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Giménez-Esparza Vich C, Oliver Hurtado B, Relucio Martinez MA, Sanchez Pino S, Portillo Requena C, Simón Simón JD, Pérez Gómez IM, Andrade Rodado FM, Laghzaoui Harbouli F, Sotos Solano FJ, Montenegro Moure CA, Carrillo Alcaraz A. Postintensive care syndrome in patients and family members. Analysis of COVID-19 and non-COVID-19 cohorts, with face-to-face follow-up at three months and one year. Med Intensiva 2024:S2173-5727(24)00082-1. [PMID: 38734493 DOI: 10.1016/j.medine.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/12/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Compare prevalence and profile of post-intensive care patient (P-PICS) and family/caregiver (F-PICS) syndrome in two cohorts (COVID and non-COVID) and analyse risk factors for P-PICS. DESIGN Prospective, observational cohort (March 2018-2023), follow-up at three months and one year. SETTING 14-bed polyvalent Intensive Care Unit (ICU), Level II Hospital. PATIENTS OR PARTICIPANTS 265 patients and 209 relatives. Inclusion criteria patients: age > 18 years, mechanical ventilation > 48 h, ICU stay > 5 days, delirium, septic shock, acute respiratory distress syndrome, cardiac arrest. Inclusion criteria family: those who attended. INTERVENTIONS Follow-up 3 months and 1 year after hospital discharge. MAIN VARIABLES OF INTEREST Patients: sociodemographic, clinical, evolutive, physical, psychological and cognitive alterations, dependency degree and quality of life. Main caregivers: mental state and physical overload. RESULTS 64.9% PICS-P, no differences between groups. COVID patients more physical alterations than non-COVID (P = .028). These more functional deterioration (P = .005), poorer quality of life (P = .003), higher nutritional alterations (P = .004) and cognitive deterioration (P < .001). 19.1% PICS-F, more frequent in relatives of non-COVID patients (17.6% vs. 5.5%; P = .013). Independent predictors of PICS-P: first years of the study (OR: 0.484), higher comorbidity (OR: 1.158), delirium (OR: 2.935), several reasons for being included (OR: 3.171) and midazolam (OR: 4.265). CONCLUSIONS Prevalence PICS-P and PICS-F between both cohorts was similar. Main factors associated with the development of SPCI-P were: higher comorbidity, delirium, midazolan, inclusion for more than one reason and during the first years.
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Affiliation(s)
- Carola Giménez-Esparza Vich
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain.
| | - Beatriz Oliver Hurtado
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Salomé Sanchez Pino
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Cristina Portillo Requena
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - José David Simón Simón
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Isabel María Pérez Gómez
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Fadoua Laghzaoui Harbouli
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | | | - Andrés Carrillo Alcaraz
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
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Kim E, Jung S, Lee MY, Park CH, Cho SJ. Exploring the Association between Elevated Anxiety Symptoms and Low Skeletal Muscle Mass among Asymptomatic Adults: A Population-Based Study in Republic of Korea. Brain Sci 2024; 14:438. [PMID: 38790417 PMCID: PMC11119912 DOI: 10.3390/brainsci14050438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Individuals with mental health problems are at higher risk of musculoskeletal diseases. However, the association between low muscle mass (LMM) and anxiety symptoms remains uninvestigated. This cross-sectional study enrolled 174,262 adults (73,833 women, 100,429 men), aged 18 to 89, who completed the anxiety scale and body composition analyses. Using bio-electrical impedance analysis, skeletal muscle mass index (SMI) was calculated based on appendicular skeletal muscle mass (ASM) (kg)/height (m2). LMM was defined as SMI < 7.0 kg/m2 in men and <5.4 kg/m2 in women. Anxiety symptoms were screened using the Clinical Useful Anxiety Outcome Scale (CUXOS) with cut-off scores of 20, 30, and 40. Multivariable logistic regression analyses were performed. LMM prevalence was 20.17% in women, 3.86% in men (p < 0.001). The prevalence of anxiety symptoms in LMM group decreased from mild (CUXOS > 20: women, 32.74%, men, 21.17%) to moderate (CUXOS > 30: 13.34%, 7.32%), to severe anxiety symptoms (CUXOS > 40: 4.00%, 1.73%). In multivariable-adjusted models, LMM was associated with mild (aOR (95% confidence interval)), women, 1.13 (1.08-1.17); men, 1.17 (1.08-1.27)), moderate (1.17 (1.11-1.24); 1.35 (1.19-1.53) and severe anxiety symptoms (1.18 (1.07-1.3), 1.36 (1.06-1.74)), demonstrating an increased risk of ORs with escalating anxiety severity. LMM was independently associated with a higher prevalence of anxiety symptoms.
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Affiliation(s)
- Eunsoo Kim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Sra Jung
- Department of Psychiatry, Cha University Ilsan Medical Center, Goyang 10223, Republic of Korea;
| | - Mi Yeon Lee
- Division of Biostatistics, Department of Academic Research, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Chul-Hyun Park
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul 03181, Republic of Korea
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Hongo T, Yumoto T, Inaba M, Taito S, Yorifuji T, Nakao A, Naito H. Long-term, patient-centered, frailty-based outcomes of older critical illness survivors from the emergency department: a post hoc analysis of the LIFE Study. BMC Geriatr 2024; 24:257. [PMID: 38491464 PMCID: PMC10941380 DOI: 10.1186/s12877-024-04881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes. METHODS This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of < 4. Our primary outcome was patient-centered outcomes (QOL/ADL) measured by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Barthel Index six months post-ICU admission, comparing results from baseline. Secondary outcomes included exploration of factors associated with QOL/ADL six months post-ICU admission using multiple linear regression analyses. RESULTS Of 514 candidates, 390 participants responded to the EQ-5D-5L questionnaire, while 237 responded to the Barthel Index. At six months post-admission, mean EQ-5D-5L values declined in both the not frail and frail groups (0.80 to 0.73, p = 0.003 and 0.58 to 0.50, p = 0.002, respectively); Barthel Index scores also declined in both groups (98 to 83, p < 0.001 and 79 to 61, p < 0.001, respectively). Multiple linear regression analysis revealed that baseline frailty (β coefficient, -0.15; 95% CI, - 0.23 to - 0.07; p < 0.001) and pre-admission EQ-5D-5L scores (β coefficient, 0.14; 95% CI, 0.02 to 0.26; p = 0.016) affected EQ-5D-5L scores at six months. Similarly, baseline frailty (β coefficient, -12.3; 95% CI, - 23.9 to - 0.80; p = 0.036) and Barthel Index scores (β coefficient, 0.54; 95% CI, 0.30 to 0.79; p < 0.001) influenced the Barthel Index score at six months. CONCLUSIONS Regardless of frailty, older ICU survivors from the emergency department were more likely to experience reduced QOL and ADL six months after ICU admission compared to baseline.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Mototaka Inaba
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Hiroshima, 734-0037, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Zhang F, Yang W. Interaction between activities of daily living and cognitive function on risk of depression. Front Public Health 2024; 12:1309401. [PMID: 38384887 PMCID: PMC10880188 DOI: 10.3389/fpubh.2024.1309401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/04/2024] [Indexed: 02/23/2024] Open
Abstract
Objective There is a lack of literature about the joint effects of activities of daily living (ADL) limitation and cognitive impairment on depression. This study aimed to estimate the association of ADL limitation and cognitive impairment with depression among Chinese older adults aged 65 and above and to test their interaction on both additive and multiplicative scales. Methods Data was drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 11,025 eligible participants. Logistic regression models were fitted, and both multiplicative and additive interactions for ADL limitation and cognitive impairment were tested. Results A total of 3,019(27.4%) participants reported depressive symptoms. After controlling for potential confounding factors, ADL limitation and cognitive impairment were both positively associated with depression. The adjusted additive interaction of basic and instrumental activities of daily living limitation were 2.47 (95%CI:1.92-3.19) and 3.67 (95%CI:2.88-4.66), respectively, but the multiplicative interaction items were both insignificant. Conclusion ADL limitation and cognitive impairment were both risk factors for depression among Chinese older adults. Moreover, the significant interaction of ADL limitation and cognitive impairment was found in the additive model, suggesting that improving ADL may be helpful in reducing the risk of depression among older people with cognitive impairment.
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Affiliation(s)
- Fenghao Zhang
- Department of Neonatology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Wenyan Yang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Guidet B, Vallet H, Flaatten H, Joynt G, Bagshaw SM, Leaver SK, Beil M, Du B, Forte DN, Angus DC, Sviri S, de Lange D, Herridge MS, Jung C. The trajectory of very old critically ill patients. Intensive Care Med 2024; 50:181-194. [PMID: 38236292 DOI: 10.1007/s00134-023-07298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
Abstract
The demographic shift, together with financial constraint, justify a re-evaluation of the trajectory of care of very old critically ill patients (VIP), defined as older than 80 years. We must avoid over- as well as under-utilisation of critical care interventions in this patient group and ensure the inclusion of health care professionals, the patient and their caregivers in the decision process. This new integrative approach mobilises expertise at each step of the process beginning prior to intensive care unit (ICU) admission and extending to long-term follow-up. In this review, several international experts have contributed to provide recommendations that can be universally applied. Our aim is to define a minimum core dataset of information to be shared and discussed prior to ICU admission and to facilitate the shared-decision-making process with the patient and their caregivers, throughout the patient journey. Documentation of uncertainty may contribute to a tailored level of care and ultimately to discussions around possible limitations of life sustaining treatments. The goal of ICU care is not only to avoid death, but more importantly to maintain an acceptable quality of life and functional autonomy after hospital discharge. Societal consideration is important to highlight, together with alternatives to ICU admission. We discuss challenges for the future and potential areas of research. In summary, this review provides a state-of-the-art current overview and aims to outline future directions to address the challenges in the treatment of VIP.
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Affiliation(s)
- Bertrand Guidet
- Medical ICU, Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.
| | - Helene Vallet
- Department of Geriatrics, Sorbonne Université, Institut National de la Santé Et de la Recherche Médicale (INSERM), UMRS 1135, Centre d'immunologie et de Maladies Infectieuses (CIMI), Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), 75012, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Gavin Joynt
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | | | - Michael Beil
- Department of Medical Intensive Care, Faculty of Medicine, Hebrew University and Hadassah University Medical Center, Jerusalem, Israel
| | - Bin Du
- Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Daniel N Forte
- Departament of Emergency Medicine, Faculdade de Medicina, Universidade de São Paulo, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Derek C Angus
- Critical Care Medicine, UPMC and University of Pittsburgh, Pittsburgh, USA
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Christian Jung
- Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany
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6
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Davies TW, Kelly E, van Gassel RJJ, van de Poll MCG, Gunst J, Casaer MP, Christopher KB, Preiser JC, Hill A, Gundogan K, Reintam-Blaser A, Rousseau AF, Hodgson C, Needham DM, Schaller SJ, McClelland T, Pilkington JJ, Sevin CM, Wischmeyer PE, Lee ZY, Govil D, Chapple L, Denehy L, Montejo-González JC, Taylor B, Bear DE, Pearse RM, McNelly A, Prowle J, Puthucheary ZA. A systematic review and meta-analysis of the clinimetric properties of the core outcome measurement instruments for clinical effectiveness trials of nutritional and metabolic interventions in critical illness (CONCISE). Crit Care 2023; 27:450. [PMID: 37986015 PMCID: PMC10662687 DOI: 10.1186/s13054-023-04729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND CONCISE is an internationally agreed minimum set of outcomes for use in nutritional and metabolic clinical research in critically ill adults. Clinicians and researchers need to be aware of the clinimetric properties of these instruments and understand any limitations to ensure valid and reliable research. This systematic review and meta-analysis were undertaken to evaluate the clinimetric properties of the measurement instruments identified in CONCISE. METHODS Four electronic databases were searched from inception to December 2022 (MEDLINE via Ovid, EMBASE via Ovid, CINAHL via Healthcare Databases Advanced Search, CENTRAL via Cochrane). Studies were included if they examined at least one clinimetric property of a CONCISE measurement instrument or recognised variation in adults ≥ 18 years with critical illness or recovering from critical illness in any language. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for systematic reviews of Patient-Reported Outcome Measures was used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in line with COSMIN guidance. The COSMIN checklist was used to evaluate the risk of bias and the quality of clinimetric properties. Overall certainty of the evidence was rated using a modified Grading of Recommendations, Assessment, Development and Evaluation approach. Narrative synthesis was performed and where possible, meta-analysis was conducted. RESULTS A total of 4316 studies were screened. Forty-seven were included in the review, reporting data for 12308 participants. The Short Form-36 Questionnaire (Physical Component Score and Physical Functioning), sit-to-stand test, 6-m walk test and Barthel Index had the strongest clinimetric properties and certainty of evidence. The Short Physical Performance Battery, Katz Index and handgrip strength had less favourable results. There was limited data for Lawson Instrumental Activities of Daily Living and the Global Leadership Initiative on Malnutrition criteria. The risk of bias ranged from inadequate to very good. The certainty of the evidence ranged from very low to high. CONCLUSIONS Variable evidence exists to support the clinimetric properties of the CONCISE measurement instruments. We suggest using this review alongside CONCISE to guide outcome selection for future trials of nutrition and metabolic interventions in critical illness. TRIAL REGISTRATION PROSPERO (CRD42023438187). Registered 21/06/2023.
