependant factor after the second survey wave as: First survey response; no limitation; incident (first episode of disability); persistent (limitation which was seen on all questionnaires after the incident episode); resilient (noted in previous surveys but not present); and recurrent (noted in present survey, and limitations noted as present and absent in previous surveys). Results There were 1,745 participants in 1996 at a mean age of 76 years. Incident BADL limitations increased substantially with age: from 1% at age 75 to 15% at age 95. Similarly, persistent limitations increased with age: from 0.4% at age 75 to 18% at age 95. However, BADL function was fluid, with many individuals grouped within the resilient and recurrent patterns. Similar age effects and variability were noted in IADLs. Conclusion New and persistent disabilities are highly associated with age. However, there is considerable change in functional status over time.
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Affiliation(s)
- Philip D St John
- Section of Geriatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.,Centre on Aging, University of Manitoba, Winnipeg, MB
| | - Audrey U Swift
- Dept of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Robert B Tate
- Centre on Aging, University of Manitoba, Winnipeg, MB.,Dept of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
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13
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St John PD, Menec V, Tyas SL, Tate R, Griffith L. Multimorbidity in Canadians living in the community: Results from the Canadian Longitudinal Study of Aging. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:187-197. [PMID: 33727380 PMCID: PMC7963011 DOI: 10.46747/cfp.6703187] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the mean number of chronic diseases in Canadians aged 45 to 85 years who are living in the community, and to characterize the association of multimorbidity with age, sex, and social position. DESIGN An analysis of data from the Canadian Longitudinal Study on Aging. The number of self-reported chronic diseases was summed, and then the mean number of chronic health problems was standardized to the 2011 Canadian population. Analyses were conducted stratified on sex, age, individual income, household income, and education level. SETTING Canada. PARTICIPANTS A total of 21 241 community-living Canadians aged 45 to 85 years. MAIN OUTCOME MEASURES Overall, 31 chronic diseases (self-reported from a list) were considered, as were risk factors that were not mental health conditions or acute in nature. Age, sex, education, and household and individual incomes were also self-reported. RESULTS Multimorbidity was common, and the mean number of chronic illnesses was 3.1. Women had a higher number of chronic illnesses than men. Those with lower income and less education had more chronic conditions. The number of chronic conditions was strongly associated with age. The mean number of conditions was 2.1 in those aged 45 to 54; 2.9 in those 55 to 64; 3.8 in those aged 65 to 74, and 4.8 in those aged 75 and older (P < .05, ANOVA [analysis of variance]). CONCLUSION Multimorbidity is common in the Canadian population and is strongly related to age.
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Affiliation(s)
| | - Verena Menec
- Social psychologist at the University of Manitoba in Winnipeg
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14
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Smeuninx B, Elhassan YS, Manolopoulos KN, Sapey E, Rushton AB, Edwards SJ, Morgan PT, Philp A, Brook MS, Gharahdaghi N, Smith K, Atherton PJ, Breen L. The effect of short-term exercise prehabilitation on skeletal muscle protein synthesis and atrophy during bed rest in older men. J Cachexia Sarcopenia Muscle 2021; 12:52-69. [PMID: 33347733 PMCID: PMC7890266 DOI: 10.1002/jcsm.12661] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Poor recovery from periods of disuse accelerates age-related muscle loss, predisposing individuals to the development of secondary adverse health outcomes. Exercise prior to disuse (prehabilitation) may prevent muscle deterioration during subsequent unloading. The present study aimed to investigate the effect of short-term resistance exercise training (RET) prehabilitation on muscle morphology and regulatory mechanisms during 5 days of bed rest in older men. METHODS Ten healthy older men aged 65-80 years underwent four bouts of high-volume unilateral leg RET over 7 days prior to 5 days of inpatient bed rest. Physical activity and step-count were monitored over the course of RET prehabilitation and bed rest, whilst dietary intake was recorded throughout. Prior to and following bed rest, quadriceps cross-sectional area (CSA), and hormone/lipid profiles were determined. Serial muscle biopsies and dual-stable isotope tracers were used to determine integrated myofibrillar protein synthesis (iMyoPS) over RET prehabilitation and bed rest phases, and acute postabsorptive and postprandial myofibrillar protein synthesis (aMyoPS) rates at the end of bed rest. RESULTS During bed rest, daily step-count and light and moderate physical activity time decreased, whilst sedentary time increased when compared with habitual levels (P < 0.001 for all). Dietary protein and fibre intake during bed rest were lower than habitual values (P < 0.01 for both). iMyoPS rates were significantly greater in the exercised leg (EX) compared with the non-exercised control leg (CTL) over prehabilitation (1.76 ± 0.37%/day vs. 1.36 ± 0.18%/day, respectively; P = 0.007). iMyoPS rates decreased similarly in EX and CTL during bed rest (CTL, 1.07 ± 0.22%/day; EX, 1.30 ± 0.38%/day; P = 0.037 and 0.002, respectively). Postprandial aMyoPS rates increased above postabsorptive values in EX only (P = 0.018), with no difference in delta postprandial aMyoPS stimulation between legs. Quadriceps CSA at 40%, 60%, and 80% of muscle length decreased significantly in EX and CTL over bed rest (0.69%, 3.5%, and 2.8%, respectively; P < 0.01 for all), with no differences between legs. No differences in fibre-type CSA were observed between legs or with bed rest. Plasma insulin and serum lipids did not change with bed rest. CONCLUSIONS Short-term resistance exercise prehabilitation augmented iMyoPS rates in older men but did not offset the relative decline in iMyoPS and muscle mass during bed rest.
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Affiliation(s)
- Benoit Smeuninx
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | - Yasir S. Elhassan
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Centre for Endocrinology, Diabetes and MetabolismBirmingham Health PartnersBirminghamUK
| | - Konstantinos N. Manolopoulos
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Centre for Endocrinology, Diabetes and MetabolismBirmingham Health PartnersBirminghamUK
| | - Elizabeth Sapey
- NIHR Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust and Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
| | - Alison B. Rushton
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | - Sophie J. Edwards
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | - Paul T. Morgan
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
| | - Andrew Philp
- Garvan Institute of Medical ResearchSydneyNSWAustralia
- St Vincents Medical School, UNSW MedicineUNSW SydneySydneyNSWAustralia
| | - Matthew S. Brook
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Nima Gharahdaghi
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Kenneth Smith
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Philip J. Atherton
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
- MRC‐Arthritis Research UK Centre for Musculoskeletal Ageing ResearchUniversity of BirminghamUK
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15
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Boltz M, BeLue R, Resnick B, Kuzmik A, Galik E, Jones JR, Arendacs R, Sinvani L, Mogle J, Galvin JE. Disparities in Physical and Psychological Symptoms in Hospitalized African American and White Persons with Dementia. J Aging Health 2020; 33:340-349. [PMID: 33371763 DOI: 10.1177/0898264320983210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: This study examined differences in physical function, delirium, depressive symptoms, and behavioral and psychological symptoms of dementia (BPSD) in hospitalized African American and white older adults with dementia. Methods: This secondary data analysis using baseline data from an ongoing trial testing family-centered function-focused care included African American (n = 159) and white persons (n =135) with dementia. Results: A multivariate analysis of covariance showed that controlling for relevant demographic and health characteristics, African Americans with dementia had lower physical function, more delirium, and more depressive symptoms upon admission than white participants. There were no significant differences in BPSD between African American and white persons. Discussion: To our knowledge, this is the first study to examine racial differences in admission symptoms of hospitalized persons with dementia. While the findings are preliminary, they can be used to inform the design of future research, including identifying the causes of disparities.
