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Young DL, Hannum SM, Engels R, Colantuoni E, Friedman LA, Hoyer EH. Dynamic Prediction of Post-Acute Care Needs for Hospitalized Medicine Patients. J Am Med Dir Assoc 2024; 25:104939. [PMID: 38387858 DOI: 10.1016/j.jamda.2024.01.008] [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: 05/10/2023] [Revised: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC) discharge. DESIGN Retrospective cohort analysis of electronic medical records. SETTING AND PARTICIPANTS Patients admitted to the two participating Hospitals from November 2016 through December 2019 with ≥72 hours in a general medicine service. METHODS Discharge location (PAC vs home) was the primary outcome, and 2 time-varying measures of patient mobility, Activity Measure for Post-Acute Care (AM-PAC) Mobility "6-clicks" and Johns Hopkins Highest Level of Mobility, were the primary predictors. Other predictors included demographic and clinical characteristics. For each day of hospitalization, we predicted discharge to PAC using the demographic and clinical characteristics and most recent mobility data within a random forest (RF) for survival, longitudinal, and multivariate (RF-SLAM) data. A regression tree for the daily predicted probabilities of discharge to PAC was constructed to represent a global summary of the RF. RESULTS There were 23,090 total patients and compared to PAC, those discharged home were younger (64 vs 71), had shorter length of stay (5 vs 8 days), higher AM-PAC at admission (43 vs 32), and average AM-PAC throughout hospitalization (45 vs 35). AM-PAC was the most important predictor, followed by age, and whether the patient lives alone. The area under the hospital day-specific receiver operating characteristic curve ranged from 0.76 to 0.79 during the first 5 days. The global summary tree explained 75% of the variation in predicted probabilities for PAC from the RF. Sensitivity (75%), specificity (70%), and accuracy (72%) were maximized at a PAC probability threshold of 40%. CONCLUSIONS AND IMPLICATIONS Daily assessment of patient mobility should be part of routine practice to help inform care planning by hospital teams. Our prediction model could be used as a valuable tool by multidisciplinary teams in the discharge planning process.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Engels
- Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ribbink ME, MacNeil Vroomen JL, Franssen R, Kolk D, Ben ÂJ, Willems HC, Buurman BM. Investigating the Effectiveness of Care Delivery at an Acute Geriatric Community Hospital for Older Adults in the Netherlands: A Prospective Controlled Observational Study. J Am Med Dir Assoc 2024; 25:704-710. [PMID: 38159913 DOI: 10.1016/j.jamda.2023.11.018] [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: 01/11/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Hospital admission in older adults is associated with unwanted outcomes such as readmission, institutionalization, and functional decline. To reduce these outcomes, the Netherlands introduced an alternative to hospital-based care: the Acute Geriatric Community Hospital (AGCH). The AGCH is an acute care unit situated outside of a hospital focusing on early rehabilitation and comprehensive geriatric assessment. The objective of this study was to evaluate if AGCH care is associated with decreasing unplanned readmissions or death compared with hospital-based care. DESIGN Prospective cohort study controlled with a historic cohort. SETTING AND PARTICIPANTS A (sub)acute care unit (AGCH) and 6 hospitals in the Netherlands; participants were acutely ill older adults. METHODS We used inverse propensity score weighting to account for baseline differences. The primary outcome was 90-day readmission or death. Secondary outcomes included 30-day readmission or death, time to death, admission to long-term residential care, occurrence of falls and functioning over time. Generalized logistic regression models and multilevel regression analyses were used to estimate effects. RESULTS AGCH patients (n = 206) had lower 90-day readmission or death rates [odds ratio (OR) 0.39, 95% CI 0.23-0.67] compared to patients treated in hospital (n = 401). AGCH patients had a lower risk of 90-day readmission (OR 0.38, 95% CI 0.21-0.67) but did not differ on all-cause mortality (OR 0.89, 95% CI 0.44-1.79) compared with the hospital control group. AGCH patients had lower 30-day readmission or death rates. Secondary outcomes did not differ. CONCLUSIONS AND IMPLICATIONS AGCH patients had lower rates of readmission and/or death than patients treated in a hospital. Our results support further research on the implementation and cost-effectiveness of AGCH in the Netherlands and other countries seeking alternatives to hospital-based care.
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Affiliation(s)
- Marthe E Ribbink
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Janet L MacNeil Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Remco Franssen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Daisy Kolk
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | - Hanna C Willems
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Han Y, Wang S. Disability risk prediction model based on machine learning among Chinese healthy older adults: results from the China Health and Retirement Longitudinal Study. Front Public Health 2023; 11:1271595. [PMID: 38026309 PMCID: PMC10665855 DOI: 10.3389/fpubh.2023.1271595] [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: 08/02/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Predicting disability risk in healthy older adults in China is essential for timely preventive interventions, improving their quality of life, and providing scientific evidence for disability prevention. Therefore, developing a machine learning model capable of evaluating disability risk based on longitudinal research data is crucial. Methods We conducted a prospective cohort study of 2,175 older adults enrolled in the China Health and Retirement Longitudinal Study (CHARLS) between 2015 and 2018 to develop and validate this prediction model. Several machine learning algorithms (logistic regression, k-nearest neighbors, naive Bayes, multilayer perceptron, random forest, and XGBoost) were used to assess the 3-year risk of developing disability. The optimal cutoff points and adjustment parameters are explored in the training set, the prediction accuracy of the models is compared in the testing set, and the best-performing models are further interpreted. Results During a 3-year follow-up period, a total of 505 (23.22%) healthy older adult individuals developed disabilities. Among the 43 features examined, the LASSO regression identified 11 features as significant for model establishment. When comparing six different machine learning models on the testing set, the XGBoost model demonstrated the best performance across various evaluation metrics, including the highest area under the ROC curve (0.803), accuracy (0.757), sensitivity (0.790), and F1 score (0.789), while its specificity was 0.712. The decision curve analysis (DCA) indicated showed that XGBoost had the highest net benefit in most of the threshold ranges. Based on the importance of features determined by SHAP (model interpretation method), the top five important features were identified as right-hand grip strength, depressive symptoms, marital status, respiratory function, and age. Moreover, the SHAP summary plot was used to illustrate the positive or negative effects attributed to the features influenced by XGBoost. The SHAP dependence plot explained how individual features affected the output of the predictive model. Conclusion Machine learning-based prediction models can accurately evaluate the likelihood of disability in healthy older adults over a period of 3 years. A combination of XGBoost and SHAP can provide clear explanations for personalized risk prediction and offer a more intuitive understanding of the effect of key features in the model.