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Affiliation(s)
- T W Davies
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK.
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK.
| | - E Kelly
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - R J J van Gassel
- Department of Intensive Care Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M C G van de Poll
- Department of Intensive Care Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J Gunst
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - M P Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - K B Christopher
- Division of Renal Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - J C Preiser
- Medical Direction, Erasme University Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - A Hill
- Department of Intensive Care Medicine, University Hospital RWTH, 52074, Aachen, Germany
- Department of Anesthesiology, University Hospital RWTH, 52074, Aachen, Germany
| | - K Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - A Reintam-Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - A-F Rousseau
- Department of Intensive Care, University Hospital of Liège, Liege, Belgium
| | - C Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 3/553 St Kilda Rd, Melbourne, VIC, 3004, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - D M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S J Schaller
- Department of Anesthesiology and Intensive Care Medicine (CVK, CCM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - T McClelland
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - J J Pilkington
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - C M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P E Wischmeyer
- Department of Anesthesiology, Duke University School of Medicine, DUMC, Box 3094 Mail # 41, 2301 Erwin Road, Durham, NC, 5692 HAFS27710, USA
| | - Z Y Lee
- Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia
- Department of Cardiac, Anesthesiology & Intensive Care Medicine, Charité, Berlin, Germany
| | - D Govil
- Institute of Critical Care and Anesthesia, Medanta: The Medicty, Gurugram, Haryana, India
| | - L Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - L Denehy
- School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Allied Health, Peter McCallum Cancer Centre, Melbourne, Australia
| | - J C Montejo-González
- Instituto de Investigación I+12, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - B Taylor
- Department of Research for Patient Care Services, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - D E Bear
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R M Pearse
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - A McNelly
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - J Prowle
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - Z A Puthucheary
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
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Lauridsen MD, Rørth R, Butt JH, Strange JE, Schmidt M, Kristensen SL, Kragholm K, Johnsen SP, Møller JE, Hassager C, Køber L, Fosbøl EL. Need for home care or nursing home admission after myocardial infarction complicated by cardiogenic shock and/or out-of-hospital cardiac arrest. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:707-715. [PMID: 36509229 DOI: 10.1093/ehjqcco/qcac084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
AIMS Myocardial infarction (MI) with cardiogenic shock (CS) and/or out-of-hospital cardiac arrest (OHCA) are conditions with potential loss of autonomy. In patients with MI, the association between CS and OHCA and need for home care or nursing home admission was examined. METHODS AND RESULTS Danish nationwide registries identified patients with MI (2008-19), who prior to the event lived at home without home care and discharged alive. One-year cumulative incidences and hazard ratios (HRs) were reported for home care need or nursing home admission, a composite proxy for disability in activities of daily living (ADL), along with all-cause mortality. The study population consisted of 67 109 patients with MI (by groups: -OHCA/-CS: 63 644; -OHCA/+CS: 1776; +OHCA/-CS: 968; and +OHCA/+CS: 721). The 1-year cumulative incidences of home care/nursing home were 7.1% for patients who survived to discharge with -OHCA/-CS, 20.9% for -OHCA/+CS, 5.4% for +OHCA/-CS, and 8.2% for those with +OHCA/+CS. The composite outcome was driven by home care. With the -OHCA/-CS as reference, the adjusted HRs for home care/nursing home were 2.86 (95% CI: 2.57-3.19) for patients with -OHCA/+CS; 1.31 (95% CI: 1.00-1.73) for + OHCA/-CS; and 2.18 (95% CI: 1.68-2.82) for those with +OHCA/+CS. The 1-year cumulative mortality were 5.1% for patients with -OHCA/-CS, 9.8% for -OHCA/+CS, 3.0% for +OHCA/-CS, and 3.4% for those with +OHCA/+CS. CONCLUSION In patients discharged alive after a MI, CS, and to a lesser degree OHCA were associated with impaired ADL with a two-fold higher 1-year incidence of home care or nursing home admission compared with MI patients without CS or OHCA.
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Affiliation(s)
- Marie D Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jarl E Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Jacob E Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
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8
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Ganidagli S, Ozturk E, Ozturk ZA. Risk factors of poor sleep quality in older adults: an analysis based on comprehensive geriatric assessment. Curr Med Res Opin 2023; 39:701-706. [PMID: 36927301 DOI: 10.1080/03007995.2023.2192124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Sleep quality is associated with many diseases and conditions that affect individuals' health in various ways. We aimed to investigate the association between sleep quality and common geriatric conditions in older adults. METHODS The study included 237 older adults admitted to the geriatric outpatient clinic of a university hospital. All patients underwent comprehensive geriatric assessment (CGA). The Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life (EQ-5D), Pittsburgh Sleep Quality Index (PSQI), Katz Index of Independence in Activities of Daily Living (ADL) and Lawton and Brody Instrumental Activities of Daily Living (IADL) questionnaires, Tinetti Balance and Gait Assessment (TBGA), and Mini Nutritional Assessment (MNA) were performed on the participants. RESULTS Participants had a mean age of 72.2 ± 6.3 years, and 146 (61.6%) of them had poor sleep quality. Of the participants, 61.2% were female. In the poor sleep quality group, GDS and BAI scores were higher while ADL, IADL, MNA, and EQ-5D index scores were lower. PSQI score had a negative correlation with ADL (r = -.207, p = .01), EQ-5D index (r = -.372, p = .00), MNA (r = -.277, p = .00), and TBGA (r = -.263, p = .41) scores and a positive correlation with GDS (r = .426, p = .00) and BAI (r = .450, p = .00) scores according to the results of correlation analysis. Multivariate logistic regression analysis showed that the presence of diabetes mellitus (DM) and higher GDS and BAI scores were independent variables for poor sleep quality [(p = .48, OR = 1.92; p = .20, OR = 1.11; and p <.01, OR = 1.11, respectively)]. CONCLUSIONS We found that DM and depressive and anxiety symptoms were the risks of poor sleep quality. In addition, participants with poor sleep quality had a worse quality-of-life and nutritional status. Improving sleep quality may be helpful in the management of geriatric syndromes and that sleep quality assessment should be part of CGA.
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Affiliation(s)
- Sencer Ganidagli
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Ercument Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
| | - Zeynel Abidin Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Sahinbey, Turkey
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9
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Affiliation(s)
- Margaret S Herridge
- From Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto; and Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris
| | - Élie Azoulay
- From Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto; and Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris
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10
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Brunker LB, Boncyk CS, Rengel KF, Hughes CG. Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges. Clin Interv Aging 2023; 18:93-112. [PMID: 36714685 PMCID: PMC9879046 DOI: 10.2147/cia.s365968] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 01/23/2023] Open
Abstract
There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.
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Affiliation(s)
- Lucille B Brunker
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina S Boncyk
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly F Rengel
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher G Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Gao L, Yang J, Liu J, Xin T, Liu Y. Activities of Daily Living and Depression in Chinese Elderly of Nursing Homes: A Mediation Analysis. Psychol Res Behav Manag 2023; 16:29-38. [PMID: 36636291 PMCID: PMC9831252 DOI: 10.2147/prbm.s394787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose This study aimed to explore the role of sleep quality as a mediator in the activities of daily living (ADLs) and depression. Patients and Methods Participants (N=645; age≥60) were included in six nursing homes in Weifang, Shandong Province, using convenience sampling. Participants completed questionnaires to assess sleep quality, ADLs, and depression. Depression condition was assessed by the Patient Health Questionnaire (PHQ-9), ADLs was assessed by the Barthel Index (BI), and sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Mediation analysis was carried out by SPSS PROCESS. Results ADLs (r=0.449, P<0.01) and sleep quality (r=0.450, P<0.01) were found to be positively associated with depression among the elderly. Sleep quality plays a significant mediating role in the influence of ADLs on depression in the elderly in nursing homes (Bootstrap 95% CI [0.076, 0.139]), The pathway from ADLs to sleep quality to depression yielded a medium effect size of 20.23%. Conclusion ADLs help to explain how sleep quality partly mediates depression among the elderly in nursing homes. It is therefore recommended that timely detection and efficient interventions should focus on promoting physical function and improving sleep quality among the elderly in nursing homes.
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Affiliation(s)
- Lunan Gao
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China
| | - Jinhong Yang
- Department of Oncology, Weifang People’s Hospital, Weifang, People’s Republic of China
| | - Jiang Liu
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China
| | - Tingting Xin
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China
| | - Yuxiu Liu
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China,Correspondence: Yuxiu Liu, School of Nursing, Weifang Medical University, No. 7166 Baotong Western Street, Weifang, People’s Republic of China, Tel +8618663608162, Email
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12
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Kong JY, Hong H, Kang H. Relationship between physical activity and depressive symptoms in older Korean adults: moderation analysis of muscular strength. BMC Geriatr 2022; 22:884. [PMID: 36411413 PMCID: PMC9677686 DOI: 10.1186/s12877-022-03610-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This population-based cross-sectional study examined the associations between physical activity (PA) and lower body muscle strength (LBMS) with late-life depression in a representative sample of older Korean adults aged 65 years and older. METHODS The data used in the current study (n = 10,097/60% women) were extracted from the 2020 Korea Longitudinal Study on Aging, which is a nationwide population-based survey conducted in Korea. Depressive symptoms were assessed with the Geriatric Depression Scale Short-Form. PA and LBMS were evaluated with a self-reported questionnaire and the 5 times sit-to-stand test, respectively. Covariates include age, gender, body mass index, education level, smoking status, alcohol intake, and comorbidity. RESULTS Insufficient PA had higher odds of depression (odds ratio [OR] = 1.201, 95% confidence interval [CI] = 1.035-1.393, p = 0.016), even after adjustments for all covariates, compared to sufficient PA. Poor LBMS had higher odds of depression (OR = 2.173, 95% CI = 1.821-2.593, p < 0.001), even after adjustments for all covariates, compared to good LBMS. Particularly, a significant moderation effect of LBMS on the relationship between PA and depressive symptoms was observed (β = 0.3514 and 95% CI = 0.1294 ~ 0.5733, p < 0.001). Individuals with poor LBMS had a greater odd of depression associated with physical inactivity compared to their counterparts with good LBMS. CONCLUSIONS The results of this study support the importance of promoting muscular strength through regular exercise as a preventive strategy against late-life depression in Korean adults.