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Affiliation(s)
- Marie Boltz
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | | | - Barbara Resnick
- School of Nursing, 12265University of Maryland, Baltimore, MD, USA
| | - Ashley Kuzmik
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | - Elizabeth Galik
- School of Nursing, 12265University of Maryland, Baltimore, MD, USA
| | - Joanne R Jones
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | - Rachel Arendacs
- College of Nursing, 311285The Pennsylvania State University, University Park, PA, USA
| | - Liron Sinvani
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jacqueline Mogle
- Center for Healthy Aging, 311285The Pennsylvania State University, University Park, PA, USA
| | - James E Galvin
- Cognitive Disorder Division, 5452University of Miami, Coral Gables, FL, USA
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16
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Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Ramírez-Vélez R, García-Hermoso A, Cadore EL, Casas-Herrero Á, Galbete A, Izquierdo M. Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults. J Cachexia Sarcopenia Muscle 2020; 11:997-1006. [PMID: 32155323 PMCID: PMC7432584 DOI: 10.1002/jcsm.12564] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A classic consequence of short-term bed rest in older adults is the significant loss in skeletal muscle mass and muscle strength that underlies the accelerated physical performance deficits. Structured exercise programmes applied during acute hospitalization can prevent muscle function deterioration. METHODS A single-blind randomized clinical trial conducted in an acute care for elders unit in a tertiary public hospital in Navarre (Spain). Three hundred seventy hospitalized patients [56.5% female patients; mean age (standard deviation) 87.3 (4.9) years] were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training programme performed during 5-7 consecutive days (2 sessions/day). The usual-care group received habitual hospital care, which included physical rehabilitation when needed. The main endpoints were change in maximal dynamic strength (i.e. leg-press, chest-press, and knee extension exercises) and maximal isometric knee extensors and hip flexors strength from baseline to discharge. Changes in muscle power output at submaximal and maximal loads were also measured after the intervention. RESULTS The physical exercise programme provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 19.6 kg [95% confidence interval (CI), 16.0, 23.2; P < 0.001] on the one-repetition maximum (1RM) in the leg-press exercise, 5.7 kg (95% CI, 4.7, 6.8; P < 0.001) on the 1RM in the chest-press exercise, and 9.4 kg (95% CI, 7.3, 11.5; P < 0.001) on the 1RM in the knee extension exercise over usual-care group. There were improvements in the intervention group also in the isometric maximal knee extension strength [14.8 Newtons (N); 95% CI, 11.2, 18.5 vs. -7.8 N; 95% CI, -11.0, -3.5 in the control group; P < 0.001] and the hip flexion strength (13.6 N; 95% CI, 10.7, 16.5 vs. -7.2 N; 95% CI, -10.1, -4.3; P < 0.001). Significant benefits were also observed in the exercise group for the muscle power output at submaximal loads (i.e. 30% 1RM, 45% 1RM, 60% 1RM, and 75% 1RM; all P < 0.001) over usual-care group. CONCLUSIONS An individualized, multicomponent exercise training programme, with special emphasis on muscle power training, proved to be an effective therapy for improving muscle power output of lower limbs at submaximal loads and maximal muscle strength in older patients during acute hospitalization.
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Affiliation(s)
- Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - Eduardo L Cadore
- Laboratory of Exercise Research, School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Álvaro Casas-Herrero
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Arkaitz Galbete
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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17
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Marshall RN, Smeuninx B, Morgan PT, Breen L. Nutritional Strategies to Offset Disuse-Induced Skeletal Muscle Atrophy and Anabolic Resistance in Older Adults: From Whole-Foods to Isolated Ingredients. Nutrients 2020; 12:nu12051533. [PMID: 32466126 PMCID: PMC7284346 DOI: 10.3390/nu12051533] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
Preserving skeletal muscle mass and functional capacity is essential for healthy ageing. Transient periods of disuse and/or inactivity in combination with sub-optimal dietary intake have been shown to accelerate the age-related loss of muscle mass and strength, predisposing to disability and metabolic disease. Mechanisms underlying disuse and/or inactivity-related muscle deterioration in the older adults, whilst multifaceted, ultimately manifest in an imbalance between rates of muscle protein synthesis and breakdown, resulting in net muscle loss. To date, the most potent intervention to mitigate disuse-induced muscle deterioration is mechanical loading in the form of resistance exercise. However, the feasibility of older individuals performing resistance exercise during disuse and inactivity has been questioned, particularly as illness and injury may affect adherence and safety, as well as accessibility to appropriate equipment and physical therapists. Therefore, optimising nutritional intake during disuse events, through the introduction of protein-rich whole-foods, isolated proteins and nutrient compounds with purported pro-anabolic and anti-catabolic properties could offset impairments in muscle protein turnover and, ultimately, the degree of muscle atrophy and recovery upon re-ambulation. The current review therefore aims to provide an overview of nutritional countermeasures to disuse atrophy and anabolic resistance in older individuals.
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Affiliation(s)
- Ryan N. Marshall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (R.N.M.); (B.S.); (P.T.M.)
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Benoit Smeuninx
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (R.N.M.); (B.S.); (P.T.M.)
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Paul T. Morgan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (R.N.M.); (B.S.); (P.T.M.)
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (R.N.M.); (B.S.); (P.T.M.)
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Correspondence: ; Tel.: +44-121-414-4109
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18
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Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Casas-Herrero Á, Cadore EL, Ramirez-Velez R, Izquierdo M. Inter-individual variability in response to exercise intervention or usual care in hospitalized older adults. J Cachexia Sarcopenia Muscle 2019; 10:1266-1275. [PMID: 31407876 PMCID: PMC6903436 DOI: 10.1002/jcsm.12481] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Exercise protocols applied during hospitalization can prevent functional and cognitive decline in older adults. The purpose of this study was to examine the individual response of acutely hospitalized patients to usual care and to physical exercise on functional capacity, muscle strength, and cognitive function and to assess the relationship with mortality at 1 year post-discharge. METHODS In a single-blind randomized clinical trial, 370 hospitalized patients [56.5% women; mean age (standard deviation) 87.3 (4.9) years] were allocated to an exercise intervention group (IG, n = 185) or a control group (CG, n = 185). The participants were older adults aged 75 years or older in an acute care unit in a tertiary public hospital in Navarra, Spain. The usual care group received habitual hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized multicomponent exercise training programme performed during 5-7 consecutive days (two sessions/day). Functional capacity was assessed with the Short Physical Performance Battery (SPPB) test and the Gait Velocity Test (GVT). Handgrip strength and cognitive function were also measured at admission and discharge. Patients in both groups were categorized as responders (Rs), non-responders (NRs), and adverse responders (ARs) based on the individual response to each treatment during hospitalization. RESULTS The prevalence of Rs was higher and the prevalence of NRs and ARs was lower in the intervention group than in the control group for functional capacity (SPPB IG: Rs 85.3%, NRs 8.7%, ARs 6.0% vs. CG: Rs 37.9%, NRs 28.8%, ARs 33.3% and GVT IG: Rs 51.2%, NRs 47.3, ARs 1.6% vs. CG: Rs 18.0%, NRs 67.7%, ARs 14.3%), muscle strength (IG: Rs 62.3%, NRs 26.5%, ARs 11.3% vs. CG: Rs 20.0%, NRs 38.0%, ARs 42.0%), and cognition (IG: Rs 41.5%, NRs 57.1%, ARs 1.4% vs. CG: Rs 13.8%, NRs 76.6%, ARs 9.7%) (all P < 0.001). The ARs for the GVT in the control group and the ARs for the SPPB in the intervention group had a significantly higher rate of mortality than the NRs and Rs in the equivalent groups (0.01 and 0.03, respectively) at follow-up. CONCLUSIONS Older patients performing an individualized exercise intervention presented higher prevalence of Rs and a lower prevalence of NRs and ARs for functional capacity, muscle strength, and cognitive function than those who were treated with usual care during acute hospitalization. An adverse response on functional capacity in older patients to physical exercise or usual care during hospitalization was associated with mortality at 1 year post-discharge.