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Affiliation(s)
| | - Shaobing Wang
- School of Public Health, Hubei University of Medicine, Shiyan, Hubei, China
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Lavezza A, Hoyer E, Friedman LA, Daley K, Steele A, Rosen S, Young D. Activities of Daily Living Assessment Early in Hospitalization Is Associated With Key Outcomes. Am J Occup Ther 2023; 77:7705205100. [PMID: 37812648 DOI: 10.5014/ajot.2023.050167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
IMPORTANCE Assessing patients' activities of daily living (ADLs) function early in hospitalization may help identify patients at risk for poor outcomes. OBJECTIVE To investigate the association between patients' ADL function at hospital admission and length of stay, inpatient falls, hospital-acquired pressure injuries, and discharge disposition. DESIGN Retrospective cohort study using scores collected on the Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF) in routine care at admission. SETTING Two inpatient units at the Johns Hopkins Hospital. PARTICIPANTS Hospitalized patients with various diagnoses, including neurosurgical, stroke, and general neurology (N = 1,899). RESULTS People with lower AM-PAC scores (every 10-point difference) had increased odds (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.4-1.8) of being in the highest length-of-stay quartile (≥8 days), having an injurious fall (OR = 1.7; 95% CI = 1.3-2.2), acquiring a pressure injury (OR = 2.7; 95% CI = 1.5-5.3), and being discharged to a postacute care facility (OR = 3.02; 95% CI = 2.1-2.7). CONCLUSIONS AND RELEVANCE Greater functional impairments in ADLs, measured with the AM-PACS IASF, were significantly associated with worse outcomes. AM-PAC IASF scores may be useful in identifying patients with ADL deficits and targeting occupational therapy services for patients who are at higher risk for negative outcomes. What This Article Adds: Early assessment of ADL function in routine care of hospitalized patients may aid in treatment and care plan decisions, particularly for inpatients who may be at higher risk for adverse outcomes.
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Affiliation(s)
- Annette Lavezza
- Annette Lavezza, OTR/L, is Director, Inpatient Rehabilitation Therapy Services, Johns Hopkins Hospital, Baltimore, MD, and Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD;
| | - Erik Hoyer
- Erik Hoyer, MD, is Associate Professor, Department of Physical Medicine and Rehabilitation and Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Lisa Aronson Friedman
- Lisa Aronson Friedman, ScM, is Senior Biostatistician, Division of Pulmonary and Critical Care Medicine, Outcomes After Critical Illness and Surgery (OACIS) Research Group, School of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Amber Steele
- Amber Steele, PT, DPT, CSCS, is Physical Therapist, Department of Physical Therapy, University of Nevada, Las Vegas
| | - Stephanie Rosen
- Stephanie Rosen, PT, DPT, is Physical Therapist, Department of Physical Therapy, University of Nevada, Las Vegas
| | - Daniel Young
- Daniel Young, PT, DPT, PhD, is Associate Professor, School of Integrated Health Sciences-Physical Therapy, University of Nevada, Las Vegas, and Adjunct Associate Professor, Department of Physical Medicine and Rehabilitation and Outcomes After Critical Illness and Surgery (OACIS) Research Group, School of Medicine, Johns Hopkins University, Baltimore, MD
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Terbraak M, Kolk D, Vroomen JLM, Twisk JWR, Buurman BM, van der Schaaf M. Post-discharge light physical activity indicates recovery in acutely hospitalized older adults - the Hospital-ADL study. BMC Geriatr 2023; 23:311. [PMID: 37202735 DOI: 10.1186/s12877-023-04031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Physical activity (PA) levels might be a simple overall physical function indicator of recovery in acutely hospitalized older adults; however it is unknown which amount and level of PA is associated with recovery. Our objective was to evaluate the amount and level of post discharge PA and its optimum cut-off values associated with recovery among acutely hospitalized older adults and stratified for frailty. METHODS We performed a prospective observational cohort study including acutely hospitalized older adults (≥ 70 years). Frailty was assessed using Fried's criteria. PA was assessed using Fitbit up to one week post discharge and quantified in steps and minutes light, moderate or higher intensity. The primary outcome was recovery at 3-months post discharge. ROC-curve analyses were used to determine cut-off values and area under the curve (AUC), and logistic regression analyses to calculate odds ratios (ORs). RESULTS The analytic sample included 174 participants with a mean (standard deviation) age of 79.2 (6.7) years of whom 84/174 (48%) were frail. At 3-months, 109/174 participants (63%) had recovered of whom 48 were frail. In all participants, determined cut-off values were 1369 steps/day (OR: 2.7, 95% confidence interval [CI]: 1.3-5.9, AUC 0.7) and 76 min/day of light intensity PA (OR: 3.9, 95% CI: 1.8-8.5, AUC 0.73). In frail participants, cut-off values were 1043 steps/day (OR: 5.0, 95% CI: 1.7-14.8, AUC 0.72) and 72 min/day of light intensity PA (OR: 7.2, 95% CI: 2.2-23.1, AUC 0,74). Determined cut-off values were not significantly associated with recovery in non-frail participants. CONCLUSIONS Post-discharge PA cut-offs indicate the odds of recovery in older adults, especially in frail individuals, however are not equipped for use as a diagnostic test in daily practice. This is a first step in providing a direction for setting rehabilitation goals in older adults after hospitalization.