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Affiliation(s)
- Ji-Young Kong
- grid.264381.a0000 0001 2181 989XCollege of Sport Science, Sungkyunkwan University, Suwon, 16419 Republic of Korea
| | - Haeryun Hong
- grid.264381.a0000 0001 2181 989XCollege of Sport Science, Sungkyunkwan University, Suwon, 16419 Republic of Korea
| | - Hyunsik Kang
- grid.264381.a0000 0001 2181 989XCollege of Sport Science, Sungkyunkwan University, Suwon, 16419 Republic of Korea
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Mejía Vanegas D, Arias Díaz JA, Leyton Toro L, Ayala Grajales KY, Becerra Londoño AM, Vallejo Ospina JI, Rincón Hurtado ÁM. Calidad de vida y funcionalidad en sobrevivientes de cuidados intensivos: Una revisión exploratoria. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introducción: La calidad de vida en pacientes críticos que sobreviven al tratamiento en unidades de cuidados intensivos es inferior al de la población general. La condición de salud basal y la severidad de la condición clínica al ingreso a terapia intensiva son factores de riesgo para la calidad de vida y la funcionalidad. Objetivo: Analizar el nivel de conocimiento en la calidad de vida y la funcionalidad de los sobrevivientes de cuidados intensivos. Materiales y métodos: Se realizó una revisión exploratoria en las bases de datos: Scielo, PubMed, Science Direct, ProQuest, Redalyc, Dialnet, OVID, Scopus, publicados entre enero del año 2010 y mayo del año 2020. El estudio se desarrolló según la estructura de la Metodología PRISMA. Se revisaron y analizaron los textos completos que cumplían los criterios de inclusión para la selección final de los artículos. Resultados: De 1814 artículo seleccionados, se eligieron 65 artículos que describen la calidad de vida y la funcionalidad en pacientes después de cuidados intensivos, y finalmente, 16 artículos son incluidos, donde se analizaron las características de los artículos, las características de la población estudiada, y las variables de análisis sobre la evaluación de la calidad de vida y la funcionalidad en los sobrevivientes después cuidados intensivos. Conclusión: Los estudios sobre calidad de vida y funcionalidad en sobrevivientes de cuidados intensivos se realizaron en mayor proporción en Europa en los años 2010 a 2016. Con estudios observacionales prospectivos que correlacionan los factores que determinan la salud mental y física después del egreso de cuidados intensivos. Se aplicaron múltiples escalas siendo las más utilizadas SF-36 y el EQ-5D para evaluar la calidad de vida y del índice de Barthel para determinar el estado de funcionalidad en los egresados de cuidados intensivos. El SF-36 y el índice de Barthel reportaron una afectación en la calidad de vida y en la funcionalidad en la población sobreviviente de cuidados intensivos.
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Lau VI, Johnson JA, Bagshaw SM, Rewa OG, Basmaji J, Lewis KA, Wilcox ME, Barrett K, Lamontagne F, Lauzier F, Ferguson ND, Oczkowski SJW, Fiest KM, Niven DJ, Stelfox HT, Alhazzani W, Herridge M, Fowler R, Cook DJ, Rochwerg B, Xie F. Health-related quality-of-life and health-utility reporting in critical care. World J Crit Care Med 2022; 11:236-245. [PMID: 36051941 PMCID: PMC9305682 DOI: 10.5492/wjccm.v11.i4.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/16/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Mortality is a well-established patient-important outcome in critical care studies. In contrast, morbidity is less uniformly reported (given the myriad of critical care illnesses and complications of each) but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life (HRQoL). Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences. Hence, as mortality decreases within critical care, it becomes increasingly important to measure intensive care unit (ICU) survivor HRQoL. HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0 (representing death) and 1 (representing full health). They can be combined with survival to calculate quality-adjusted life-years (QALY), which are one of the most widely used methods of combining morbidity and mortality into a composite outcome. Although QALYs have been use for health-technology assessment decision-making, an emerging and novel role would be to inform clinical decision-making for patients, families and healthcare providers about what expected HRQoL may be during and after ICU care. Critical care randomized control trials (RCTs) have not routinely measured or reported HRQoL (until more recently), likely due to incapacity of some patients to participate in patient-reported outcome measures. Further differences in HRQoL measurement tools can lead to non-comparable values. To this end, we propose the validation of a gold-standard HRQoL tool in critical care, specifically the EQ-5D-5L. Both combined health-utility and mortality (disaggregated) and QALYs (aggregated) can be reported, with disaggregation allowing for determination of which components are the main drivers of the QALY outcome. Increased use of HRQoL, health-utility, and QALYs in critical care RCTs has the potential to: (1) Increase the likelihood of finding important effects if they exist; (2) improve research efficiency; and (3) help inform optimal management of critically ill patients allowing for decision-making about their HRQoL, in additional to traditional health-technology assessments.
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Affiliation(s)
- Vincent Issac Lau
- Department of Critical Care Medicine, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - Jeffrey A Johnson
- School of Public Health, Inst Hlth Econ, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, University of Alberta, Edmonton T6G 2B7, AB, Canada
| | - John Basmaji
- Department of Medicine, Division of Critical Care, Western University, London N6A 5W9, Canada
| | - Kimberley A Lewis
- Division of Critical Care, McMaster University, Hamilton L8N 4A6, Canada
| | - M Elizabeth Wilcox
- Interdepartmental Division of Critical Care, University of Toronto, Toronto M5T 2S8, Canada
| | - Kali Barrett
- Interdepartmental Division of Critical Care, University of Toronto, Toronto M5T 2S8, Canada
| | | | - Francois Lauzier
- Departments of Medicine and Anesthesiology, University Laval, Laval G1V 4G2, Canada
| | - Niall D Ferguson
- Department Critical Care Medicine, University of Toronto, Toronto M5G 2C4, Canada
| | - Simon J W Oczkowski
- Department of Medicine, McMaster Clin, Hamilton Gen Hosp, McMaster University, Hamilton L8N 4A6, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences & Institute for Public Health, University of Calgary, Calgary T2N 2T9, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University Calgary, Calgary T2N 2T9, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary T2N 2T9, Canada
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton L8N 4A6, Canada
| | - Margaret Herridge
- Indepartmental Division of Critical Care, University Health Network, Toronto M5G 2C4, Canada
| | - Robert Fowler
- Departments of Medicine and Critical Care Medicine, Sunnybrook Health Sciences Center, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto M4N 3M5, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton L8N 4A6, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton L8N 4A6, Canada
| | - Feng Xie
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton L8N 3Z5, Canada
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15
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Depression and mortality after craniotomy for brain tumor removal: A Nationwide cohort study in South Korea. J Affect Disord 2021; 295:291-297. [PMID: 34482061 DOI: 10.1016/j.jad.2021.08.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to investigate the prevalence and associated factors of newly developed depression in patients who underwent craniotomy for brain tumor removal, as well as its effect on long-term mortality. METHODS Using a nationwide cohort database in South Korea, we included adult patients diagnosed with brain tumors who underwent craniotomy for brain tumor removal from January 1, 2011, to December 31, 2017. We excluded patients with a preoperative history of depression. RESULTS Among 4,275 patients, 727 (17.0%) patients were newly diagnosed with depression within one year, postoperatively. Two-year all-cause mortality and mortality due to brain cancer occurred in 1,233 (28.8%) and 1,099 (25.7%) patients, respectively. In the multivariable logistic regression model, older age, living in rural areas, newly acquired brain disability, underlying other psychiatric disorders, and longer length of hospital stay were associated with a higher incidence of newly developed depression. In the multivariable Cox regression model, newly acquired depression was associated with a 1.58-fold higher 2-year all-cause mortality compared with that in other patients (hazard ratio: 1.58, 95% confidence interval: 1.38-1.80; P < 0.001). LIMITATION Lack of information regarding severity and pathologic tumor type. CONCLUSION Within one follow-up year, 17.0% of patients were newly diagnosed with depression after craniotomy for brain tumor removal. Some factors (old age, living in rural areas, newly acquired brain disability, longer length of hospital stay, and underlying other psychiatric illnesses) could be risk factors for newly diagnosed depression. Furthermore, newly developed depression was associated with an increased 2-year all-cause mortality.
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Mart MF, Girard TD, Thompson JL, Whitten-Vile H, Raman R, Pandharipande PP, Heyland DK, Ely EW, Brummel NE. Nutritional Risk at intensive care unit admission and outcomes in survivors of critical illness. Clin Nutr 2021; 40:3868-3874. [PMID: 34130034 PMCID: PMC8243837 DOI: 10.1016/j.clnu.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/07/2021] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Risk factors for poor outcomes after critical illness are incompletely understood. While nutritional risk is associated with mortality in critically ill patients, its association with disability, cognitive, and health-related quality of life is unclear in survivors of critical illness. This study's objective was to determine whether greater nutritional risk at ICU admission is associated with greater disability, worse cognition, and worse HRQOL at 3 and 12-month follow-up. METHODS We enrolled adults (≥18 years of age) with respiratory failure or shock treated in medical and surgical intensive care units from two U.S. centers. We measured nutritional risk using the modified Nutrition Risk in Critically Ill (mNUTRIC) score (range 0-9 [highest risk]) at intensive care unit admission. We measured associations between mNUTRIC scores and discharge destination, disability in basic activities of daily living (ADLs) using the Katz ADL, instrumental ADLs using the Functional Activities Questionnaire (FAQ), global cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), executive function using the Trail Making Test Part B (Trails B), and health-related quality of life using the SF-36, adjusting for sex, education, BMI, baseline frailty, disability, and cognition, severity of illness, days of delirium, coma, and mechanical ventilation. RESULTS Of the 821 patients enrolled in the ICU, 636 patients survived to hospital discharge. We assessed outcomes in 448 of 535 survivors (84%) at 3 months and 382 of 476 survivors (80%) at 12 months. Higher mNUTRIC scores predicted greater odds of discharge to an institution (OR 2.0, 95% CI: 1.6 to 2.6; P < 0.01). Higher mNUTRIC scores were associated with a trend towards greater disability in basic activities of daily living (IRR 1.3, 95% CI 1.0 to 1.7) at 3 months that did not reach significance (p = 0.09) with no association demonstrated at 12 months. There were no associations between mNUTRIC scores and FAQ, RBANS, or Trails B scores. mNUTRIC scores were inconsistently associated with SF-36 physical and mental component scale scores. CONCLUSIONS Greater nutritional risk at ICU admission is associated with disability in survivors of critical illness. Future studies should evaluate interventions in those at high nutritional risk as a means to speed recovery.
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Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
| | - Timothy D Girard
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Thompson
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hannah Whitten-Vile
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
| | - Rameela Raman
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Pratik P Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; VA Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, TN, USA; Vanderbilt Center for Quality Aging, Nashville, TN, USA
| | - Nathan E Brummel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University College of Medicine, Columbus OH, USA; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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17
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Jung H, Tanaka S, Iwamoto Y, Yamasaki M, Tanaka R. Relationship between Mobility-Related Activities of Daily Living and Health-Related Quality of Life among Healthy Older Adults: A Cross-Sectional Study Using Structural Equation Modeling. Gerontol Geriatr Med 2021; 7:23337214211013166. [PMID: 34026928 PMCID: PMC8120528 DOI: 10.1177/23337214211013166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/22/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To develop a conceptual model that confirms whether mobility-related activities of daily living (ADLs) abilities are strongly associated with reduced health-related quality of life (HRQOL) in older adults. Methods: A total of 153 participants (63 men, 90 women) were analyzed. The mobility-related ADL survey from the Ministry of Education, Culture, Sports, Science, and Technology of Japan was used. The Japanese version (v1.2) of the Medical Outcomes Study 36-item Short-Form Health Survey was administered to evaluate HRQOL. Structural equation modeling was performed to test a hypothetical model: mobility-related ADL abilities would influence HRQOL. Results: The chi-square value was not significant (chi-square = 9.463, p = .305), and goodness-of-fit values were high, implying that the model was validated; goodness-of-fit index, 0.981; adjusted goodness-of-fit index, 0.949; comparative fit index, 0.996; and root mean square error of approximation, 0.035. Results showed that mobility-related ADL abilities influenced the physical health including physical function and general health in HRQOL. Conclusions: This study developed the conceptual model confirming the influence of mobility-related ADL abilities especially on physical health. Further intervention studies on instructions/training for physical activity of healthy older adults should assess this causal relationship.