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Affiliation(s)
- Mikel L Sáez de Asteasu
- Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain.,Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra (CHN), Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Álvaro Casas-Herrero
- Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra (CHN), Pamplona, Navarra, Spain
| | - Eduardo L Cadore
- Federal University of the Rio Grande of Sul, Porto Alegre, Brazil
| | | | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain.,Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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Bhattacharyya T, Chopra Chatterjee S. Experience of family caregivers of hospitalized older people in Kolkata, India. Int J Health Plann Manage 2019; 35:e81-e95. [PMID: 31713916 DOI: 10.1002/hpm.2933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/10/2019] [Indexed: 11/05/2022] Open
Abstract
In India, family caregivers (FCs) play a major role in providing care to their older kin during hospitalization. This article explores the challenges encountered by them while providing care in a public hospital. It draws upon empirical insights obtained through interviews with 54 FCs and field observations. The findings show that the hospital was not congenial for FCs and exposes the factors impeding their caregiving role. FC experience was found to be highly complex and fraught with multiple practical challenges during admission, in-hospital treatment, and at discharge. All these had repercussions on various aspects of their own life and well-being like poor health outcomes, financial stress, and social isolation. The article concludes that the needs, preferences, and challenges of the FCs need to be considered to make hospitals conducive for FCs of older people.
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Affiliation(s)
- Tulika Bhattacharyya
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Suhita Chopra Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, Kharagpur, India
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20
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Factors Affecting Discharge to Home of Medical Patients Treated in an Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224324. [PMID: 31698814 PMCID: PMC6887772 DOI: 10.3390/ijerph16224324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to examine the factors affecting the discharge to home of medical patients treated in an intensive care unit, including elements of in-hospital rehabilitation and prehospital movement ability. The participants of this retrospective cohort study were medical patients treated in an intensive care unit (ICU) and who began rehabilitation in ICU. We assessed the participants in the ICU and analyzed data on patient background, hospitalization, and rehabilitation status. There were 155 ICU patients available for analysis. A multivariable logistic regression model identified the four variables of age (OR 1.06, 95% CI 1.02–1.09), APACHE II score (OR 1.12, 95% CI 1.04–1.24), independence in home life before admission (OR 7.10, 95% CI 1.65–30.44), and standing within 5 days of admission (OR 6.58, 95% CI 2.60–16.61) as factors significantly related to discharge from hospital to home. Independence of home life before admission and early start of standing were identified as factors strongly related to discharge to home. The degree of independence in living before hospital admission and progress toward early mobilization are helpful when considering an ICU patient’s discharge destination.
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21
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Shinohara T, Tsuchida N, Yamane T, Shindo K, Otani T, Ishii D. Association between patients' state upon admission and decline in activities of daily living. J Phys Ther Sci 2019; 31:813-818. [PMID: 31645812 PMCID: PMC6801333 DOI: 10.1589/jpts.31.813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/04/2019] [Indexed: 11/26/2022] Open
Abstract
[Purpose] In this study, we aimed to determine the components of activities of daily
living that decline easily during hospitalization. [Participants and Methods] We performed
a prospective cohort study of 2,819 inpatients who were hospitalized and discharged. We
prospectively evaluated the Barthel Index at admission and discharge, age, length of
hospital stay, clinical department, and rehabilitation type. We divided the inpatients
into two groups based on the Barthel Index score at admission and compared the items of
the index at admission and discharge to analyze the characteristics of decline in
activities of daily living. [Results] Forty-nine inpatients (2.0%) had declined in
activities of daily living. There were no significant between-group differences in age,
length of hospital stay, clinical department, or ratio of individual rehabilitation.
However, transfer and toilet use remarkably decreased in the group with Barthel Index
scores at admission <85, and bathing and ascending/descending remarkably decreased in
the group with Barthel Index at admission ≥85. [Conclusion] The characteristics of
decrease in each activity of daily living vary, and our results suggested the components
that easily declined when inpatients were divided based on their performance of activities
of daily living at admission.
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Affiliation(s)
- Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare: 501 Nakaorui-machi, Takasaki-shi, Gunma 370-0033, Japan
| | | | - Tatsuya Yamane
- Department of Rehabilitation Center, Maebashi Red Cross Hospital, Japan
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22
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Tanderup A, Ryg J, Rosholm JU, Lassen AT. Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study. BMJ Open 2019; 9:e026881. [PMID: 31023760 PMCID: PMC6501979 DOI: 10.1136/bmjopen-2018-026881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/18/2018] [Accepted: 01/17/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation. DESIGN Population-based prospective cohort study. SETTING ED of a large university hospital. PARTICIPANTS All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014). PRIMARY AND SECONDARY OUTCOME MEASURES Patients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation. RESULTS A total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71-85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact. CONCLUSION Prehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.
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Affiliation(s)
- Anette Tanderup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Jens-Ulrik Rosholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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So C, Lage DE, Slocum CS, Zafonte RD, Schneider JC. Utility of Functional Metrics Assessed During Acute Care on Hospital Outcomes: A Systematic Review. PM R 2019; 11:522-532. [PMID: 30758920 PMCID: PMC10108704 DOI: 10.1002/pmrj.12013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/10/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Traditionally, illness severity, social factors, and comorbid conditions have been examined as predictors of hospital outcomes. However, recent research in the rehabilitation setting demonstrated that physical function outperformed comorbidity indices as a predictor of 30-day readmission. The purpose of this study was to review the literature examining the association between acute hospital physical function and various hospital outcomes and health care utilization. TYPE: Systematic review. LITERATURE SURVEY A review of the MEDLINE database was performed. Search terms included acute functional outcomes and frailty outcomes. Studies up to September 2017 were included if they were in English and examined how functional metrics collected at acute care hospitalization affected hospital outcomes. METHODOLOGY Cohort characteristics and measures of associations were extracted from the studies. Outcomes include hospital readmission, length of stay, mortality, discharge location, and physical function post acute care. The studies were assessed for potential confounders as well as selection, attrition, and detection bias. SYNTHESIS A total of 30 studies were identified (hospital readmissions: 6; discharge location: 11; length of stay: 4; mortality: 15; function: 6). Thirteen different metrics assessed function during acute care. Lower function during acute care was associated with statistically significant higher odds of hospital readmission, lower likelihood of discharge to home, longer hospital length of stay, increased mortality, and worse functional recovery when compared to patients with higher function during acute care, when adjusted for age and gender. The Barthel Index may be a useful marker for mortality in the elderly whereas the Functional Independence Measure instrument may be valuable for examining discharge location. CONCLUSIONS There is increasing evidence that function measured during acute care predicts a broad array of meaningful clinical outcomes. Further research would help direct the use of practical, yet parsimonious functional metrics that effectively screen high-need, high-cost patients to deliver optimal care. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Conan So
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,University of Maryland School of Medicine, Baltimore, MD
| | - Daniel E Lage
- Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Olotu C, Weimann A, Bahrs C, Schwenk W, Scherer M, Kiefmann R. The Perioperative Care of Older Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:63-69. [PMID: 30950385 PMCID: PMC6444041 DOI: 10.3238/arztebl.2019.0063] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 08/21/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Elderly patients are a growing and vulnerable group with an elevated perioperative risk. Perioperative treatment pathways that take these patients' special risks and requirements into account are often not implemented in routine clinical practice. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, the AWMF guideline database, and the Cochrane database for guidelines from Germany and abroad, meta-analyses, and Cochrane reviews. RESULTS The care of elderly patients who need surgery calls for an interdisciplinary, interprofessional treatment concept. One component of this concept is preoperative preparation of the patient ("prehabilitation"), which is best initiated before hospital admission, e.g., correction of deficiency states, optimization of chronic drug treatment, and respiratory training. Another important component consists of pre-, intra-, and postoperative measures to prevent delirium, which can lower the frequency of this complication by 30-50%: these include orientation aids, avoidance of inappropriate drugs for elderly patients, adequate analgesia, early mobilization, short fasting times, and a perioperative nutrition plan. Preexisting cognitive impairment predisposes to postoperative delirium (odds ratios [OR] ranging from 2.5 to 4.5). Frailty is the most important predictor of the postoperative course (OR: 2.6-11). It follows that preoperative assessment of the patient's functional and cognitive status is essential. CONCLUZION The evidence-based and guideline-consistent care of elderly patients requires not only close interdisciplinary, interprofessional, and cross-sectoral collaboration, but also the restructuring and optimization of habitual procedural pathways in the hospital. Elderly patients' special needs can only be met by a treatment concept in which the entire perioperative phase is considered as a single, coherent process.