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Affiliation(s)
- Michel Terbraak
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.
- Amsterdam UMC, Location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, Netherlands.
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, Netherlands.
- Department of Physical Therapy, Amsterdam University of Applied Sciences, Tafelbergweg 51, Amsterdam, 1105 BD, Netherlands.
| | - Daisy Kolk
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, Netherlands
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, Netherlands
| | - Janet L MacNeil Vroomen
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, Netherlands
| | - Jos W R Twisk
- Epidemiology and Biostatistics, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, Netherlands
| | - Bianca M Buurman
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Amsterdam UMC, Location University of Amsterdam, Rehabilitation, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, Netherlands
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van Nuland M, Butterhoff M, Verwijmeren K, Berger F, Hogervorst VM, de Jonghe A, van der Linden PD. Assessment of drug-related problems at the emergency department in older patients living with frailty: pharmacist-led medication reviews within a geriatric care team. BMC Geriatr 2023; 23:215. [PMID: 37016324 PMCID: PMC10074685 DOI: 10.1186/s12877-023-03942-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Older patients are vulnerable to experiencing drug related problems (DRPs), which may result in emergency department (ED) visits. However, it is not standard practice to conduct medications reviews during ED visit. The aim of this study was to assess the number of DRPs in older patients living with frailty at the ED, identified through pharmacist-led medication reviews within a geriatric care team, and to determine the acceptance rate of pharmacists' recommendations among hospital physicians and general practitioners or elderly care specialists. METHODS A retrospective observational study was performed in patients ≥ 70 years living with frailty at the ED at Tergooi Medical Center. Pharmacist-led medication reviews were conducted to identify and classify DRPs as part of a larger geriatric assessment. The acceptance rate of given recommendations was determined during follow-up. RESULTS A total of 356 ED visits were included. The mean (standard deviation, SD) age of patients was 83 (6.8) years. About 76% of patients had at least one DRP. In total, 548 DRPs were identified with a mean of 1.5 DRP (SD 1.3) per patient. The acceptance rate of medication recommendations in admitted patients was 55%, and 32% among general practitioners/elderly care specialists in discharged patients. CONCLUSIONS Pharmacist-led medication reviews as part of a geriatric care team identified DRPs in 76% of older patients living with frailty at the ED. The acceptance rate was substantially higher in admitted patients compared to discharged patients.
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Affiliation(s)
- Merel van Nuland
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands.
| | - Madelon Butterhoff
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Karin Verwijmeren
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Florine Berger
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | | | | | - Paul D van der Linden
- Department of Clinical Pharmacy, Tergooi Medical Center, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
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Arntzen RJ, Bekker R, Smeekes OS, Buurman BM, Willems HC, Bhulai S, van der Mei RD. Reduced Waiting Times by Preference-Based Allocation of Patients to Nursing Homes. J Am Med Dir Assoc 2022; 23:2010-2014.e1. [PMID: 35609636 DOI: 10.1016/j.jamda.2022.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The long waiting times for nursing homes can be reduced by applying advanced waiting-line management. In this article, we implement a preference-based allocation model for older adults to nursing homes, evaluate the performance in a simulation setting for 2 case studies, and discuss the implementation in practice. DESIGN Simulation study. SETTING AND PARTICIPANTS Older adults requiring somatic nursing home care, from an urban region (Rotterdam) and a rural region (Twente) in the Netherlands. METHODS Data about nursing homes and capacities for the 2 case studies were identified. A set of preference profiles was defined with aims regarding waiting time preferences and flexibility. Guidelines for implementation of the model in practice were obtained by addressing the tasks of all stakeholders. Thereafter, the simulation was run to compare the current practice with the allocation model based on specified outcome measures about waiting times and preferences. RESULTS We found that the allocation model decreased the waiting times in both case studies. Compared with the current practice policy, the allocation model reduced the waiting times until placement by at least a factor of 2 (from 166 to 80 days in Rotterdam and 178 to 82 days in Twente). Moreover, more of the older adults ended up in their preferred nursing home and the aims of the distinct preference profiles were satisfied. CONCLUSIONS AND IMPLICATIONS The results show that the allocation model outperforms commonly used waiting-line policies for nursing homes, while meeting individual preferences to a larger extent. Moreover, the model is easy to implement and of a generic nature and can, therefore, be extended to other settings as well (eg, to allocate older adults to home care or daycare). Finally, this research shows the potential of mathematical models in the care domain for older adults to face the increasing need for cost-effective solutions.
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Affiliation(s)
- Rebekka J Arntzen
- Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Stochastics Group, Centrum Wiskunde en Informatica, Amsterdam, The Netherlands.
| | - René Bekker
- Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Oscar S Smeekes
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanna C Willems
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandjai Bhulai
- Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Stochastics Group, Centrum Wiskunde en Informatica, Amsterdam, The Netherlands
| | - Rob D van der Mei
- Department of Mathematics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Stochastics Group, Centrum Wiskunde en Informatica, Amsterdam, The Netherlands
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Physical Therapists. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Woods RL, Espinoza S, Thao LTP, Ernst ME, Ryan J, Wolfe R, Shah RC, Ward SA, Storey E, Nelson MR, Reid CM, Lockery JE, Orchard SG, Trevaks RE, Fitzgerald SM, Stocks NP, Williamson JD, McNeil JJ, Murray AM, Newman AB. Effect of Aspirin on Activities of Daily Living Disability in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:2007-2014. [PMID: 33367621 PMCID: PMC8514067 DOI: 10.1093/gerona/glaa316] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cerebrovascular events, dementia, and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin's effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults. METHODS The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100 mg aspirin versus placebo recruited 19 114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the United States. Six basic ADLs were assessed every 6 months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after 6 months. Proportional hazards modeling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk. RESULTS Over a median of 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing, and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 vs 5.3 events/1000 py; hazard ratio [HR] = 0.81, 95% confidence interval [CI]: 0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability, there were more deaths in the aspirin group (24 vs 12). DISCUSSION Low-dose aspirin in initially healthy older people did not reduce the risk of incident ADL disability, although there was evidence of reduced persistent ADL disability.