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Affiliation(s)
- Hungu Jung
- Hiroshima University, Higashi-Hiroshima City, Japan.,Hiroshima Bunka Gakuen University, Akigunsakacho, Japan
| | | | - Yuji Iwamoto
- Hiroshima University, Higashi-Hiroshima City, Japan
| | | | - Ryo Tanaka
- Hiroshima University, Higashi-Hiroshima City, Japan
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Ho EP, Neo HY. COVID 19: prioritise autonomy, beneficence and conversations before score-based triage. Age Ageing 2021; 50:11-15. [PMID: 32975564 PMCID: PMC7543287 DOI: 10.1093/ageing/afaa205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/31/2020] [Indexed: 12/14/2022] Open
Abstract
At the start of the COVID-19 pandemic, mounting demand overwhelmed critical care surge capacities, triggering implementation of triage protocols to determine ventilator allocation. Relying on triage scores to ration care, while relieving clinicians from making morally distressing decisions under high situational pressure, distracts clinicians from what is essentially deeply humanistic issues entrenched in this protracted public health crisis. Such an approach will become increasingly untenable as countries flatten their epidemic curves. Decisions regarding ICU admission are particularly challenging in older people, who are most likely to require critical care, but for whom benefits are most uncertain. Before applying score-based triage, physicians must first discern if older people will benefit from critical care (beneficence) and second, if he wants critical care (autonomy). When deliberating beneficence, physicians should steer away from solely using age-stratified survival probabilities from epidemiological data. Instead, decisions must be based on individualised risk-stratification that encompasses evidence-based predictors of adverse outcomes specific to older adults. Survival will also need to be weighed against burden of treatment, as well as longer-term functional deficits and quality-of-life. By identifying the robust older people who may benefit from critical care, clinicians should proceed to elicit his values and preferences that would determine the treatment most aligned with his best interest. During these dialogues, physicians must truthfully convey the emergent clinical reality, discern the older person’s therapeutic goals and discuss the feasibility of achieving them. Given that COVID-19 is here to stay, these conversations aimed at achieving goal-cordant care must become a new clinical norm.
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Affiliation(s)
| | - Han-Yee Neo
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
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19
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Zeggwagh Z, Abidi K, Kettani MN, Iraqi A, Dendane T, Zeggwagh AA. Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge. Indian J Crit Care Med 2020; 24:531-538. [PMID: 32963435 PMCID: PMC7482352 DOI: 10.5005/jp-journals-10071-23489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The aims of this study were to evaluate changes in health-related quality of life (HRQoL) before ICU admission and after ICU discharge in elderly patients and to determine predictors of this HRQoL. Materials and methods This prospective study has been realized in the medical ICU (August 2012-March 2013). All patients 65 years of age or older who were hospitalized for ≥48 hours in our medical ICU have been included. The HRQoL was assessed 1 month prior to ICU admission in all the patients at admission and 3 months after ICU discharge for survivors using the Arabic version of MOS SF-36 questionnaire. Results We enrolled 118 patients (66 M: 55.9% and 52 F: 44.1%). The mean age was 72 ± 6 years. ICU mortality rate was 47.5% and three-month mortality rate was 55.1%. The reliability and validity of MOS SF-36 were satisfactory. Among the 53 survivors at follow-up, the subscales of MOS SF-36 decreased significantly at 3 months after ICU stay except the “Bodily Pain”. The physical component score (PCS) and mental component score (MCS) decreased also significantly. The independent factors strongly associated with PCS and its variations were: age (β = −1.56, p = 0.001), prior functional status (β = −22.10, p = 0.002) and SAPSII (β = −0.16, p = 0.04). For MCS, these factors were: live alone (β = 16.50, p = 0.006), previous functional status (β = −9.09, p = 0.008) and existence of education level (β = 2.98, p = 0.037). Conclusion We demonstrated a fall in the physical and psychical aspects of HRQoL 3 months after ICU discharge in the elderly patients. In addition to factors such as age, prior functional status and severity of illness, family status and educational level seem decisive in the post-ICU HRQoL. How to cite this article Zeggwagh Z, Abidi K, Kettani MNZ, Iraqi A, Dendane T, Zeggwagh AA. Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge. Indian J Crit Care Med 2020;24(7):531–538.
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Affiliation(s)
- Zineb Zeggwagh
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Khalid Abidi
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Nz Kettani
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Amina Iraqi
- King Fahd Highschool, Abdelmalek Essaadi University of Tanger, Morocco
| | - Tarek Dendane
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Amine Ali Zeggwagh
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
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20
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Marques A, Gomez-Baya D, Peralta M, Frasquilho D, Santos T, Martins J, Ferrari G, Gaspar de Matos M. The Effect of Muscular Strength on Depression Symptoms in Adults: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165674. [PMID: 32781526 PMCID: PMC7460504 DOI: 10.3390/ijerph17165674] [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] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/16/2023]
Abstract
The aim was to systematically review the relationship between muscular strength (MS) and depression symptoms (DS) among adults, and conduct a meta-analysis to determine the pooled odds ratio (OR) for the relationship between MS and DS. The strategies employed in this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies published up to December 2019 were systematically identified by searching in the PubMed, Scopus, and Web of Science electronic databases. Inclusion criteria were: (1) cross-sectional, longitudinal and intervention studies; (2) outcomes included depression or DS; (3) participants were adults and older adults; and (4) the articles were published in English, French, Portuguese, or Spanish. A total of 21 studies were included in the review, totalling 87,508 adults aged ≥18 years, from 26 countries. The systematic review findings suggest that MS has a positive effect on reducing DS. Meta-analysis findings indicate that MS is inversely and significantly related to DS 0.85 (95% CI: 0.80, 0.89). Interventions aiming to improve MS have the potential to promote mental health and prevent depression. Thus, public health professionals could use MS assessment and improvement as a strategy to promote mental health and prevent depression.
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Affiliation(s)
- Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Lisbon, Portugal; (A.M.); (J.M.)
- ISAMB, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal; (T.S.); (M.G.d.M.)
- Escuela de Doctorado, Universidad de Huelva, 21007 Huelva, Spain;
| | - Diego Gomez-Baya
- Escuela de Doctorado, Universidad de Huelva, 21007 Huelva, Spain;
- Departamento de Psicología Social, Evolutiva y de la Educación, Universidad de Huelva, 21007 Huelva, Spain
| | - Miguel Peralta
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Lisbon, Portugal; (A.M.); (J.M.)
- ISAMB, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal; (T.S.); (M.G.d.M.)
- Correspondence: ; Tel.: +351-214-149-100
| | - Diana Frasquilho
- Champalimaud Clinical Center, Champalimaud Centre for the Unknown, Champalimaud Foundation, 1400-038 Lisbon, Portugal;
| | - Teresa Santos
- ISAMB, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal; (T.S.); (M.G.d.M.)
- Faculdade de Ciências da Saúde e do Desporto, Universidade Europeia, 1500-210 Lisbon, Portugal
| | - João Martins
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Lisbon, Portugal; (A.M.); (J.M.)
- ISAMB, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal; (T.S.); (M.G.d.M.)
| | - Gerson Ferrari
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320000, Chile;
| | - Margarida Gaspar de Matos
- ISAMB, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal; (T.S.); (M.G.d.M.)
- Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Lisbon, Portugal
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Ethical considerations about artificial intelligence for prognostication in intensive care. Intensive Care Med Exp 2019; 7:70. [PMID: 31823128 PMCID: PMC6904702 DOI: 10.1186/s40635-019-0286-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/28/2019] [Indexed: 11/25/2022] Open
Abstract
Background Prognosticating the course of diseases to inform decision-making is a key component of intensive care medicine. For several applications in medicine, new methods from the field of artificial intelligence (AI) and machine learning have already outperformed conventional prediction models. Due to their technical characteristics, these methods will present new ethical challenges to the intensivist. Results In addition to the standards of data stewardship in medicine, the selection of datasets and algorithms to create AI prognostication models must involve extensive scrutiny to avoid biases and, consequently, injustice against individuals or groups of patients. Assessment of these models for compliance with the ethical principles of beneficence and non-maleficence should also include quantification of predictive uncertainty. Respect for patients’ autonomy during decision-making requires transparency of the data processing by AI models to explain the predictions derived from these models. Moreover, a system of continuous oversight can help to maintain public trust in this technology. Based on these considerations as well as recent guidelines, we propose a pathway to an ethical implementation of AI-based prognostication. It includes a checklist for new AI models that deals with medical and technical topics as well as patient- and system-centered issues. Conclusion AI models for prognostication will become valuable tools in intensive care. However, they require technical refinement and a careful implementation according to the standards of medical ethics.
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A system for bedside assistance that integrates a robotic bed and a mobile manipulator. PLoS One 2019; 14:e0221854. [PMID: 31618205 PMCID: PMC6795421 DOI: 10.1371/journal.pone.0221854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/18/2019] [Indexed: 11/22/2022] Open
Abstract
Various situations, such as injuries or long-term disabilities, can result in people receiving physical assistance while in bed. We present a robotic system for bedside assistance that consists of a robotic bed and a mobile manipulator (i.e., a wheeled robot with arms) that work together to provide better assistance. Many assistive tasks depend on moving with respect to the person’s body, and the complementary physical and perceptual capabilities of the two robots help with respect to this general goal. The system provides autonomy for common tasks, as well as an interface for direct teleoperation of the two robots. Autonomy handles coarse motions of the robots by estimating the person’s pose using a pressure sensing mat and then moving the robots to configurations optimized for the task. After completing these motions, the user is given fine control of the robots to complete the task. In an evaluation using a medical mannequin, we found that the robotic bed’s motion and perception each improved the assistive robotic system’s performance. The system achieved 100% success over 9 trials involving 3 tasks. Using the system with the bed movement or the body pose estimation capabilities turned off resulted in success in only 33% or 78% of the trials, respectively. We also evaluated our system with Henry Evans, a person with severe quadriplegia, in his home. In a formal test, Henry successfully used the bedside-assistance system to perform 3 different tasks, 5 times each, without any failures. Henry’s feedback on the system was positive regarding usefulness and ease of use, and he noted benefits of using our system over fully manual teleoperation. Overall, our results suggest that a robotic bed and a mobile manipulator can work collaboratively to provide effective personal assistance and that the combination of the two robots is beneficial.
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23
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24
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A computer vision system for deep learning-based detection of patient mobilization activities in the ICU. NPJ Digit Med 2019; 2:11. [PMID: 31304360 PMCID: PMC6550251 DOI: 10.1038/s41746-019-0087-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/15/2019] [Indexed: 02/01/2023] Open
Abstract
Early and frequent patient mobilization substantially mitigates risk for post-intensive care syndrome and long-term functional impairment. We developed and tested computer vision algorithms to detect patient mobilization activities occurring in an adult ICU. Mobility activities were defined as moving the patient into and out of bed, and moving the patient into and out of a chair. A data set of privacy-safe-depth-video images was collected in the Intermountain LDS Hospital ICU, comprising 563 instances of mobility activities and 98,801 total frames of video data from seven wall-mounted depth sensors. In all, 67% of the mobility activity instances were used to train algorithms to detect mobility activity occurrence and duration, and the number of healthcare personnel involved in each activity. The remaining 33% of the mobility instances were used for algorithm evaluation. The algorithm for detecting mobility activities attained a mean specificity of 89.2% and sensitivity of 87.2% over the four activities; the algorithm for quantifying the number of personnel involved attained a mean accuracy of 68.8%.