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Affiliation(s)
- Cynthia Olotu
- Department of Intensive Care Medicine, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE)
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery Klinikum St. Georg, Leipzig
| | - Christian Bahrs
- Clinic for Trauma and Reconstructive Surgery, BG Hospital, Tübingen
| | - Wolfgang Schwenk
- Department of General-, Visceral- and Vascular Surgery, Städtisches Klinikum Solingen gGmbH
| | - Martin Scherer
- Department of General Practice / Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE)
| | - Rainer Kiefmann
- Department of Anesthesiology and Intensive Care Medicine, Rotkreuzklinikum München
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Tanderup A, Lassen AT, Rosholm JU, Ryg J. Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study. BMJ Open 2018; 8:e023803. [PMID: 30552269 PMCID: PMC6303572 DOI: 10.1136/bmjopen-2018-023803] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The objective was to describe the prevalence of geriatric conditions among older medical patients in the emergency department (ED) and the association with admission, mortality, reattendance and loss of independency. DESIGN Population-based prospective cohort study. SETTING ED of a large university hospital. PARTICIPANTS All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014). PRIMARY AND SECONDARY OUTCOME MEASURES Based on information from healthcare registers, we defined geriatric conditions as disability, recently increased disability, polypharmacy and comorbidity. Outcomes were admission, length of admission, 30 days postdischarge mortality, 30 days hospital reattendance and home care dependency 0-360 days following ED contact. RESULTS Totally, 3775 patients (55% women) were included, age 78 (71-85) years (median (IQR)). No patients were lost to follow-up. The prevalence of 0-4 geriatric conditions was 14.9%, 27.3%, 25.2%, 22.3% and 10.3%, respectively. The number of conditions was significantly associated with hospital admission, length of admission, 30 days postdischarge mortality and 30 days hospital reattendance. Among patients with no geriatric conditions, 70% lived independent all 360 days after discharge, whereas all patients with ≥3 conditions had some dependency or were dead within 360 days following discharge. CONCLUSION Among older medical patients in the ED, 50% had two or more geriatric conditions which were associated with poor health outcomes. This highlights the need for studies of the effect of geriatric awareness and competences in the ED.
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Affiliation(s)
- Anette Tanderup
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Jens-Ulrik Rosholm
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Skelton DA, Mavroeidi A. How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course, and are there particular ages where MBSBA are most important? J Frailty Sarcopenia Falls 2018; 3:74-84. [PMID: 32300696 PMCID: PMC7155320 DOI: 10.22540/jfsf-03-074] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/21/2022] Open
Abstract
This narrative review focuses on the role of strength and balance activities throughout the lifecycle to improve physical capacity and reduce all-cause mortality. The evidence suggests strong associations in middle and older age, with poor balance, poor strength or poor physical function having strong associations with mortality. Currently in the UK, the proportions of adults (69% of men and 76% of women) not meeting the strength and balance guidelines (of 2 or more sessions/week) is concerning. This report identifies specific time points in the lifecycle where specific promotion of and engagement with strength and balance activities would be most beneficial for health: 18-24y to maximize bone and muscle mass gains, 40-50y to maintain strength and reduce that downward cycle, and over 65s to preserve balance and strength and maintain independence). This review also suggests specific transition points/events in life where there may be an increase in sedentary behaviour or loss of muscle function (pregnancy, menopause, onset of on diagnosis of disease, retirement, on becoming a carer and following hospitalization), where it would be useful to initiate additional strength and balance exercises to improve future health outcomes.
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Affiliation(s)
- Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alexandra Mavroeidi
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Gardner RC, Dams-O'Connor K, Morrissey MR, Manley GT. Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions. J Neurotrauma 2018; 35:889-906. [PMID: 29212411 PMCID: PMC5865621 DOI: 10.1089/neu.2017.5371] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.
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Affiliation(s)
- Raquel C. Gardner
- Department of Neurology, University of California San Francisco, and San Francisco VA Medical Center, San Francisco, California
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, California
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Molly Rose Morrissey
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Geoffrey T. Manley
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, California
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California
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Greene M, Ahalt C, Stijacic-Cenzer I, Metzger L, Williams B. Older adults in jail: high rates and early onset of geriatric conditions. HEALTH & JUSTICE 2018; 6:3. [PMID: 29455436 PMCID: PMC5816733 DOI: 10.1186/s40352-018-0062-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/05/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults. METHODS This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth. RESULTS All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older. CONCLUSIONS Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.
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Affiliation(s)
- Meredith Greene
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA USA
| | - Cyrus Ahalt
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA USA
| | - Irena Stijacic-Cenzer
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA USA
| | - Lia Metzger
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA USA
| | - Brie Williams
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, CA USA
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Elli S, Contro D, Castaldi S, Fornili M, Ardoino I, Caserta AV, Panella L. Caregivers' misperception of the severity of hip fractures. Patient Prefer Adherence 2018; 12:1889-1895. [PMID: 30288029 PMCID: PMC6159810 DOI: 10.2147/ppa.s164380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient's health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure. PATIENTS AND METHODS We enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient's caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient. RESULTS Analysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland-Altman plot of -2.43, 95% CI=-2.93 to -1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition. CONCLUSION This study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient's social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual's care and assistance need to be assembled.