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Affiliation(s)
- Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sara Espinoza
- Division of Geriatrics, Gerontology and Palliative Medicine, Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, USA
- Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, USA
| | - Le T P Thao
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, USA
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Jessica E Lockery
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ruth E Trevaks
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharyn M Fitzgerald
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Jeff D Williamson
- Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Clinical Outcomes and Research, Minneapolis Medical Research Foundation, Hennepin Healthcare Research Institute, Minneapolis, USA
- Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, USA
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pennsylvania, USA
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Kolk D, Melis RJF, MacNeil-Vroomen JL, Buurman BM. Physical Resilience in Daily Functioning Among Acutely Ill Hospitalized Older Adults: The Hospital-ADL Study. J Am Med Dir Assoc 2021; 23:903.e1-903.e12. [PMID: 34543629 DOI: 10.1016/j.jamda.2021.08.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Insight into older adults' physical resilience is needed to predict functional recovery after hospitalization. We assessed functional trajectories in response to acute illness and subsequent hospitalization and investigated baseline variables and dynamic variables associated with these trajectories. DESIGN Prospective observational cohort study (Hospitalization-Associated Disability and impact on daily Life Study). SETTING AND PARTICIPANTS This study included 207 older adults (aged 79.8 ± 6.9 years, 49% female, 57% frail) acutely hospitalized in 6 Dutch hospitals. METHODS Functional disability was assessed using the 15-item modified activities of daily living index retrospectively 2 weeks before admission, and prospectively from admission up to 3 months after discharge. Baseline variables including frailty, somatic, physical, and psychosocial factors were assessed at admission. Dynamic variables (step count, pain, fatigue, and fear of falling) were continuously or repeatedly assessed during hospitalization. We performed individual spline modeling using random effects. Baseline variables and within-person mean levels and variability in the dynamic variables were assessed as predictors of functional trajectories. RESULTS Functional disability significantly increased before admission and decreased from admission to 3 months post discharge. Frail participants had a significantly higher increase in functional disability before admission compared with nonfrail participants. Lower step count, higher pain scores, and higher within-person variability in fear of falling were significantly associated with higher increase in functional disability before admission. Higher within-person variability in fear of falling was associated with more recovery. CONCLUSIONS AND IMPLICATIONS Older adults increase in functional disability before hospitalization and start to recover from admission onward. Frailty and dynamic variables are associated with a higher increase in functional disability after acute illness. Our findings give more insight into older adults' physical resilience, which may improve the prediction of functional recovery and may improve therapeutic decision-making and rehabilitation strategies to improve functional recovery after acute hospitalization.
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Affiliation(s)
- Daisy Kolk
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | - René J F Melis
- Department of Geriatric Medicine/Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Janet L MacNeil-Vroomen
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bianca M Buurman
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands; ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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11
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van Seben R, Covinsky KE, Reichardt LA, Aarden JJ, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Insight Into the Posthospital Syndrome: A 3-Month Longitudinal Follow up on Geriatric Syndromes and Their Association With Functional Decline, Readmission, and Mortality. J Gerontol A Biol Sci Med Sci 2021; 75:1403-1410. [PMID: 32072168 PMCID: PMC7302165 DOI: 10.1093/gerona/glaa039] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Acute hospitalization may lead to posthospital syndrome, but no studies have investigated how this syndrome manifests and geriatric syndromes are often used as synonym. However, studies on longitudinal associations between syndromes and adverse outcomes are scarce. We aimed to analyze longitudinal associations between geriatric syndromes and functional decline (FD), readmission, and mortality. Methods Prospective cohort study, including 401 acutely hospitalized patients (aged ≥ 70). We performed: (i) logistic regression analyses to assess associations between patterns of geriatric syndromes as they develop over time (between admission and 1 month postdischarge), and FD and readmission; (ii) generalized estimating equations to assess longitudinal associations between geriatric syndromes over five time points (admission, discharge, 1, 2, and 3 months postdischarge) and FD, mortality, and readmission at 3 months postdischarge. Results After syndrome absent, syndrome present at both admission and 1 month postdischarge was most prevalent. Persistent patterns of apathy (odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.54–12.30), pain (OR = 3.26, 95% CI = 1.21–8.8), malnutrition (OR = 3.4, 95% CI = 1.35–8.56), mobility impairment (OR = 6.65, 95% CI = 1.98–22.38), and fear of falling (OR = 3.17, 95% CI = 1.25–8.02) were associated with FD. Developing cognitive impairment (OR = 6.40, 95% CI = 1.52–26.84), fatigue (OR = 4.71, 95% CI = 1.03–21.60), and fall risk (OR = 4.30, 95% CI = 1.21–16.57) postdischarge, was associated with readmission; however, only 4%–6% developed these syndromes. Over the course of five time points, mobility impairment, apathy, and incontinence were longitudinally associated with FD; apathy, malnutrition, fatigue, and fall risk with mortality; malnutrition with readmission. Conclusion Most geriatric syndromes are present at admission and patients are likely to retain them postdischarge. Several geriatric syndromes are longitudinally associated with mortality and, particularly, persistently present syndromes place persons are at risk of FD. Although few persons develop syndromes postdischarge, those developing cognitive impairment, fatigue, and fall risk were at increased readmission risk.