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25
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Reid JC, Clarke F, Cook DJ, Molloy A, Rudkowski JC, Stratford P, Kho ME. Feasibility, Reliability, Responsiveness, and Validity of the Patient-Reported Functional Scale for the Intensive Care Unit: A Pilot Study. J Intensive Care Med 2019; 35:1396-1404. [PMID: 30669936 DOI: 10.1177/0885066618824534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although many performance-based measures assess patients' physical function in intensive care unit (ICU) survivors, to our knowledge, there are no patient-reported ICU rehabilitation-specific measures assessing function. We developed the Patient-Reported Functional Scale-ICU (PRFS-ICU), which measures patients' perceptions of their ability to perform 6 activities (rolling, sitting edge of bed, sit-to-stand and bed-to-chair transfers, ambulation, and stair climbing). Each item is scored from 0 (unable) to 10 (able to perform at pre-ICU level) to a maximum of 60. OBJECTIVES Estimate the feasibility, reliability, responsiveness, and validity of the PRFS-ICU. METHODS This was a substudy of TryCYCLE, a single-center, prospective cohort examining the safety and feasibility of early in-bed cycling with mechanically ventilated patients (NCT01885442). To determine feasibility, we calculated the number of patients with at least 1 PRFS-ICU assessment during their hospital stay. To assess reliability, 2 raters blinded to each other's assessments administered the PRFS-ICU within 24-hours of each other. We calculated the intraclass correlation coefficient (ICC; 95% confidence interval [CI]), standard error of measurement (SEM, 95% CI), and minimal detectable change (MDC90). To assess validity, we estimated convergent validity of the PRFS-ICU with the Functional Status Score for ICU (FSS-ICU), Medical Research Council Sum Score (MRC-SS), Physical Function Test for ICU (PFIT-s), Katz Index of Independence in Activities of Daily Living (Katz ADLs), and a pooled index using Pearson's correlation coefficient (r, 95% CI). RESULTS Feasibility: 20 patients completed a PRFS-ICU assessment. Reliability and responsiveness: 16 patients contributed data. The ICC, SEM, and MDC90 were 0.91 (0.76, 0.97), 4.75 (3.51, 7.35), and 11.04 points, respectively. Validity: 19 patients contributed data and correlations were (r [95% CI]): FSS-ICU (0.40 [-0.14, 0.76]), MRC-SS (0.51 [0.02, 0.80]), PFIT-s (0.43 [-0.13, 0.78]), Katz ADLs (0.53 [0.10, 0.79]), and pooled index (0.48 [-0.14, 0.82]). CONCLUSIONS Our pilot work suggests the PRFS-ICU may be a useful tool to assess and monitor patients' perceptions of function over time.
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Affiliation(s)
- Julie C Reid
- Faculty of Health Sciences, School of Rehabilitation Science, 3710McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
| | - France Clarke
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, McMaster University Medical Center, Hamilton, Ontario, Canada.,Department of Medicine, 62703McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
| | - Alexander Molloy
- Department of Physiotherapy, 25479St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jill C Rudkowski
- Department of Medicine, 62703McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
| | - Paul Stratford
- Faculty of Health Sciences, School of Rehabilitation Science, 3710McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
| | - Michelle E Kho
- Faculty of Health Sciences, School of Rehabilitation Science, 3710McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada.,Department of Physiotherapy, 25479St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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26
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Robinson CC, Rosa RG, Kochhann R, Schneider D, Sganzerla D, Dietrich C, Sanchez ÉC, Dutra FH, Oliveira MQD, Anzolin LB, Menezes SFD, Jeffman R, Souza DD, Silva SFD, Cruz LN, Boldo R, Cardoso JR, Birriel DC, Gamboa MN, Machado AS, Andrade JMSD, Alencar C, Teixeira MC, Vieira SRR, Moreira FC, Amaral A, Silveira APM, Teles JMM, Oliveira DCD, Oliveira Júnior LCD, Castro LCE, Silva MSD, Neves RT, Gomes RDA, Ribeiro CM, Cavalcanti AB, Oliveira RPD, Maccari JG, Berto PP, Martins LA, Santos RLDS, Ue LY, Hammes LS, Sharshar T, Bozza F, Falavigna M, Teixeira C. Quality of life after intensive care unit: a multicenter cohort study protocol for assessment of long-term outcomes among intensive care survivors in Brazil. Rev Bras Ter Intensiva 2019; 30:405-413. [PMID: 30652780 PMCID: PMC6334490 DOI: 10.5935/0103-507x.20180063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/30/2018] [Indexed: 01/04/2023] Open
Abstract
Objective To establish the prevalence of physical, cognitive and psychiatric
disabilities, associated factors and their relationship with the qualities
of life of intensive care survivors in Brazil. Methods A prospective multicenter cohort study is currently being conducted at 10
adult medical-surgical intensive care units representative of the 5
Brazilian geopolitical regions. Patients aged ≥ 18 years who are
discharged from the participating intensive care units and stay 72 hours or
more in the intensive care unit for medical or emergency surgery admissions
or 120 hours or more for elective surgery admissions are consecutively
included. Patients are followed up for a period of one year by means of
structured telephone interviews conducted at 3, 6 and 12 months after
discharge from the intensive care unit. The outcomes are functional
dependence, cognitive dysfunction, anxiety and depression symptoms,
posttraumatic stress symptoms, health-related quality of life,
rehospitalization and long-term mortality. Discussion The present study has the potential to contribute to current knowledge of the
prevalence and factors associated with postintensive care syndrome among
adult intensive care survivors in Brazil. In addition, an association might
be established between postintensive care syndrome and health-related
quality of life.
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Affiliation(s)
- Caroline Cabral Robinson
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Regis Goulart Rosa
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Centro de Tratamento Intensivo Adulto, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Renata Kochhann
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Daniel Schneider
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Daniel Sganzerla
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Camila Dietrich
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Évelin Carneiro Sanchez
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Francine Hoffmann Dutra
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Maicon Quadro de Oliveira
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Luisa Barbosa Anzolin
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Suelen Fardim de Menezes
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Rodrigo Jeffman
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Denise de Souza
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Sâmia Faria da Silva
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Luciane Nascimento Cruz
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Rodrigo Boldo
- Unidade de Tratamento Intensivo, Hospital Santa Clara, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Juliana Rezende Cardoso
- Unidade de Tratamento Intensivo, Hospital Santa Clara, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Daniella Cunha Birriel
- Unidade de Tratamento Intensivo, Pavilhão Pereira Filho, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Mariana Nunes Gamboa
- Unidade de Tratamento Intensivo, Pavilhão Pereira Filho, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | | | | | - Cesar Alencar
- Centro de Tratamento Intensivo, Hospital Conceição, Grupo Hospitalar Conceição - Porto Alegre (RS), Brasil
| | - Michelle Carneiro Teixeira
- Centro de Tratamento Intensivo, Hospital Conceição, Grupo Hospitalar Conceição - Porto Alegre (RS), Brasil
| | - Silvia Regina Rios Vieira
- Centro de Tratamento Intensivo, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Fernanda Caleffe Moreira
- Centro de Tratamento Intensivo, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Alexandre Amaral
- Unidade de Tratamento Intensivo, Hospital de Urgências de Goiânia - Goiânia (GO), Brasil
| | | | - José Mario Meira Teles
- Unidade de Tratamento Intensivo, Hospital de Urgências de Goiânia - Goiânia (GO), Brasil
| | | | | | - Lívia Correa E Castro
- Unidade de Tratamento Intensivo, Hospital Regional do Baixo Amazonas - Santarém (PA), Brasil
| | - Marli Sarmento da Silva
- Unidade de Tratamento Intensivo, Hospital Regional do Baixo Amazonas - Santarém (PA), Brasil
| | | | | | | | | | | | | | - Paula Pinheiro Berto
- Centro de Tratamento Intensivo, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Lucieda Araújo Martins
- Coordenação Geral de Atenção Hospitalar, Departamento de Atenção Hospitalar e de Urgência, Secretaria de Atenção à Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Rui Leandro da Silva Santos
- Coordenação Geral de Atenção Hospitalar, Departamento de Atenção Hospitalar e de Urgência, Secretaria de Atenção à Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Luciana Yumi Ue
- Coordenação Geral de Atenção Hospitalar, Departamento de Atenção Hospitalar e de Urgência, Secretaria de Atenção à Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Luciano Serpa Hammes
- Superintendência de Educação, Pesquisa e Responsabilidade Social, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Tarek Sharshar
- Department of Histopathology and Animal Models, Institute Pasteur - Paris, France.,General Intensive Care, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines - Paris, France
| | - Fernando Bozza
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
| | - Maicon Falavigna
- Centro de Tratamento Intensivo Adulto, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Cassiano Teixeira
- Centro de Tratamento Intensivo Adulto, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
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Darvall JN, Braat S, Story DA, Greentree K, Bose T, Loth J, Lim WK. Protocol for a prospective observational study to develop a frailty index for use in perioperative and critical care. BMJ Open 2019; 9:e024682. [PMID: 30782738 PMCID: PMC6340067 DOI: 10.1136/bmjopen-2018-024682] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Frailty is of increasing importance to perioperative and critical care medicine, as the proportion of older patients increases globally. Evidence continues to emerge of the considerable impact frailty has on adverse outcomes from both surgery and critical care, which has led to a proliferation of different frailty measurement tools in recent years. Despite this, there remains a lack of easily implemented, comprehensive frailty assessment tools specific to these complex populations. Development of a frailty index using routinely collected hospital data, able to leverage the automated aspects of an electronic medical record, would aid risk stratification and benefit clinicians and patients alike. METHODS AND ANALYSIS This is a prospective observational study. 150 intensive care unit (ICU) patients aged ≥50 years and 200 surgical patients aged ≥65 years will be enrolled. The primary objective is to develop a frailty index. Secondary objectives include assessing its ability to predict in-hospital mortality and/or discharge to a new non-home location; the performance of the frailty index in predicting postoperative and ICU complications, as well as health-related quality of life at 6 months; to compare the performance of the frailty index against existing frailty measurement and risk stratification tools; and to assess its modification by patients' health assets. ETHICS AND DISSEMINATION This study has been approved by the Melbourne Health Human Research Ethics Committee(20 January 2017, HREC/16/MH/321). Dissemination will be via international and national anaesthetic and critical care conferences, and publication in the peer-reviewed literature.
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Affiliation(s)
- Jai N Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Clinical and Translational Science Platform, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David A Story
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Greentree
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tony Bose
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joel Loth
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wen K Lim
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Vesz PS, Cremonese RV, Rosa RG, Maccari JG, Teixeira C. Impact of mechanical ventilation on quality of life and functional status after ICU discharge: A cross-sectional study. ACTA ACUST UNITED AC 2018; 64:47-53. [PMID: 29561942 DOI: 10.1590/1806-9282.64.01.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/09/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact of the need for mechanical ventilation (MV) and its duration throughout ICU stay on the quality of life (QoL) and physical functional status (PFS) after the immediate ICU discharge. METHOD This was a cross-sectional study including all subjects consecutively discharged from the ICU during 1-year period. During the first week after ICU discharge, QoL was assessed through WHOQoL-Bref questionnaire and PFS through the Karnofsky Performance Status and modified-Barthel index, and retrospectively compared with the pre-admission status (variation [Δ] of indexes). RESULTS During the study, 160 subjects met the inclusion criteria. Subjects receiving MV presented PFS impairment (Δ Karnofsky Performance Status [-19.7 ± 20.0 vs. -14.9 ± 18.2; p=0.04] and Δ modified-Barthel index [-17.4 ± 12.8 vs. -13.2 ± 12.9; p=0.05]) compared with those who did not receive MV. Duration of MV was a good predictor of PFS (Δ Karnofsky Performance Status [-14.6-1.12 * total days of MV; p=0.01] and Δ modified-Barthel index [-14.2-0.74 * total days of MV; p=0.01]). QoL, assessed by WHOQoL-Bref, showed no difference between groups (14.0 ± 1.8 vs. 14.5 ± 1.9; p=0.14), and the duration of MV did not influence QoL (WHOQoL-Bref scale [14.2-0.05* total days of MV; p=0.43]). CONCLUSION Need for MV and duration of MV decrease patient PFS after ICU discharge.