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Affiliation(s)
- Sara Elli
- Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy,
| | - Diego Contro
- Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy,
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Health Management Department, Fondazione IRCCS Ca' Granda OMP, Milan, Italy
| | - Marco Fornili
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ilaria Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonello V Caserta
- Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini - CTO, Milan, Italy
| | - Lorenzo Panella
- Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini - CTO, Milan, Italy
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Torisson G, Stavenow L, Minthon L, Londos E. Importance and added value of functional impairment to predict mortality: a cohort study in Swedish medical inpatients. BMJ Open 2017; 7:e014464. [PMID: 28566362 PMCID: PMC5730010 DOI: 10.1136/bmjopen-2016-014464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Accurate estimation of prognosis in multimorbid hospital patients could improve quality of care. This study aims to determine the relative importance and added value of a performance-based activities of daily living (ADL) measure with regard to mortality prediction. METHODS 200 inpatients, aged over 60 years, were recruited at the Department of General Internal Medicine at a tertiary university hospital. Two nested survival models were built, one with established risk factors (age, sex, Charlson comorbidity index, haemoglobin, albumin, body mass index and glomerular filtration rate), and one using the same covariates with the Gottfries-Bråne-Steen (GBS)-ADL measure added. The relative importance of GBS-ADL was evaluated in the full model. The added value of GBS-ADL was determined by comparing the nested models using four approaches: difference in overall χ2, discrimination, continuous net reclassification index (NRI >0) and integrated discrimination improvement (IDI). RESULTS In the full model, GBS-ADL was the single most important predictor of mortality (χ2-df=30, p<0.001). The likelihood ratio χ2 test showed significant added value of ADL (p<0.001). The C-statistic was 0.78 with ADL and 0.72 without (difference 0.058, 95% CI 0.022 to 0.094). The NRI >0 was 0.42 (95% CI 0.20 to 0.58) and IDI 0.15 (95% CI 0.07 to 0.22). CONCLUSIONS Compared with a set of available clinical risk factors, impairment in ADL was a stronger predictor of all-cause mortality, showing substantial added value. Implementing quantitative ADL measurements could enable more appropriate and individual care for the elderly.
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Affiliation(s)
- Gustav Torisson
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Lars Stavenow
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
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Cederbom S, Denison E, Bergland A. A behavioral medicine intervention for community-dwelling older adults with chronic musculoskeletal pain: protocol for a randomized controlled trial. J Pain Res 2017; 10:845-853. [PMID: 28435321 PMCID: PMC5391824 DOI: 10.2147/jpr.s129648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is a major health problem among older adults, particularly those who live alone and/or those who are dependent on formal care. Chronic pain is associated with mobility problems, falls, fear of falling, catastrophizing thoughts, and a lower quality of life. Research shows that physical therapy interventions based on behavioral medicine approaches are beneficial for middle-aged adults with chronic pain. However, there appears to be no previous randomized controlled trials (RCTs) based on this theoretical framework that have examined the effect on older adults with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The aim of the planned study is to evaluate the effect of an individually tailored integrated physical therapy intervention based on a behavioral medicine approach compared with the effect of standard care. METHODS/DESIGN The planned study is an RCT that will include one intervention and one control group involving a total of 150 adults aged ≥75 years with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The intervention will involve a 12-week home-based individually tailored intervention that will be designed to enhance the participants' ability to perform everyday activities by improving physical function and reducing pain-related disability and beliefs. The control group will be given standard care, including general advice about physical activity. The participants will be assessed at baseline and at 3 and 6 months after baseline. The primary outcome will be pain-related disability and physical performance. DISCUSSION The intervention, if effective, will have the potential to be the basis of the first evidence-based guidelines for physical therapists who work with older adults with chronic musculoskeletal pain.
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Affiliation(s)
- Sara Cederbom
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Eva Denison
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Harrison JK, Garrido AG, Rhynas SJ, Logan G, MacLullich AMJ, MacArthur J, Shenkin S. New institutionalisation following acute hospital admission: a retrospective cohort study. Age Ageing 2017; 46:238-244. [PMID: 27744305 PMCID: PMC5860512 DOI: 10.1093/ageing/afw188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
Background institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. Objective to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. Design and setting a retrospective cohort study of people admitted to a single large Scottish teaching hospital. Subjects 100 individuals admitted to the acute hospital from home and discharged to a care home. Methods a single researcher extracted data from ward-based case notes. Results people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14-231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital. Conclusions care home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.
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Affiliation(s)
- Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Address correspondence to: J. K. Harrison. Tel: 0131 242 6371; Fax: 0131 242 6370. E-mail:
| | | | - Sarah J. Rhynas
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
- Nursing Studies, University of Edinburgh, Edinburgh, UK
| | | | - Alasdair M. J. MacLullich
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Clinical and Surgical Sciences, Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | - Juliet MacArthur
- Nursing Studies, University of Edinburgh, Edinburgh, UK
- Corporate Nursing, NHS Lothian, Edinburgh, UK
| | - Susan Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Clinical and Surgical Sciences, Geriatric Medicine, University of Edinburgh, Edinburgh, UK
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Hopfe M, Stucki G, Marshall R, Twomey CD, Üstün TB, Prodinger B. Capturing patients' needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems. BMC Health Serv Res 2016; 16:40. [PMID: 26847062 PMCID: PMC4741002 DOI: 10.1186/s12913-016-1277-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients' needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay. METHODS A systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological Abstracts using keywords related to functioning ('Functioning', 'Functional status', 'Function*, 'ICF', 'International Classification of Functioning, Disability and Health', 'Activities of Daily Living' or 'ADL') and casemix systems ('Casemix', 'case mix', 'Diagnosis Related Groups', 'Function Related Groups', 'Resource Utilization Groups' or 'AN-SNAP'). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors' discussion of results, study limitations and implications was extracted. RESULTS Ten included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest that, in particular, DRG casemix systems can be improved in predicting resource use and capturing outcomes for frail elderly or severely functioning-impaired patients. CONCLUSION Further exploration of the value of adding functioning information into casemix systems is one promising approach to improve casemix systems ability to adequately capture the differences in patient's needs for services and to better predict resource use.
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Affiliation(s)
- Maren Hopfe
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences & Health Policy, University of Lucerne, 6002 Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences & Health Policy, University of Lucerne, 6002 Lucerne, Switzerland
| | - Ric Marshall
- National Centre for Classification in Health, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW 2141 Australia
| | - Conal D. Twomey
- Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - T. Bedirhan Üstün
- World Health Organization, Classifications, Terminologies and Standards, 1211, Geneva, 27 Switzerland
| | - Birgit Prodinger
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences & Health Policy, University of Lucerne, 6002 Lucerne, Switzerland
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Martínez-Velilla N, Cadore EL, Casas-Herrero Á, Idoate-Saralegui F, Izquierdo M. Physical Activity and Early Rehabilitation in Hospitalized Elderly Medical Patients: Systematic Review of Randomized Clinical Trials. J Nutr Health Aging 2016; 20:738-51. [PMID: 27499308 DOI: 10.1007/s12603-016-0683-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients. DESIGN Systematic review of the literature. METHODS A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described. RESULTS From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned. CONCLUSION The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.
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Affiliation(s)
- N Martínez-Velilla
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra (Navarra) Spain, Campus of Tudela, Av. de Tarazona s/n. 31500 Tudela (Navarra) Spain, Tel.: + 34 948 417876, E-mail:
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Chodos AH, Kushel MB, Greysen SR, Guzman D, Kessell ER, Sarkar U, Goldman LE, Critchfield JM, Pierluissi E. Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital. J Gen Intern Med 2015; 30:1765-72. [PMID: 25986139 PMCID: PMC4636578 DOI: 10.1007/s11606-015-3395-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about hospitalization-associated disability (HAD) in older adults who receive care in safety-net hospitals. OBJECTIVES To describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital. DESIGN Secondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders. SETTING Medicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital. PARTICIPANTS A total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group. MEASUREMENTS The outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days post-discharge was ascertained by self-report of ADL function. RESULTS Many participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15). CONCLUSIONS In adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55.