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Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | | | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Martin van der Esch
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, The Netherlands
| | - Raoul H H Engelbert
- ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
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12
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Aarden JJ, Reijnierse EM, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, Twisk JWR, Maier AB, Engelbert RHH, Buurman BM. Longitudinal Changes in Muscle Mass, Muscle Strength, and Physical Performance in Acutely Hospitalized Older Adults. J Am Med Dir Assoc 2021; 22:839-845.e1. [PMID: 33428891 DOI: 10.1016/j.jamda.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Acute hospitalization may lead to a decrease in muscle measures, but limited studies are reporting on the changes after discharge. The aim of this study was to determine longitudinal changes in muscle mass, muscle strength, and physical performance in acutely hospitalized older adults from admission up to 3 months post-discharge. DESIGN A prospective observational cohort study was conducted. SETTING AND PARTICIPANTS This study included 401 participants aged ≥70 years who were acutely hospitalized in 6 hospitals. All variables were assessed at hospital admission, discharge, and 1 and 3 months post-discharge. METHODS Muscle mass in kilograms was assessed by multifrequency Bio-electrical Impedance Analysis (MF-BIA) (Bodystat; Quadscan 4000) and muscle strength by handgrip strength (JAMAR). Chair stand and gait speed test were assessed as part of the Short Physical Performance Battery (SPPB). Norm values were based on the consensus statement of the European Working Group on Sarcopenia in Older People. RESULTS A total of 343 acute hospitalized older adults were included in the analyses with a mean (SD) age of 79.3 (6.6) years, 49.3% were women. From admission up to 3 months post-discharge, muscle mass (-0.1 kg/m2; P = .03) decreased significantly and muscle strength (-0.5 kg; P = .08) decreased nonsignificantly. The chair stand (+0.7 points; P < .001) and gait speed test (+0.9 points; P < .001) improved significantly up to 3 months post-discharge. At 3 months post-discharge, 80%, 18%, and 43% of the older adults scored below the cutoff points for muscle mass, muscle strength, and physical performance, respectively. CONCLUSIONS AND IMPLICATIONS Physical performance improved during and after acute hospitalization, although muscle mass decreased, and muscle strength did not change. At 3 months post-discharge, muscle mass, muscle strength, and physical performance did not reach normative levels on a population level. Further research is needed to examine the role of exercise interventions for improving muscle measures and physical performance after hospitalization.
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Affiliation(s)
- Jesse J Aarden
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Marike van der Schaaf
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Martin van der Esch
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Lucienne A Reichardt
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rosanne van Seben
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Amsterdam UMC, Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Friedman LA, Young DL, Nelliot A, Colantuoni E, Mendez-Tellez PA, Needham DM, Dinglas VD. Factors Associated With Home Visits in a 5-Year Study of Acute Respiratory Distress Syndrome Survivors. Am J Crit Care 2020; 29:429-438. [PMID: 33130864 DOI: 10.4037/ajcc2020966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Participant retention is vital for longitudinal studies. Home visits may increase retention, but little is known about the subset of patients they benefit. OBJECTIVE To evaluate patient-related variables associated with home visits. METHODS In a 5-year, longitudinal, multisite, prospective study of 195 survivors of acute respiratory distress syndrome, in-person assessments were conducted at a research clinic. Home visits were offered to participants who could not attend the clinic. Associations between having a home visit, prior follow-up visit status, and baseline and in-hospital patient variables were evaluated with multivariable, random-intercept logistic regression models. The association between home visits and patients' posthospital clinical status was evaluated with a subsequent regression model adjusted for these variables. RESULTS Participants had a median age of 49 years and were 56% male and 58% White. The following had independent associations with home visits (adjusted odds ratio [95% CI]): age (per year: 1.03 [1.00-1.05]) and immediately preceding visit incomplete (2.46 [1.44-4.19]) or at home (8.24 [4.57-14.86]). After adjustment for prior-visit status and baseline and hospitalization variables, these posthospital patient outcome variables were associated with a subsequent home visit: instrumental activities of daily living (≥ 2 vs < 2 dependencies: 2.32 [1.29-4.17]), EQ-5D utility score (per 0.1-point decrease: 1.15 [1.02-1.30]), and 6-minute walk test (per 10-percentage-point decrease in percent-predicted distance: 1.50 [1.26-1.79]). CONCLUSIONS Home visits were important for retaining older and more physically impaired study participants, helping reduce selection bias caused by excluding them.
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Affiliation(s)
- Lisa Aronson Friedman
- Lisa Aronson Friedman is a senior biostatistician in the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland
| | - Daniel L. Young
- Daniel L. Young is a visiting scientist and adjunct associate professor in the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, and an associate professor in the Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas, Nevada
| | - Archana Nelliot
- Archana Nelliot is a resident in the Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Elizabeth Colantuoni
- Elizabeth Colantuoni is a senior scientist in the Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University
| | - Pedro A. Mendez-Tellez
- Pedro A. Mendez-Tellez is an assistant professor in the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Dale M. Needham
- Dale M. Needham is a professor in the Division of Pulmonary and Critical Care Medicine, and in the Department of Physical Medicine and Rehabilitation at Johns Hopkins University School of Medicine and at Johns Hopkins University School of Nursing, Baltimore, Maryland; and the director of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University
| | - Victor D. Dinglas
- Victor D. Dinglas is a research associate in the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University
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Choudhury A, Renjilian E, Asan O. Use of machine learning in geriatric clinical care for chronic diseases: a systematic literature review. JAMIA Open 2020; 3:459-471. [PMID: 33215079 PMCID: PMC7660963 DOI: 10.1093/jamiaopen/ooaa034] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/26/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives Geriatric clinical care is a multidisciplinary assessment designed to evaluate older patients’ (age 65 years and above) functional ability, physical health, and cognitive well-being. The majority of these patients suffer from multiple chronic conditions and require special attention. Recently, hospitals utilize various artificial intelligence (AI) systems to improve care for elderly patients. The purpose of this systematic literature review is to understand the current use of AI systems, particularly machine learning (ML), in geriatric clinical care for chronic diseases. Materials and Methods We restricted our search to eight databases, namely PubMed, WorldCat, MEDLINE, ProQuest, ScienceDirect, SpringerLink, Wiley, and ERIC, to analyze research articles published in English between January 2010 and June 2019. We focused on studies that used ML algorithms in the care of geriatrics patients with chronic conditions. Results We identified 35 eligible studies and classified in three groups: psychological disorder (n = 22), eye diseases (n = 6), and others (n = 7). This review identified the lack of standardized ML evaluation metrics and the need for data governance specific to health care applications. Conclusion More studies and ML standardization tailored to health care applications are required to confirm whether ML could aid in improving geriatric clinical care.