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Affiliation(s)
- Patrini Silveira Vesz
- PT, McS, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rehabilitation Sciences Graduate, Porto Alegre, RS, Brazil
| | | | - Regis Goulart Rosa
- MD, PhD, Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | | | - Cassiano Teixeira
- MD, PhD, UFCSPA, Rehabilitation Sciences Graduate, and Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Webb CA, Cui R, Titus C, Fiske A, Nadorff MR. Sleep Disturbance, Activities of Daily Living, and Depressive Symptoms among Older Adults. Clin Gerontol 2018; 41:172-180. [PMID: 29272210 DOI: 10.1080/07317115.2017.1408733] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Research suggests sleep disturbance plays a role in depression and risk for suicidal behavior (i.e., ideation, attempts, death by suicide). How sleep disturbance affects suicide risk is unclear and one's ability to perform activities of daily living (ADLs) may help explain this relation. This study examined associations between sleep problems, ADLs, and either depressive symptoms or suicide risk among older adults. We hypothesized that ADLs would mediate relations between sleep problems and depressive symptoms and suicide risk. METHOD Participants (N = 134; age ≥65) were recruited through Amazon's Mechanical Turk. Participants completed questionnaires that assessed insomnia symptoms, nightmares, ADLs, depressive symptoms, and suicidal behaviors. RESULTS Nightmares were associated with depressive symptoms and suicide risk but not independently associated with ADLs. Insomnia symptoms were associated with depressive symptoms, suicide risk, and ADLs. ADLs mediated the relation between insomnia symptoms and depressive symptoms. The insomnia symptom-suicidal behavior relation and the nightmare-suicidal behavior relation were significantly mediated by a pathway containing ADLs and depressive symptoms. DISCUSSION ADLs help explain how insomnia symptoms and nightmares confer suicide risk among older adults, either independently or in association with depressive symptoms. CLINICAL IMPLICATIONS Practitioners should attend to ADL performance when treating older adults with insomnia and depression.
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Affiliation(s)
- Christopher A Webb
- a Department of Psychology , Mississippi State University , Starkville , Mississippi , USA.,b Department of Psychology, California Department of State Hospitals- Atascadero , Atascadero , California , USA
| | - Ruifeng Cui
- c Department of Psychology , West Virginia University , Morgantown , West Virginia , USA
| | - Caitlin Titus
- a Department of Psychology , Mississippi State University , Starkville , Mississippi , USA
| | - Amy Fiske
- c Department of Psychology , West Virginia University , Morgantown , West Virginia , USA.,d Injury Control Research Center , West Virginia University , Morgantown , West Virginia , USA
| | - Michael R Nadorff
- a Department of Psychology , Mississippi State University , Starkville , Mississippi , USA.,e Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , Texas , USA
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Lyu W, Wolinsky FD. The Onset of ADL Difficulties and Changes in Health-Related Quality of Life. Health Qual Life Outcomes 2017; 15:217. [PMID: 29110672 PMCID: PMC5674843 DOI: 10.1186/s12955-017-0792-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood. We identified strong longitudinal associations between ADL onset and HRQoL changes for older adults in Medicare Advantage Organizations (MAOs). METHODS We analyzed 473,282 age-eligible MAO beneficiaries in the 2008-2013 Medicare Health Outcomes Surveys (M-HOS) who reported no ADL difficulties at baseline and completed their two-year follow-ups in 2010-2015. The four HRQoL measures were the physical and mental health component scores (PCS and MCS) from the SF-12V, and the CDC's counts of physically unhealthy and mentally unhealthy days (PUD and MUD) in the past month. Ordinary least squares (OLS) and zero-inflated negative binomial regressions were used. RESULTS The onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet significantly reduced PCS scores by 10.84, 11.29, 9.18, 8.98, 9.49 and 10.67 points, and MCS scores by 7.93, 8.72, 10.13, 5.34, 4.37 and 9.00 points, respectively. The onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet increased PUD days by 6.24, 6.83, 6.34, 4.93, 4.96 and 6.72 days, and MUD days by 3.00, 3.19, 3.54, 2.26, 2.07 and 3.27 days, respectively. CONCLUSIONS There is robust evidence that the onset of ADL difficulties/inabilities significantly and substantially reduced age-eligible MAO beneficiaries' HRQoL. Prevention strategies focused on ADLs would benefit the performance of MAOs.
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Affiliation(s)
- Wei Lyu
- Department of Health Management and Policy, University of Iowa College of Public Health, 145 N. Riverside Dr., 100 College of Public Health Bldg., Room N269, Iowa City, Iowa, 52242-2007, USA.
| | - Fredric D Wolinsky
- Department of Health Management and Policy, University of Iowa College of Public Health, 145 N. Riverside Dr., 100 College of Public Health Bldg., Room N269, Iowa City, Iowa, 52242-2007, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,University of Iowa College of Nursing, Iowa City, IA, USA
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Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, Rajan S, Lippert F, Folke F, Gislason G, Køber L, Fonager K, Jensen SE, Gerds TA, Torp-Pedersen C, Rasmussen BS. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. N Engl J Med 2017; 376:1737-1747. [PMID: 28467879 DOI: 10.1056/nejmoa1601891] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P=0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation. (Funded by TrygFonden and the Danish Heart Foundation.).
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Affiliation(s)
- Kristian Kragholm
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Mads Wissenberg
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Rikke N Mortensen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Steen M Hansen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Carolina Malta Hansen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Kristinn Thorsteinsson
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Shahzleen Rajan
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Freddy Lippert
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Fredrik Folke
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Gunnar Gislason
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Lars Køber
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Kirsten Fonager
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Svend E Jensen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Thomas A Gerds
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Christian Torp-Pedersen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Bodil S Rasmussen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
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Pintado MC, Villa P, Luján J, Trascasa M, Molina R, González-García N, de Pablo R. Mortality and functional status at one-year of follow-up in elderly patients with prolonged ICU stay. Med Intensiva 2015; 40:289-97. [PMID: 26706825 DOI: 10.1016/j.medin.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/23/2015] [Accepted: 08/07/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate mortality and functional status at one year of follow-up in patients>75 years of age who survive Intensive Care Unit (ICU) admission of over 14 days. DESIGN A prospective observational study was carried out. SETTING A Spanish medical-surgical ICU. PATIENTS Patients over 75 years of age admitted to the ICU. PRIMARY VARIABLES OF INTEREST ICU admission: demographic data, baseline functional status (Barthel index), baseline mental status (Red Cross scale of mental incapacity), severity of illness (APACHE II and SOFA), stay and mortality. One-year follow-up: hospital stay and mortality, functional and mental status, and one-year follow-up mortality. RESULTS A total of 176 patients were included, of which 22 had a stay of over 14 days. Patients with prolonged stay did not show more ICU mortality than those with a shorter stay in the ICU (40.9% vs 25.3% respectively, P=.12), although their hospital (63.6% vs 33.8%, P<.01) and one-year follow-up mortality were higher (68.2% vs 41.2%, P=.02). Among the survivors, one-year mortality proved similar (87.5% vs 90.6%, P=.57). These patients presented significantly greater impairment of functional status at hospital discharge than the patients with a shorter ICU stay, and this difference persisted after three months. The levels of independence at one-year follow-up were never similar to baseline. No such findings were observed in relation to mental status. CONCLUSIONS Patients over 75 years of age with a ICU stay of more than 14 days have high hospital and one-year follow-up mortality. Patients who survive to hospital admission did not show greater mortality, though their functional dependency was greater.
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Affiliation(s)
- M C Pintado
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - P Villa
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J Luján
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Trascasa
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - R Molina
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - N González-García
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - R de Pablo
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Cybulski M, Krajewska-Kulak E, Jamiolkowski J. Preferred health behaviors and quality of life of the elderly people in Poland. Clin Interv Aging 2015; 10:1555-64. [PMID: 26491271 PMCID: PMC4598206 DOI: 10.2147/cia.s92650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to assess possible differences between a group of residents of public nursing homes (PNH) and a group of members of Universities of the Third Age (UTA) measured using standard psychometric scales. MATERIALS AND METHODS The research was conducted between January 3, 2013 and February 15, 2014 on a group of 200 residents of PNH and 200 members of the UTA using five psychometric scales: Standardized Satisfaction with Life Scale (SWLS), Standardized Health Behavior Inventory (HBI), Standardized Social Support Scale (SSS), Standardized General Self-efficacy Scale (GSES), and Standardized Multiple Health Locus of Control Scale (MHLC). RESULTS The average point total in the Standardized Satisfaction with Life Scale (SWLS) in the group of residents of PNH was 18.03 (Me =19) and was significantly higher (P=0.047) in comparison with the group of UTA members (17.08). Similar to residents of PNH, a vast majority of UTA members assessed the support received from the UTA as good, which significantly influenced their satisfaction from life (P=0.028) and their feeling of self-efficacy (P=0.048). An observed dependence states that the greater the level of satisfaction from life, the greater the level of various types of support from family. CONCLUSION This study indicates that biopsychosocial problems decrease quality of life in elderly people. The elderly people require a comprehensive, holistic approach to a variety of problems that occur with aging. In future, extended interdisciplinary research should be carried out on aspects of quality of life in order to optimize comprehensive geriatric assessment.
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Affiliation(s)
- Mateusz Cybulski
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | | | - Jacek Jamiolkowski
- Department of Public Health, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
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Forte R, Boreham CAG, De Vito G, Pesce C. Health and Quality of Life Perception in Older Adults: The Joint Role of Cognitive Efficiency and Functional Mobility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:11328-44. [PMID: 26378556 PMCID: PMC4586678 DOI: 10.3390/ijerph120911328] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/25/2015] [Accepted: 09/02/2015] [Indexed: 12/26/2022]
Abstract
Cognitive and mobility functions are involved in health-related quality of life (HRQoL). The present cross-sectional study aimed at investigating what facets of efficient cognition and functional mobility interactively contribute to mental and physical HRQoL. Fifty-six healthy older individuals (aged 65–75 years) were evaluated for mental and physical HRQoL, core cognitive executive functions (inhibition, working memory, and cognitive flexibility), and functional mobility (walking) under single and dual task conditions. Multiple regression analyses were run to verify which core executive functions predicted mental and physical HRQoL and whether the ability to perform complex (dual) walking tasks moderated such association. Inhibitory efficiency and the ability to perform physical-mental dual tasks interactively predicted mental HRQoL, whereas cognitive flexibility and the ability to perform physical dual tasks interactively predicted physical HRQoL. Different core executive functions seem relevant for mental and physical HRQoL. Executive function efficiency seems to translate into HRQoL perception when coupled with tangible experience of the ability to walk under dual task conditions that mirror everyday life demands. Implications of these results for supporting the perception of mental and physical quality of life at advanced age are discussed, suggesting the usefulness of multicomponent interventions and environments conducive to walking that jointly aid successful cognitive aging and functional mobility.
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Affiliation(s)
- Roberta Forte
- Institute for Sport and Health, University College Dublin, Dublin 4, Ireland.
- Human and Health Sciences, Department of Movement, University of Rome "Foro Italico", Roma 00135, Italy.
| | - Colin A G Boreham
- Institute for Sport and Health, University College Dublin, Dublin 4, Ireland.
| | - Giuseppe De Vito
- Institute for Sport and Health, University College Dublin, Dublin 4, Ireland.
| | - Caterina Pesce
- Human and Health Sciences, Department of Movement, University of Rome "Foro Italico", Roma 00135, Italy.
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Jeitziner MM, Zwakhalen SM, Bürgin R, Hantikainen V, Hamers JP. Changes in health-related quality of life in older patients one year after an intensive care unit stay. J Clin Nurs 2015; 24:3107-17. [PMID: 26248729 DOI: 10.1111/jocn.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study investigates health-related quality of life in older patients, over one year following an intensive care unit stay. BACKGROUND Health-related quality of life is an important outcome when assessing long-term effectiveness of intensive care treatment, and to assist patients, their relatives and healthcare professionals in making treatment decisions. DESIGN Prospective non-randomised longitudinal study. METHODS The Short Form Health Survey 36 was administered 1 week after an intensive care stay (retrospective baseline), and after six months and 12 months to the study population and to an age-matched comparison group at recruitment (baseline), and after six months and 12 months. Demographic data, admission diagnosis, length of stay, severity of illness, pain, anxiety, agitation, and intratracheal suctioning, turning and intubation were recorded. Recruitment period: December 2008 to April 2011. RESULTS Health-related quality of life of the older patients was significantly lower than the comparison group, both before and after the intensive care unit stay, and showed great individual variability. Within group scores, however, were stable over the year. Both physical and mental health scores were lower for the older patients. Renal failure, cardiac surgery and illness severity were associated with lower physical health scores. Cardiovascular illness, intratracheal suctioning and turning were associated with lower mental health scores. CONCLUSIONS Health-related quality of life was lower in older patients than in the age-matched group but remained stable over one year. RELEVANCE TO CLINICAL PRACTICE Older patients with severe illnesses, acute renal failure or who have had cardiac surgery, need additional support after hospital discharge due to functional restrictions. Discharge planning should ensure that this support would be provided. Special attention should be given to develop and use methods to reduce distress during routine intensive care interventions such as intratracheal suctioning or turning.