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Affiliation(s)
- Anna H Chodos
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA. .,Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Margot B Kushel
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - S Ryan Greysen
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - David Guzman
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - Eric R Kessell
- Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - L Elizabeth Goldman
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Box 1364, San Francisco, 94143, CA, USA
| | - Jeffrey M Critchfield
- Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Edgar Pierluissi
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.,Division of Hospital Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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Jassal SV, Karaboyas A, Comment LA, Bieber BA, Morgenstern H, Sen A, Gillespie BW, De Sequera P, Marshall MR, Fukuhara S, Robinson BM, Pisoni RL, Tentori F. Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2015; 67:283-92. [PMID: 26612280 DOI: 10.1053/j.ajkd.2015.09.024] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/21/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients receiving long-term dialysis have among the highest mortality and hospitalization rates. In the nonrenal literature, functional dependence is recognized as a contributor to subsequent disability, recurrent hospitalization, and increased mortality. A higher burden of functional dependence with progressive worsening of kidney function has been observed in several studies, suggesting that functional dependence may contribute to both morbidity and mortality in dialysis patients. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 7,226 hemodialysis patients from 12 countries in the DOPPS (Dialysis Outcomes and Practice Patterns Study) phase 4 (2009-2011) with self-reported data for functional status. PREDICTOR Patients' ability to perform 13 basic and instrumental activities of daily living was summarized to create an overall functional status score (range, 1.25 [most dependent] to 13 [functionally independent]). OUTCOME Cox regression was used to estimate the association between functional status and all-cause mortality, adjusting for several demographic and clinical risk factors for mortality. Median follow-up was 17.2 months. RESULTS The proportion of patients who could perform each activity of daily living task without assistance ranged from 97% (eating) to 47% (doing housework). 36% of patients could perform all 13 tasks without assistance (functional status = 13), and 14% of patients had high functional dependence (functional status < 8). Functionally independent patients were younger and had many indicators of better health status, including higher quality of life. Compared with functionally independent patients, the adjusted HR for mortality was 2.37 (95% CI, 1.92-2.94) for patients with functional status < 8. LIMITATIONS Possible nonresponse bias and residual confounding. CONCLUSIONS We found a high burden of functional dependence across all age groups and across all DOPPS countries. When adjusting for several known mortality risk factors, including age, access type, cachexia, and multimorbidity, functional dependence was a strong consistent predictor of mortality.
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Affiliation(s)
- S Vanita Jassal
- Division of Nephrology, University Health Network, Toronto, Canada
| | | | - Leah A Comment
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | | | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Urology, Medical School, University of Michigan, Ann Arbor, MI
| | | | - Brenda W Gillespie
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | | | - Mark R Marshall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand; Baxter Healthcare (Asia Pacific), Shanghai, People's Republic of China
| | - Shunichi Fukuhara
- Kyoto University, Sakyo-ku, Kyoto, Japan; Center for Innovative Research in Community and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | | | - Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor, MI; Vanderbilt University Medical Center, Nashville, TN.
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Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Suárez N, Alonso-Renedo J, Contín KC, de Asteasu MLS, Echeverria NF, Lázaro MG, Izquierdo M. Functional and cognitive impairment prevention through early physical activity for geriatric hospitalized patients: study protocol for a randomized controlled trial. BMC Geriatr 2015; 15:112. [PMID: 26374430 PMCID: PMC4571136 DOI: 10.1186/s12877-015-0109-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older adults have reduced functional and physiological reserves, rendering them more vulnerable to the effects of hospitalization, which frequently results in failure to recover from the pre-hospitalization functional loss, new disability or even continued functional decline. Alternative care models with an emphasis on multidisciplinary and continuing care units are currently being developed. Their main objective, other than the recovery of the condition that caused admission, is the prevention of functional decline. Many studies on functional decline have discussed the available evidence regarding the effectiveness of acute geriatric units. Despite the theoretical support for the idea that mobility improvement in the hospitalized patient carries multiple benefits, this idea has not been fully translated into clinical practice. METHODS/DESIGN This study is a randomized clinical trial conducted in the Department of Geriatrics of a tertiary public hospital with 35 beds allocated. Hospitalized patients who meet the inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent exercise training programme, which will be composed of supervised progressive resistance exercise training, balance-training, and walking for 5-7 consecutive days. During the training period, patients will be trained in 20 min sessions twice a day (morning and evening). DISCUSSION Functional and cognitive impairment after and during acute hospitalization in older adults is a major determinant of the later need for health resources. If our hypothesis is correct and shows that a multicomponent, individualized and progressive exercise programme provides effective therapy for improving the functional capacity of acute elderly patients hospitalized for medical pathology versus conventional care, a change of the current system of hospitalization of elderly patients with medical conditions may be justified. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02300896 (Date of registration 19 November 2014).
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Affiliation(s)
- Nicolás Martínez-Velilla
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | - Alvaro Casas-Herrero
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | | | - Nacho Suárez
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
| | - Javier Alonso-Renedo
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | - Koldo Cambra Contín
- Navarrabiomed-Fundación Miguel Servet, Pamplona, Spain. .,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | | | | | | | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
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Wojtusiak J, Levy CR, Williams AE, Alemi F. Predicting Functional Decline and Recovery for Residents in Veterans Affairs Nursing Homes. THE GERONTOLOGIST 2015; 56:42-51. [PMID: 26185151 DOI: 10.1093/geront/gnv065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/08/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY This article describes methods and accuracy of predicting change in activities of daily living (ADLs) for nursing home patients following hospitalization. DESIGN AND METHODS Electronic Health Record data for 5,595 residents of Veterans Affairs' (VAs') Community Living Centers (CLCs) aged 70 years and older were analyzed within the VA Informatics and Computing Infrastructure. Data included diagnoses from 7,106 inpatient records, 21,318 functional status evaluations, and 69,140 inpatient diagnoses. The Barthel Index extracted from CLC's Minimum Data Set was used to assess ADLs loss and recovery. Patients' diagnoses on hospital admission, ADL status prior to hospitalization, age, and gender were used alone or in combination to predict ADL loss/gain following hospitalization. Area under the Receiver-Operator Curve (AUC) was used to report accuracy of predictions in short (14 days) and long-term (15-365 days) follow-up post-hospitalization. RESULTS Admissions fell into 7 distinct patterns of recovery and loss: early recovery 19%, delayed recovery 9%, delayed recovery after temporary decline 9%, early decline 29%, delayed decline 10%, delayed decline after temporary recovery 6%, and no change 18%. Models accurately predicted ADL's 14-day post-hospitalization (AUC for bathing 0.917, bladder 0.842, bowels 0.875, dressing 0.871, eating 0.867, grooming 0.902, toileting 0.882, transfer 0.852, and walking deficits was 0.882). Accuracy declined but remained relatively high when predicting 14-365 days post-hospitalization (AUC ranging from 0.798 to 0.875). IMPLICATIONS Predictive modeling may allow development of more personalized predictions of functional loss and recovery after hospitalization among nursing home patients.
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Affiliation(s)
- Janusz Wojtusiak
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Cari R Levy
- Department of Internal Medicine, Palliative Care, Veterans Affairs Medical Center Eastern Colorado Health Care System, Denver
| | - Allison E Williams
- Department of Research, Bay Pines Veterans Affairs Healthcare System, Bay Pines, Florida.