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Affiliation(s)
- Avishek Choudhury
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | - Emily Renjilian
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, USA
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15
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Conroy T, Heuzenroeder L, Feo R. In-hospital interventions for reducing readmissions to acute care for adults aged 65 and over: An umbrella review. Int J Qual Health Care 2020; 32:414-430. [PMID: 32558919 DOI: 10.1093/intqhc/mzaa064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The aim of this umbrella review was to synthesize existing systematic review evidence on the effectiveness of in-hospital interventions to prevent or reduce avoidable hospital readmissions in older people (≥65 years old). DATA SOURCES A comprehensive database search was conducted in May 2019 through MEDLINE, EMBASE, CINAHL, the JBI Database of Systematic Reviews, DARE and Epistemonikos. STUDY SELECTION Systematic reviews and other research syntheses, including meta-analyses, exploring the effectiveness of hospital-based interventions to reduce readmissions for people aged 65 and older, irrespective of gender or clinical condition, were included for review. If a review did not exclusively focus on this age group, but data for this group could be extracted, then it was considered for inclusion. Only reviews in English were included. DATA EXTRACTION Data extracted for each review included the review objective, participant details, setting and context, type of studies, intervention type, comparator and findings. RESULTS OF DATA SYNTHESIS Twenty-nine reviews were included for analysis. Within these reviews, 11 intervention types were examined: in-hospital medication review, discharge planning, comprehensive geriatric assessment, early recovery after surgery, transitional care, interdisciplinary team care, in-hospital nutrition therapy, acute care geriatric units, in-hospital exercise, postfall interventions for people with dementia and emergency department-based palliative care. Except for discharge planning and transitional care, none of the interventions significantly reduced readmissions among older adults. CONCLUSION There is limited evidence to support the effectiveness of existing hospital-based interventions to reduce readmissions for people aged 65 and older.
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Affiliation(s)
- Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Louise Heuzenroeder
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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16
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Freburger JK, Chou A, Euloth T, Matcho B. Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia. JAMA Netw Open 2020; 3:e2012979. [PMID: 32886119 PMCID: PMC7489809 DOI: 10.1001/jamanetworkopen.2020.12979] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Pneumonia often leads to functional decline during and after hospitalization and is a leading cause of hospital readmissions. Physical and occupational therapists help improve functional mobility and may be of help in this population. OBJECTIVE To evaluate whether use of physical and occupational therapy in the acute care hospital is associated with 30-day hospital readmission risk or death. DESIGN, SETTING, AND PARTICIPANTS This cohort study included the electronic health records and administrative claims data of 30 746 adults discharged alive with a primary or secondary diagnosis of pneumonia or influenza-related conditions from January 1, 2016, to March 30, 2018. Patients were treated at 12 acute care hospitals in a large health care system in western Pennsylvania. Data for this study were analyzed from September 2019 through March 2020. EXPOSURES Number of physical and occupational therapy visits during the acute care stay categorized as none, low (1-3), medium (4-6), or high (>6). MAIN OUTCOMES AND MEASURES Outcomes were 30-day hospital readmission or death. Generalized linear mixed models were estimated to examine the association of therapy use and outcomes, controlling for patient demographic and clinical characteristics. Subgroup analyses were conducted for patients older than 65 years, for patients with low functional mobility scores, for patients discharged to the community, and for patients discharged to a post-acute care facility (ie, skilled nursing or inpatient rehabilitation facility). RESULTS Of 30 746 patients, 15 507 (50.4%) were men, 26 198 (85.2%) were White individuals, and the mean (SD) age was 67.1 (17.4) years. The 30-day readmission rate was 18.4% (5645 patients), the 30-day death rate was 3.7% (1146 patients), and the rate of either outcome was 19.7% (6066 patients). Relative to no therapy visits, the risk of 30-day readmission or death decreased as therapy visits increased (1-3 visits: odds ratio, 0.98; 95% CI, 0.89-1.08; 4-6 visits: odds ratio, 0.89; 95% CI, 0.79-1.01; >6 visits: odds ratio, 0.86; 95% CI, 0.75-0.98). The association was stronger in the subgroup with low functional mobility and in individuals discharged to a community setting. CONCLUSIONS AND RELEVANCE In this study, the number of therapy visits received was inversely associated with the risk of readmission or death. The association was stronger in the subgroups of patients with greater mobility limitations and those discharged to the community.