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Affiliation(s)
- Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital (Inselspital), Bern, Switzerland.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Sandra Mg Zwakhalen
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Reto Bürgin
- National Centre of Competence in Research, University of Geneva, Geneva, Switzerland
| | - Virpi Hantikainen
- Institute of Applied Nursing Science, University of Applied Sciences, St. Gallen, Switzerland
| | - Jan Ph Hamers
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study. Crit Care Med 2015; 43:973-82. [PMID: 25668751 DOI: 10.1097/ccm.0000000000000860] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality of life among survivors of critical illness. DESIGN Prospective multicenter observational cohort study. SETTING ICUs in six hospitals from across Alberta, Canada. PATIENTS Four hundred twenty-one critically ill patients who were 50 years or older. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Frailty was operationalized by a score of more than 4 on the Clinical Frailty Scale. Health-related quality of life was measured by the EuroQol Health Questionnaire and Short-Form 12 Physical and Mental Component Scores at 6 and 12 months. Multiple logistic and linear regression with generalized estimating equations was used to explore the association between frailty and health-related quality of life. In total, frailty was diagnosed in 33% (95% CI, 28-38). Frail patients were older, had more comorbidities, and higher illness severity. EuroQol-visual analogue scale scores were lower for frail compared with not frail patients at 6 months (52.2 ± 22.5 vs 64.6 ± 19.4; p < 0.001) and 12 months (54.4 ± 23.1 vs 68.0 ± 17.8; p < 0.001). Frail patients reported greater problems with mobility (71% vs 45%; odds ratio, 3.1 [1.6-6.1]; p = 0.001), self-care (49% vs 15%; odds ratio, 5.8 [2.9-11.7]; p < 0.001), usual activities (80% vs 52%; odds ratio, 3.9 [1.8-8.2]; p < 0.001), pain/discomfort (68% vs 47%; odds ratio, 2.0 [1.1-3.8]; p = 0.03), and anxiety/depression (51% vs 27%; odds ratio, 2.8 [1.5-5.3]; p = 0.001) compared with not frail patients. Frail patients described lower health-related quality of life on both physical component score (34.7 ± 7.8 vs 37.8 ± 6.7; p = 0.012) and mental component score (33.8 ± 7.0 vs 38.6 ± 7.7; p < 0.001) at 12 months. CONCLUSIONS Frail survivors of critical illness experienced greater impairment in health-related quality of life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.
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Das Neves AV, Vasquez DN, Loudet CI, Intile D, Sáenz MG, Marchena C, Gonzalez AL, Moreira J, Reina R, Estenssoro E. Symptom burden and health-related quality of life among intensive care unit survivors in Argentina: A prospective cohort study. J Crit Care 2015; 30:1049-54. [PMID: 26105747 DOI: 10.1016/j.jcrc.2015.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/11/2015] [Accepted: 05/23/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Our goal was to describe the evolution of selected physical and psychologic symptoms and identify the determinants of health-related quality of life (HRQOL) after intensive care unit (ICU) discharge. METHODS The study is a prospective cohort of consecutive adult patients admitted to a mixed ICU in a university-affiliated hospital, mechanically ventilated for more than 48 hours. During ICU stay, epidemiological data and events probably associated to worsening outcomes were recorded. After discharge, patients were interviewed at 1, 3, 6, and 12 months. Health-related quality of life was assessed with EuroQoL Questionnaire-5 Dimensions, which includes the EQ-index and EQ-Visual Analogue Scale. RESULTS One hundred twelve patients were followed up, aged 33 [24-49] years, 68% male, 76% previously healthy, and cranial trauma was the main diagnosis. Physical and psychologic symptoms and moderate/severe problems according to the EQ index progressively decreased after discharge, yet were still highly prevalent after 1 year. EQ index improved from 0.22 [0.01-0.69] to 0.52 [0.08-0.81], 0.66 [0.17-0.79], and 0.68 [0.26-0.86] (P < .001, for all vs month 1). EQ-Visual Analogue Scale remained stable, within acceptable values. Independent determinants of EQ-index were time, duration of mechanical ventilation, shock, weakness, and return to study/work. CONCLUSIONS Determinants of HRQOL after ICU discharge were both related to late sequelae of critical illness and to some events occurring in the ICU. Notwithstanding the high symptom burden, patients still perceived their HRQOL as good.
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Affiliation(s)
- Andrea V Das Neves
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos San Martin de La Plata 1 y 70, 1900 La Plata, Buenos Aires, Argentina
| | - Daniela N Vasquez
- Servicio de Terapia Intensiva, Sanatorio Anchorena, Tomas de Anchorena, C1425ELP, 1872 Ciudad Autónoma de Buenos Aires, Argentina
| | - Cecilia I Loudet
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos San Martin de La Plata 1 y 70, 1900 La Plata, Buenos Aires, Argentina
| | - Dante Intile
- Servicio de Terapia Intensiva, Sanatorio Anchorena, Tomas de Anchorena, C1425ELP, 1872 Ciudad Autónoma de Buenos Aires, Argentina
| | - María Gabriela Sáenz
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos San Martin de La Plata 1 y 70, 1900 La Plata, Buenos Aires, Argentina
| | - Cecilia Marchena
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos San Martin de La Plata 1 y 70, 1900 La Plata, Buenos Aires, Argentina
| | - Ana L Gonzalez
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos San Martin de La Plata 1 y 70, 1900 La Plata, Buenos Aires, Argentina
| | - Joaquin Moreira
- Instituto del Diagnostico, 62 n° 370, 1900 La Plata, Buenos Aires, Argentina
| | - Rosa Reina
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos San Martin de La Plata 1 y 70, 1900 La Plata, Buenos Aires, Argentina
| | - Elisa Estenssoro
- Servicio de Terapia Intensiva, Hospital Interzonal General de Agudos San Martin de La Plata 1 y 70, 1900 La Plata, Buenos Aires, Argentina.
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Jeitziner MM, Zwakhalen SM, Hantikainen V, Hamers JP. Healthcare resource utilisation by critically ill older patients following an intensive care unit stay. J Clin Nurs 2015; 24:1347-56. [PMID: 25669142 DOI: 10.1111/jocn.12749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study examines the utilisation of healthcare resources by critically ill older patients over one year following an intensive care unit stay. BACKGROUND Information on healthcare resource utilisation following intensive care unit treatment is essential during times of limited financial resources. DESIGN Prospective longitudinal nonrandomised study. METHODS Healthcare resource utilisation by critically ill older patients (≥65 years) was recorded during one year following treatment in a medical-surgical intensive care unit. Age-matched community-based participants served as comparison group. Data were collected at one-week following intensive care unit discharge/study recruitment and after 6 and 12 months. Recorded were length of stay, (re)admission to hospital or intensive care unit, general practitioner and medical specialist visits, rehabilitation program participation, medication use, discharge destination, home health care service use and level of dependence for activities of daily living. RESULTS One hundred and forty-five critically ill older patients and 146 age-matched participants were recruited into the study. Overall, critically ill older patients utilised more healthcare resources. After 6 and 12 months, they visited general practitioners six times more frequently, twice as many older patients took medications and only the intensive care unit group patients participated in rehabilitation programs (n = 99, 76%). The older patients were less likely to be hospitalised, very few transferred to nursing homes (n = 3, 2%), and only 7 (6%) continued to use home healthcare services 12 months following the intensive care unit stay. CONCLUSIONS Critically ill older patients utilise more healthcare resources following an intensive care unit stay, however, most are able to live at home with no or minimal assistance after one year. RELEVANCE TO CLINICAL PRACTICE Adequate healthcare resources, such as facilitated access to medical follow-up care, rehabilitation programs and home healthcare services, must be easily accessible for older patients following hospital discharge. Nurses need to be aware of the healthcare services available and advise patients accordingly.
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Affiliation(s)
- Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital (Inselspital), Bern, Switzerland; Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Parry SM, Granger CL, Berney S, Jones J, Beach L, El-Ansary D, Koopman R, Denehy L. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med 2015; 41:744-62. [PMID: 25652888 DOI: 10.1007/s00134-015-3672-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/16/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE To identify measures used to evaluate the broad constructs of functional impairment and limitations in the critically ill across the continuum of recovery, and to evaluate, synthesise and compare the clinimetric properties of the measures identified. METHODS A systematic review of articles was carried out using the databases Medline (1950-2014), CINAHL (1982-2014), EMBASE (1980-2014), Cochrane Library (2014) and Scopus (1960-2014). Additional studies were identified by searching personal files. Eligibility criteria for selection: Search 1: studies which assessed muscle mass, strength or function using objective non-laboratory measures; Search 2: studies which evaluated a clinimetric property (reliability, measurement error, validity or responsiveness) for one of the measures identified in search one. Two independent reviewers assessed articles for inclusion and assessed risk of bias using the consensus-based standards for selection of health status measurement instruments checklist. RESULTS Thirty-three measures were identified; however, only 20 had established clinimetric properties. Ultrasonography, dynamometry, physical function in intensive care test scored and the Chelsea critical care physical assessment tool performed the strongest for the measurement of impairment of body systems (muscle mass and strength) and activity limitations (physical function), respectively. CONCLUSIONS There is considerable variability in the type of measures utilized to measure physical impairments and limitations in survivors of critical illness. Future work should identify a core set of standardized measures, which can be utilized across the continuum of critical illness recovery embedded within the International Classification of Functioning framework. This will enable improved comparisons between future studies, which in turn will assist in identifying the most effective treatment strategies to ameliorate the devastating longer-term outcomes of a critical illness.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia,
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Muszalik M, Kornatowski T, Zielińska-Więczkowska H, Kędziora-Kornatowska K, Dijkstra A. Functional assessment of geriatric patients in regard to health-related quality of life (HRQoL). Clin Interv Aging 2014; 10:61-7. [PMID: 25565788 PMCID: PMC4279673 DOI: 10.2147/cia.s72825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose The main aim of our research was to evaluate general health, functioning, and performance parameters, as well as care problems of Geriatric Clinic inpatients in relation to deficits in fulfilling needs. The assessment of health-related quality of life was also performed. Patients and methods The research subjects were patients attending the Clinic of Geriatrics: 149 women and 78 men; 227 persons in total. The research was carried out using a diagnostic poll method, with the application of the Activities of Daily Living questionnaire of assessment of daily efficiency on the basis of the Katz index, the Instrumental Activities of Daily Living questionnaire, the Care Dependency Scale used to measure the level of care dependency and human needs, and the Nottingham Health Profile scale. Results The results showed that the majority of respondents achieved high and medium levels of functional capability. The main problems associated with the fulfillment of needs were difficulties with the adoption of appropriate body posture, movement restrictions, and problems related to participating in unassisted leisure activities outside the home. The general deficit in fulfilling the needs of the patients was low. The most significant problems were related to sleep disorders, restrictions in freedom of movement, loss of vital energy, and ailments resulting in the observable presence of pain. Conclusion Good daily functioning of elderly patients significantly depended on their intellectual and mental efficiency. Elderly patients require a comprehensive, holistic approach to a variety of problems that occur with aging.