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia. Office of Chief of Staff, District of Columbia Veterans Affairs Medical Center, Washington, DC
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Hennessy S, Kurichi JE, Pan Q, Streim JE, Bogner HR, Xie D, Stineman MG. Disability Stage is an Independent Risk Factor for Mortality in Medicare Beneficiaries Aged 65 Years and Older. PM R 2015; 7:1215-1225. [PMID: 26003869 DOI: 10.1016/j.pmrj.2015.05.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stages of activity limitation based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) have been found to predict mortality in persons aged 70 years and older but have not been examined in Medicare beneficiaries aged 65 years and older using data that are routinely collected. OBJECTIVE To examine the association between functional stages based on items of ADLs and IADLs with 3-year mortality in Medicare beneficiaries aged 65 years and older, accounting for baseline sociodemographics, health status, smoking, subjective health, and psychological well-being. DESIGN A cohort study using the Medicare Current Beneficiary Survey (MCBS) and associated health care utilization data. SETTING Community administered survey. PARTICIPANTS The study included 9698 Medicare beneficiaries aged 65 years and older who participated in the MCBS in 2005-2007. MAIN OUTCOME MEASURES Death within 3 years of cohort entry. RESULTS The overall mortality rate was 3.6 per 100 person years, and 3-year cumulative mortality was 10.3%. Unadjusted 3-year mortality was monotonically associated with both ADL stage and IADL stage. Adjusted 3-year mortality was associated with ADL and IADL stages, except that in some models the hazard ratio for stage III (which includes persons with atypical activity limitation patterns) was numerically lower than that for stage II. CONCLUSION We found nearly monotonic relationships between ADL and IADL stage and adjusted 3-year mortality. These findings could aid in the development of population health approaches and metrics for evaluating the success of alternative economic, social, or health policies on the longevity of older adults with activity limitations.
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Affiliation(s)
- Sean Hennessy
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 803 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021.,Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Qiang Pan
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - Dawei Xie
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Cross-sectional associations of depressive symptom severity and functioning with health service use by older people in low-and-middle income countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3774-92. [PMID: 25849540 PMCID: PMC4410215 DOI: 10.3390/ijerph120403774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/13/2015] [Accepted: 03/25/2015] [Indexed: 11/16/2022]
Abstract
Background: Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). Methods: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis. Results: After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with “any community HSU” (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01–1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02–1.26) but not “any community HSU”. Conclusions: Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems.
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He S, Craig BA, Xu H, Covinsky KE, Stallard E, Thomas J, Hass Z, Sands LP. Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability. J Gerontol A Biol Sci Med Sci 2015; 70:1128-32. [PMID: 25834196 DOI: 10.1093/gerona/glv028] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/23/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality. METHODS A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information. RESULTS Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p = .018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities. CONCLUSION Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.
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Affiliation(s)
- Shuang He
- Department of Statistics, Purdue University, West Lafayette, Indiana
| | - Bruce A Craig
- Department of Statistics, Purdue University, West Lafayette, Indiana
| | - Huiping Xu
- School of Medicine, Indiana University, Indianapolis
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California at San Francisco, San Francisco Veterans Affairs Medical Center
| | - Eric Stallard
- Center for Population Health and Aging, Duke University, Durham, North Carolina
| | - Joseph Thomas
- College of Pharmacy, Center on Aging and the Life Course, Regenstrief Center for Healthcare Engineering, Center for Health Outcomes Research and Policy, Purdue University, West Lafayette, Indiana
| | - Zach Hass
- Department of Statistics, Purdue University, West Lafayette, Indiana
| | - Laura P Sands
- School of Nursing and Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana.
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De Buyser SL, Petrovic M, Taes YE, Vetrano DL, Corsonello A, Volpato S, Onder G. Functional changes during hospital stay in older patients admitted to an acute care ward: a multicenter observational study. PLoS One 2014; 9:e96398. [PMID: 24820733 PMCID: PMC4018466 DOI: 10.1371/journal.pone.0096398] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance. METHODS The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ≥65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission. RESULTS Mean age of the study participants was 79 years (range 65-98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement. CONCLUSION Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge.
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Affiliation(s)
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Youri E. Taes
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - Davide L. Vetrano
- Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmaco-epidemiology, IRCCS - Italian National Research Centre on Aging (INRCA), Cosenza, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Graziano Onder
- Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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Hoogerduijn JG, de Rooij SE, Grobbee DE, Schuurmans MJ. Predicting functional decline in older patients undergoing cardiac surgery. Age Ageing 2014; 43:218-21. [PMID: 24190876 DOI: 10.1093/ageing/aft165] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND a growing number of older patients undergo cardiac surgery. Some of these patients are at increased risk of post-operative functional decline, potentially leading to reduced quality of life and autonomy, and other negative health outcomes. First step in prevention is to identify patients at risk of functional decline. There are no current published tools available to predict functional decline following cardiac surgery. OBJECTIVE to validate the identification of seniors at risk-hospitalised patients (ISAR-HP), in older patients undergoing cardiac surgery. DESIGN AND METHODS a multicenter cohort study in cardiac surgery wards of two university hospitals with follow-up 3 months after hospital admission. INCLUSION CRITERIA consecutive cardiac surgery patients, aged ≥65. Functional decline was defined as a decline of at least one point on the Katz ADL Index at follow-up compared with preadmission status. RESULTS 475 patients were included, 16% of all patients and 20% of patients ≥70+ suffered functional decline. The amended prediction model predicted functional decline using four criteria: preadmission need for daily assistance in instrumental activities of daily living, use of a walking device, need for assistance in travelling and no education after age 14. Area under the receiver operating curve for patients ≥70 it was 0.73. For the amended ISAR-HP sensitivity, specificity, positive and negative predictive values were 85, 48, 29 and 93%, respectively. CONCLUSIONS the amended ISAR-HP used in older cardiac surgery patients showed good discriminative values at score ≥1, supporting the generalisability of this prediction model for this patient group.
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The Simplified Acute Physiology Score III Is Superior to the Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II in Predicting Surgical and ICU Mortality in the "Oldest Old". Curr Gerontol Geriatr Res 2014; 2014:934852. [PMID: 24696680 PMCID: PMC3948612 DOI: 10.1155/2014/934852] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 11/03/2013] [Accepted: 12/02/2013] [Indexed: 11/18/2022] Open
Abstract
Elderly patients in the USA account for 26-50% of all intensive care unit (ICU) admissions. The applicability of validated ICU scoring systems to predict outcomes in the "Oldest Old" is poorly documented. We evaluated the utility of three commonly used ICU scoring systems (SAPS II, SAPS III, and APACHE II) to predict clinical outcomes in patients > 90 years. 1,189 surgical procedures performed upon 951 patients > 90 years (between 2000 and 2010) were analyzed. SAPS II, SAPS III, and Acute APACHE II were calculated for all patients admitted to the SICU. Differences between survivors and nonsurvivors were analyzed using the Student's t-test and binary logistic regression analysis. A receiver operating characteristic (ROC) curve was constructed for each scoring system studied. The area under the ROC curve (aROC) for the SAPS III was 0.81 at a cut-off value of 57, whereas the aROC for SAPS II was 0.75 at a cut-off score of 44 and the aROC for APACHE II was 0.74 at a cut-off score of 13. The SAPS III ROC curve for prediction of hospital mortality exhibited the greatest sensitivity (84%) and specificity (66%) with a score of 57 for the "Oldest Old" population.
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Grimmer K, Milanese S, Beaton K, Atlas A. Additional measures do not improve the diagnostic accuracy of the Hospital Admission Risk Profile for detecting downstream quality of life in community-dwelling older people presenting to a hospital emergency department. Clin Interv Aging 2014; 9:233-42. [PMID: 24489463 PMCID: PMC3904779 DOI: 10.2147/cia.s56086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction The Hospital Admission Risk Profile (HARP) instrument is commonly used to assess risk of functional decline when older people are admitted to hospital. HARP has moderate diagnostic accuracy (65%) for downstream decreased scores in activities of daily living. This paper reports the diagnostic accuracy of HARP for downstream quality of life. It also tests whether adding other measures to HARP improves its diagnostic accuracy. Methods One hundred and forty-eight independent community dwelling individuals aged 65 years or older were recruited in the emergency department of one large Australian hospital with a medical problem for which they were discharged without a hospital ward admission. Data, including age, sex, primary language, highest level of education, postcode, living status, requiring care for daily activities, using a gait aid, receiving formal community supports, instrumental activities of daily living in the last week, hospitalization and falls in the last 12 months, and mental state were collected at recruitment. HARP scores were derived from a formula that summed scores assigned to age, activities of daily living, and mental state categories. Physical and mental component scores of a quality of life measure were captured by telephone interview at 1 and 3 months after recruitment. Results HARP scores are moderately accurate at predicting downstream decline in physical quality of life, but did not predict downstream decline in mental quality of life. The addition of other variables to HARP did not improve its diagnostic accuracy for either measure of quality of life. Conclusion HARP is a poor predictor of quality of life.