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Affiliation(s)
- Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aileen Chou
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracey Euloth
- University of Pittsburgh Medical Center Rehabilitation Services, Pittsburgh, Pennsylvania
| | - Beth Matcho
- University of Pittsburgh Medical Center Rehabilitation Services, Pittsburgh, Pennsylvania
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Reichardt LA, Nederveen FE, van Seben R, Aarden JJ, van der Schaaf M, Engelbert RHH, van der Esch M, Twisk JWR, Bosch JA, Buurman BM. The longitudinal association between depressive symptoms and functional abilities in older patients. J Psychosom Res 2020; 137:110195. [PMID: 32731046 DOI: 10.1016/j.jpsychores.2020.110195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the course of depressive symptoms, and basic and instrumental activities of daily living (collectively described as, (I)ADL functioning) from acute admission until one year post-discharge, the longitudinal association between depressive symptoms and (I)ADL functioning, and to disaggregate between- and within-person effects to examine whether changes in depressive symptoms are associated with changes in (I)ADL functioning. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥70. Data gathered over a one-year period were assessed using validated measures of depressive symptoms (GDS-15) and physical functioning (Katz-ADL index). A Poisson mixed model analysis was used to examine the association between the courses and a hybrid model was used to disentangle between- and within-subject effects. RESULTS The analytic sample included 398 patients (mean age = 79.6 years, SD = 6.6). Results showed an improvement in depressive symptoms and physical functions over time, whereby changes in depressive symptoms were significantly associated with the course of ADL function (rate ratio (RR) = 0.91, p < .001) and IADL function (RR = 0.94, p < .001), even after adjustment for confounding variables. Finally, both between- and within-person effects of depressive symptoms were significantly associated with the course of ADL function (between-person: RR = 0.85, p < .001; within-person: RR = 0.94, p < .001) and IADL function (between-person: RR = 0.87, p < .001; within-person: RR = 0.97, p < .001). CONCLUSION The course of depressive symptoms and physical functions improved over time, whereby changes in depressive symptoms were significantly associated with changes in physical functions, both at group and individual level. These changes in (I)ADL functioning lie mostly above the estimated minimally important change for both scales, implying clinically relevant changes.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Floor E Nederveen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands..
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
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Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study. J Am Med Dir Assoc 2020; 22:425-432. [PMID: 32713773 DOI: 10.1016/j.jamda.2020.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. DESIGN Prospective observational cohort study conducted in 2015-2017. SETTING AND PARTICIPANTS Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. METHODS Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. RESULTS The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250-1146] at the last day of hospitalization. This increased to 1750 (IQR 675-4114) steps 1 day postdischarge, and to 1997 (IQR 938-4098) steps 7 days postdischarge. Age [β = -57.93; 95% confidence interval (CI) -111.15 to -4.71], physical performance (β = 224.95; 95% CI 117.79-332.11), and steps in hospital (β = 0.76; 95% CI 0.46-1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = -1400; 95% CI -2380 to -420; P = .005). CONCLUSIONS AND IMPLICATIONS Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.
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Ribbink ME, Macneil-Vroomen JL, van Seben R, Oudejans I, Buurman BM. Investigating the effectiveness of care delivery at an acute geriatric community hospital for older adults in the Netherlands: a protocol for a prospective controlled observational study. BMJ Open 2020; 10:e033802. [PMID: 32234741 PMCID: PMC7170597 DOI: 10.1136/bmjopen-2019-033802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Hospital admission in older adults with multiple chronic conditions is associated with unwanted outcomes like readmission, institutionalisation, functional decline and mortality. Providing acute care in the community and integrating effective components of care models might lead to a reduction in negative outcomes. Recently, the first geriatrician-led Acute Geriatric Community Hospital (AGCH) was introduced in the Netherlands. Care at the AGCH is focused on the treatment of acute diseases, comprehensive geriatric assessment, setting patient-led goals, early rehabilitation and streamlined transitions of care. METHODS AND ANALYSIS This prospective cohort study will investigate the effectiveness of care delivery at the AGCH on patient outcomes by comparing AGCH patients to two historic cohorts of hospitalised patients. Propensity score matching will correct for potential population differences. The primary outcome is the 3-month unplanned readmission rate. Secondary outcomes include functional decline, institutionalisation, healthcare utilisation, occurrence of delirium or falls, health-related quality of life, mortality and patient satisfaction. Measurements will be conducted at admission, discharge and 1, 3 and 6 months after discharge. Furthermore, an economic evaluation and qualitative process evaluation to assess facilitators and barriers to implementation are planned. ETHICS AND DISSEMINATION The study will be conducted according to the Declaration of Helsinki. The Medical Ethics Research Committee confirmed that the Medical Research Involving Human Subjects Act did not apply to this research project and official approval was not required. The findings of this study will be disseminated through public lectures, scientific conferences and journal publications. Furthermore, the findings of this study will aid in the implementation and financing of this concept (inter)nationally. TRIAL REGISTRATION NUMBER NL7896; Pre-results.