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Affiliation(s)
- Marta Muszalik
- Clinic of Geriatrics, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Tomasz Kornatowski
- Department of Preventive Medicine and Environmental Health, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Halina Zielińska-Więczkowska
- Department of Pedagogy and Nursing Didactics, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | | | - Ate Dijkstra
- Research group iHuman, NHL University for Applied Sciences, Leeuwarden, the Netherlands
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Min L, Reuben D, Karlamangla A, Naeim A, Prenovost K, Lee P, Wenger N. Abbreviated care-process quality indicator sets linked with survival and functional status benefit in older adults under ambulatory care. J Am Geriatr Soc 2014; 62:1442-50. [PMID: 25041473 DOI: 10.1111/jgs.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify subsets of ambulatory care (outpatient only) quality indicators (QIs) associated with better survival and physical function outcomes. DESIGN Observational cohort study. SETTING Pooled data from the Assessing Care of Vulnerable Elders (ACOVE)-1 study, which measured quality of care using 140 care-process QIs, and the subsequent ACOVE-2 study, which reduced the QIs to 69 ambulatory care QIs. PARTICIPANTS Older adults receiving ambulatory care (N=1,015). MEASUREMENTS To prioritize and reduce the QIs into subsets, an expert panel rated each of 69 ambulatory care QIs for the strength of the link between process and benefit, defined as direct trial evidence on older adults or high expectation of benefit if a trial were conducted in older adults. This resulted in three reduced QI sets, reflecting their intended benefit: 17 QIs for survival (ACOVE Quality for Survival (AQS)-17), five QIs to preserve function (AQF-5), and 16 QIs to improve quality-of-life related to physical health and symptoms (AQQ-16). Whether AQS-17 would predict 3-year survival was first tested in 1,015 pooled ACOVE-1 and ACOVE-2 participants. Second, whether AQF-5 (n=74) and AQQ-16 (n=359) would predict change in the Physical Component Summary (PCS) score of the Medical Outcomes Study 12-item Short-Form Survey at 1 year was tested in the ACOVE-2 cohort. Control variables were age, function-based vulnerability, and comorbidity. RESULTS Each 20-percentage-point increment in AQS-17 was associated with survival (hazard ratio (HR)=0.83, P=.01) up to 500 days but not thereafter. AQF-5, but not AQQ-16, predicted 1-year improvement in PCS score (1.13-points per 20%-point increment in AQF-5, P=.02). CONCLUSION Subsets of care processes can be linked with outcomes important to older adults. The AQS-17 and AQF-5 are potential tools for improving ambulatory care of older adults.
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Affiliation(s)
- Lillian Min
- Division of Geriatric and Palliative Medicine, Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan; Geriatrics Research, Education and Clinical Care Center, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan
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Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 2013; 186:E95-102. [PMID: 24277703 DOI: 10.1503/cmaj.130639] [Citation(s) in RCA: 331] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserves that confers vulnerability to adverse outcomes. We determined the prevalence, correlates and outcomes associated with frailty among adults admitted to intensive care. METHODS We prospectively enrolled 421 critically ill adults aged 50 or more at 6 hospitals across the province of Alberta. The primary exposure was frailty, defined by a score greater than 4 on the Clinical Frailty Scale. The primary outcome measure was in-hospital mortality. Secondary outcome measures included adverse events, 1-year mortality and quality of life. RESULTS The prevalence of frailty was 32.8% (95% confidence interval [CI] 28.3%-37.5%). Frail patients were older, were more likely to be female, and had more comorbidities and greater functional dependence than those who were not frail. In-hospital mortality was higher among frail patients than among non-frail patients (32% v. 16%; adjusted odds ratio [OR] 1.81, 95% CI 1.09-3.01) and remained higher at 1 year (48% v. 25%; adjusted hazard ratio 1.82, 95% CI 1.28-2.60). Major adverse events were more common among frail patients (39% v. 29%; OR 1.54, 95% CI 1.01-2.37). Compared with nonfrail survivors, frail survivors were more likely to become functionally dependent (71% v. 52%; OR 2.25, 95% CI 1.03-4.89), had significantly lower quality of life and were more often readmitted to hospital (56% v. 39%; OR 1.98, 95% CI 1.22-3.23) in the 12 months following enrolment. INTERPRETATION Frailty was common among critically ill adults aged 50 and older and identified a population at increased risk of adverse events, morbidity and mortality. Diagnosis of frailty could improve prognostication and identify a vulnerable population that might benefit from follow-up and intervention.
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Penguins and palliative care: facilitating cultural change in the ICU. Crit Care Med 2013; 41:2443-4. [PMID: 24060776 DOI: 10.1097/ccm.0b013e31829136f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dinglas VD, Colantuoni E, Ciesla N, Mendez-Tellez PA, Shanholtz C, Needham DM. Occupational therapy for patients with acute lung injury: factors associated with time to first intervention in the intensive care unit. Am J Occup Ther 2013; 67:355-62. [PMID: 23597694 DOI: 10.5014/ajot.2013.007807] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Very early occupational therapy intervention in the intensive care unit (ICU) improves patients' physical recovery. We evaluated the association of patient, ICU, and hospital factors with time to first occupational therapy intervention in ICU patients with acute lung injury (ALI). METHOD We conducted a prospective cohort study of 514 consecutive patients with ALI from 11 ICUs in three hospitals in Baltimore, MD. RESULTS Only 30% of patients ever received occupational therapy during their ICU stay. Worse organ failure, continuous hemodialysis, and uninterrupted continuous infusion of sedation were independently associated with delayed occupational therapy initiation, and hospital study site and admission to a trauma ICU were independently associated with earlier occupational therapy. CONCLUSION Severity of illness and ICU practices for sedation administration were associated with delayed occupational therapy. Both hospital study site and type of ICU were independently associated with timing of occupational therapy, indicating modifiable environmental factors for promoting early occupational therapy in the ICU.
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Affiliation(s)
- Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine and Outcomes after Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
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Haas JS, Teixeira C, Cabral CR, Fleig AHD, Freitas APR, Treptow EC, Rizzotto MI, Machado AS, Balzano PC, Hetzel MP, Dallegrave DM, Oliveira RP, Savi A, Vieira SR. Factors influencing physical functional status in intensive care unit survivors two years after discharge. BMC Anesthesiol 2013; 13:11. [PMID: 23773812 PMCID: PMC3701489 DOI: 10.1186/1471-2253-13-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background Studies suggest that in patients admitted to intensive care units (ICU), physical functional status (PFS) improves over time, but does not return to the same level as before ICU admission. The goal of this study was to assess physical functional status two years after discharge from an ICU and to determine factors influencing physical status in this population. Methods The study reviewed all patients admitted to two non-trauma ICUs during a one-year period and included patients with age ≥ 18 yrs, ICU stay ≥ 24 h, and who were alive 24 months after ICU discharge. To assess PFS, Karnofsky Performance Status Scale scores and Lawton-Instrumental Activities of Daily Living (IADL) scores at ICU admission (K-ICU and L-ICU) were compared to the scores at the end of 24 months (K-24mo and L-24mo). Data at 24 months were obtained through telephone interviews. Results A total of 1,216 patients were eligible for the study. Twenty-four months after ICU discharge, 499 (41.6%) were alive, agreed to answer the interview, and had all hospital data available. PFS (K-ICU: 86.6 ± 13.8 vs. K-24mo: 77.1 ± 19.6, p < 0.001) and IADL (L-ICU: 27.0 ± 11.7 vs. L-24mo: 22.5 ± 11.5, p < 0.001) declined in patients with medical and unplanned surgical admissions. Most strikingly, the level of dependency increased in neurological patients (K-ICU: 86 ± 12 vs. K-24mo: 64 ± 21, relative risk [RR] 2.6, 95% CI, 1.8–3.6, p < 0.001) and trauma patients (K-ICU: 99 ± 2 vs. K-24mo: 83 ± 21, RR 2.7, 95% CI, 1.6–4.6, p < 0.001). The largest reduction in the ability to perform ADL occurred in neurological patients (L-ICU: 27 ± 7 vs. L-24mo: 15 ± 12, RR 3.3, 95% CI, 2.3–4.6 p < 0.001), trauma patients (L-ICU: 32 ± 0 vs. L-24mo: 25 ± 11, RR 2.8, 95% CI, 1.5–5.1, p < 0.001), patients aged ≥ 65 years (RR 1.4, 95% CI, 1.07–1.86, p = 0.01) and those who received mechanical ventilation for ≥ 8 days (RR 1.48, 95% CI, 1.02–2.15, p = 0.03). Conclusions Twenty-four months after ICU discharge, PFS was significantly poorer in patients with neurological injury, trauma, age ≥ 65 tears, and mechanical ventilation ≥ 8 days. Future studies should focus on the relationship between PFS and health-related quality of life in this population.
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Affiliation(s)
- Jaqueline S Haas
- Postgraduate Program in Medical Science, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Cassiano Teixeira
- Medical School - Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Claudia R Cabral
- Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil
| | - Alessandra H D Fleig
- Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil
| | - Ana Paula R Freitas
- Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil
| | - Erika C Treptow
- Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil
| | - Márcia Ib Rizzotto
- Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil
| | - André S Machado
- Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Patrícia C Balzano
- Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Márcio P Hetzel
- Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil
| | - Daniele M Dallegrave
- Department of Critical Care - Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil
| | | | - Augusto Savi
- Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Silvia Rr Vieira
- Postgraduate Program in Medical Science, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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den Ouden MEM, Schuurmans MJ, Mueller-Schotte S, van der Schouw YT. Identification of high-risk individuals for the development of disability in activities of daily living. A ten-year follow-up study. Exp Gerontol 2013; 48:437-43. [PMID: 23403381 DOI: 10.1016/j.exger.2013.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/16/2013] [Accepted: 02/03/2013] [Indexed: 11/18/2022]
Abstract
Independence in activities of daily living (ADL) is important in an aging population. ADL disability is a multifactorial problem, therefore a multifactorial approach is needed in the prediction of ADL disability. Our objective is to identify predictors for the development of ADL disability over a course of ten years in middle-aged and older persons. In a prospective cohort study, 478 middle-aged and older persons (61.2 years, range 40-78 years) without ADL disability at baseline were included. ADL disability was measured using the Katz-questionnaire. We included the following candidate predictors: number of chronic diseases, MMSE, Short Physical Performance Battery, leg strength, handgrip strength, physical activity, cholesterol/HDL ratio, BMI, pulse wave velocity, the degree of urbanization, age, gender and socioeconomic status. Associations between candidate predictors and ADL disability were examined using Poisson regression analysis. Performance of the prediction model was assessed with calibration and discrimination measures. The number of chronic diseases, muscle strength, age, gender and socioeconomic status were predictors of ADL disability at ten-year follow-up. The model showed a good calibration and discrimination (c-statistic: 0.83) between persons who will and will not develop ADL disability. In conclusion, the present study showed that using a multifactorial prediction model - based on easily and readily available measurements - individuals who are at high risk of developing ADL disability could be identified. The prediction model could be used as a screening tool to identify which persons most likely benefit from preventive strategies and interventions.
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Functional status, life-space mobility, and quality of life: a longitudinal mediation analysis. Qual Life Res 2012; 22:1621-32. [PMID: 23161329 DOI: 10.1007/s11136-012-0315-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2012] [Indexed: 01/03/2023]
Abstract
PURPOSE Using the Wilson-Cleary model of patient outcomes as a conceptual framework, the impact of functional status on health-related quality of life (HRQoL) among older adults was examined, including tests of the mediation provided by life-space mobility. METHODS Participants were enrollees in a population-based, longitudinal study of mobility among community-dwelling older adults. Data from four waves of the study equally spaced approximately 18 months apart (baseline, 18, 36, and 54 months) were used for participants who survived at least 1 year beyond the 54-month assessment (n = 677). Autoregressive mediation models using longitudinal data and cross-sectional mediation models using baseline data were evaluated and compared using structural equation modeling. RESULTS The longitudinal autoregressive models supported the mediating role of life-space mobility and suggested that this effect is larger for the mental component summary score than the physical component summary score of the SF-12. Evidence for a reciprocal relationship over time between functional status, measured by ADL difficulty, and life-space mobility was suggested by modification indices; these model elaborations did not alter the substantive meaning of the mediation effects. Mediated effect estimates from longitudinal autoregressive models were generally larger than those from cross-sectional models, suggesting that mediating relationships would have been missed or were potentially underestimated in cross-sectional models. CONCLUSIONS These results support a mediating role for life-space mobility in the relationship between functional status and HRQoL. Functional status limitations might cause diminished HRQoL in part by limiting mobility. Mobility limitations may precede functional status limitations in addition to being a consequence thereof.
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