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Affiliation(s)
- K Grimmer
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - S Milanese
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - K Beaton
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - A Atlas
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
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Studenski S. Prognosis for recovery after injurious falls: clinical and policy implications of varying definitions of recovery. JAMA Intern Med 2013; 173:1786-7. [PMID: 23959545 PMCID: PMC4877621 DOI: 10.1001/jamainternmed.2013.8252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Stephanie Studenski
- Division of Geriatrics and Gerontology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Tan A, Kuo YF, Goodwin JS. Predicting life expectancy for community-dwelling older adults from Medicare claims data. Am J Epidemiol 2013; 178:974-83. [PMID: 23851579 DOI: 10.1093/aje/kwt054] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Estimates of life expectancy are useful in assessing whether different prevention strategies are appropriate in different populations. We developed sex-specific Cox proportional-hazard models that use Medicare claims data to predict life expectancy and risk of death at up to 10 years for older adults. We identified a cohort of Medicare beneficiaries 66-90 years of age from the 5% Medicare claims data in 2000 (n = 1,137,311) and tracked each subject's vital status until December 31, 2009. Subjects were split randomly into training and validation samples. Models were developed from the training sample and validated by comparison of predicted to actual survival in the validation sample. The C statistics for the models including predictors of age and Elixhauser comorbidities were 0.76-0.79 for men and women for prediction of death at the 1-, 5-, 7-, and 10-year follow-up periods. More than 80% of subjects with <25% risk of death at 5, 7, and 10 years survived longer than the chosen cutoff years. More than 80% of subjects with ≥75% risk of death at 5, 7, and 10 years died by those cutoff years. The models overestimated the risk of death at 1 year for the high-risk groups. Sex-specific models that use age and Elixhauser comorbidities can accurately predict patient life expectancy and risk of death at 5-10 years.
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Thomas JM, Cooney LM, Fried TR. Systematic review: Health-related characteristics of elderly hospitalized adults and nursing home residents associated with short-term mortality. J Am Geriatr Soc 2013; 61:902-911. [PMID: 23692412 DOI: 10.1111/jgs.12273] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify the domains of health-related characteristics of older hospitalized adults and nursing home residents most strongly associated with short-term mortality. DESIGN Systematic review. SETTING Studies published in English in MEDLINE, Scopus, or Web of Science before August 1, 2010. PARTICIPANTS Prospective studies consisting of persons aged 65 and older that evaluated the association between at least one health-related participant characteristic and mortality within a year in multivariable analysis. MEASUREMENTS All health-related characteristics associated with mortality in multivariable analysis were extracted and categorized into domains. The frequency, with all studies combined, with which particular domains were associated with mortality in multivariable analysis was determined. RESULTS Thirty-three studies (28 in hospitalized individuals, five in nursing home residents) reported a large number of characteristics associated with mortality that could be categorized in seven domains: cognitive function, disease diagnosis, laboratory values, nutrition, physical function, pressure ulcers, and shortness of breath. Measures of physical function and nutrition were the domains most frequently associated with mortality up to 1 year from the time of evaluation for hospitalized individuals and nursing home residents; measures of physical function, cognitive function, and nutrition were the domains most frequently associated with in-hospital mortality for hospitalized individuals. CONCLUSION Of a large number of health-related characteristics of older persons shown to be associated with short-term mortality, measures of nutrition, physical function, and cognitive function were the domains of health most frequently associated with mortality. These domains provide easily measurable factors that may serve as helpful markers for individuals at high mortality risk.
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Affiliation(s)
- John M Thomas
- Department of Medicine, Yale University, New Haven, Connecticut, USA.
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Beaton K, Grimmer K. Tools that assess functional decline: systematic literature review update. Clin Interv Aging 2013; 8:485-94. [PMID: 23662052 PMCID: PMC3646484 DOI: 10.2147/cia.s42528] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Screening for risk of functional decline in the elderly is increasingly important in ambulatory health care settings, to ensure that appropriate services are provided to reduce the risk of downstream decline. These screening tools should have sound psychometric properties and clinical utility. Design An updated systematic literature review for (1) new screening tools published since the last review, conducted in 2007 and published in 2008, and (2) recent research into psychometric properties of the five tools identified in the previous review. Methods A comprehensive review of multiple databases using the search terms from the Sutton et al review was conducted. The reference lists of included articles were hand-searched for additional articles, and the literature was evaluated with the appropriate critical appraisal tool. Included screening tools should be designed for, or applicable to, hospital emergency departments. Results Two relevant new tools were identified (the Simplified PROFUNCTION index and Brief Risk Identification for Geriatric Health Tool). Six additional papers testing psychometric properties of four of the five previously reported screening tools were also found. Conclusion Seven relevant screening tools are available with similar validity and reliability estimates. They consider similar constructs and have convincing evidence of applicability to a range of older populations, or different cultures. Identification of Seniors at Risk, is the most frequently reported screening tool. The wider unanswered question is how, why, and where these functional decline screening tools are used; how valid the findings are on ill, stressed, older people in emergency departments; and how the findings are acted upon in terms of community intervention to slow functional decline.
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Affiliation(s)
- Kate Beaton
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
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Helvik AS, Engedal K, Selbæk G. Three-year mortality in previously hospitalized older patients from rural areas--the importance of co-morbidity and self-reported poor health. BMC Geriatr 2013; 13:17. [PMID: 23419167 PMCID: PMC3600034 DOI: 10.1186/1471-2318-13-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/14/2013] [Indexed: 11/13/2022] Open
Abstract
Background The risk factors for mortality after hospitalization in older persons are not fully understood. The aim of the present study was to examine the three-year (1,096 days) mortality in previously hospitalized older patients from rural areas, and to explore how objectively and self-reported health indicators at baseline were associated with mortality. Methods The study included 484 (241 men) medical inpatients with age range 65–101 (mean 80.7, SD 7.4) years. Baseline information included the following health measures: the Charlson Index, the Mini-Mental-State Examination, Lawton and Brody’s scales for physical self-maintenance and the instrumental activities of daily living, the Hospital Anxiety and Depression scale, self-reported health (one item), and perceived social functioning (one item) and assistance in living at discharge. Results In all, 172 (35.5%) of those patients included had died within the three years of the follow-up period. Three-year mortality was associated with a high score at baseline on the Charlson Index (HR 1.73, 95%CI 1.09-2.74) and poor self-reported health (HR 1.52, 95%CI 1.03-2.25) in a Cox regression analysis adjusted for age, gender, other objectively measured health indicators, and perceived impaired social functioning. Conclusion In a study of older adults admitted to a general hospital for a wide variety of disorders, we found co-morbidity (as measured with the Charlson Index) and poor self-reported health associated with three-year mortality in analysis adjusting for age, gender, and other health-related indicators. The results suggest that self-reported health is a measure that should be included in future studies.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim NO-7491, Norway.
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