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Affiliation(s)
- Marthe E Ribbink
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | - Janet L Macneil-Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | - Irène Oudejans
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
- ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Noord-Holland, Netherlands
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Ribbink ME, van Seben R, Reichardt LA, Aarden JJ, van der Schaaf M, van der Esch M, Engelbert RH, Twisk JW, Bosch JA, MacNeil Vroomen JL, Buurman BM, Kuper I, de Jonghe A, Leguit-Elberse M, Kamper A, Posthuma N, Brendel N, Wold J. Determinants of Post-acute Care Costs in Acutely Hospitalized Older Adults: The Hospital-ADL Study. J Am Med Dir Assoc 2019; 20:1300-1306.e1. [DOI: 10.1016/j.jamda.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 01/23/2023]
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Aarden JJ, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, Twisk JWR, Buurman BM, Engelbert RHH. Muscle strength is longitudinally associated with mobility among older adults after acute hospitalization: The Hospital-ADL study. PLoS One 2019; 14:e0219041. [PMID: 31276471 PMCID: PMC6611658 DOI: 10.1371/journal.pone.0219041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background 30 to 60% of the acute hospitalized older adults experience functional decline after hospitalization. The first signs of functional decline after discharge can often be observed in the inability to perform mobility tasks, such as raising from a chair or walking. Information how mobility develops over time is scarce. Insight in the course of mobility is needed to prevent and decrease mobility limitations. Objectives The objectives of this study were to determine (i) the course of mobility of acute hospitalized older adults and (ii) the association between muscle strength and the course of mobility over time controlled for influencing factors. Methods In a multicenter, prospective, observational cohort study, measurements were taken at admission, discharge, one- and three months post-discharge. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. The longitudinal association between muscle strength and mobility was analysed with a Linear Mixed Model and controlled for potential confounders. Results 391 older adults were included in the analytic sample with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from admission up to three months post-discharge but did not reach normative levels. Muscle strength was associated with the course of mobility (beta = 0.64; p<0.01), even after controlling for factors as age, cognitive impairment, fear of falling and depressive symptoms (beta = 0.35; p<0.01). Conclusion Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted, in acute hospitalized older adults.
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Affiliation(s)
- Jesse J. Aarden
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Marike van der Schaaf
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, Netherlands
| | - Lucienne A. Reichardt
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Rosanne van Seben
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Jos A. Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jos W. R. Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands
| | - Bianca M. Buurman
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Hopelessness and Other Depressive Symptoms in Adults 70 Years and Older as Predictors of All-Cause Mortality Within 3 Months After Acute Hospitalization: The Hospital-ADL Study. Psychosom Med 2019; 81:477-485. [PMID: 30985404 DOI: 10.1097/psy.0000000000000694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depression among older adults predicts mortality after acute hospitalization. Depression is highly heterogeneous in its presentation of symptoms, whereas individual symptoms may differ in predictive value. This study aimed to investigate the prevalence of individual cognitive-affective depressive symptoms during acute hospitalization and investigate the predictive value of both overall and individual cognitive-affective depressive symptoms for mortality between admission up to 3-month postdischarge among older patients. METHODS A prospective multicenter cohort study enrolled 401 acutely hospitalized patients 70 years and older (Hospitalization-Associated Disability and impact on daily Life Study). The predictive value of depressive symptoms, assessed using the Geriatric Depression Scale 15, during acute hospitalization on mortality was analyzed with multiple logistic regression. RESULTS The analytic sample included 398 patients (M (SD) = 79.6 (6.6) years; 51% men). Results showed that 9.3% of participants died within 3 months, with symptoms of apathy being most frequently reported. The depression total score during hospitalization was associated with increased mortality risk (admission: odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.2-1.3; discharge: OR = 1.2, 95% CI = 1.2-1.4). Stepwise multiple logistic regression analyses yielded the finding that feelings of hopelessness during acute hospitalization were a strong unique predictor of mortality (admission: OR = 3.6, 95% CI = 1.8-7.4; discharge: OR = 5.7, 95% CI = 2.5-13.1). These associations were robust to adjustment for demographic factors, somatic symptoms, and medical comorbidities. CONCLUSIONS Symptoms of apathy were most frequently reported in response to acute hospitalization. However, feelings of hopelessness about their situation were the strongest cognitive-affective predictor of mortality. These results imply that this item is important in identifying patients who are in the last phase of their lives and for whom palliative care may be important.
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Reichardt LA, van Seben R, Aarden JJ, van der Esch M, van der Schaaf M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study. J Psychosom Res 2019; 120:66-73. [PMID: 30929710 DOI: 10.1016/j.jpsychores.2019.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify trajectories of cognitive-affective depressive symptoms among acutely hospitalized older patients and whether trajectories are related to prognostic baseline factors and three-month outcomes such as functional decline, falls, unplanned readmissions, and mortality. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥ 70. Depressive trajectories were based on Group Based Trajectory Modeling, using the Geriatric Depression Scale-15. Outcomes were functional decline, falls, unplanned readmission, and mortality within three months post-discharge. RESULTS The analytic sample included 398 patients (mean age = 79.6 years; SD = 6.6). Three distinct depressive symptoms trajectories were identified: minimal (63.6%), mild persistent (25.4%), and severe persistent (11.0%). Unadjusted results showed that, compared to the minimal symptoms group, the mild and severe persistent groups showed a significantly higher risk of functional decline (mild: OR = 3.9, p < .001; severe: OR = 3.0, p = .04), falls (mild: OR = 2.0, p = .02; severe: OR = 6.0, p < .001), and mortality (mild: OR = 2.2, p = .05; severe: OR = 3.4, p = .009). Patients with mild or severe persistent symptoms were more malnourished, anxious, and functionally limited and had more medical comorbidities at admission. CONCLUSION Nearly 40% of the acutely hospitalized older adults exhibited mild to severe levels of cognitive-affective depressive symptoms. In light of the substantially elevated risk of serious complications and the fact that elevated depressive symptoms was not a transient phenomenon identification of these patients is needed. This further emphasizes the need for acute care hospitals, as a point of engagement with older adults, to develop discharge or screening procedures for managing cognitive-affective depressive symptoms.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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van Dronkelaar C, Tieland M, Aarden JJ, Reichardt LA, van Seben R, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Decreased Appetite is Associated with Sarcopenia-Related Outcomes in Acute Hospitalized Older Adults. Nutrients 2019; 11:E932. [PMID: 31027202 PMCID: PMC6520962 DOI: 10.3390/nu11040932] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Decreased appetite is one of the main risk factors of malnutrition. Little is known on how appetite changes during hospitalization and after discharge and how it relates with sarcopenia-related outcomes. We analyzed data of the Hospital-ADL study, a multicenter prospective cohort study that followed 400 acutely hospitalized older adults (≥70 year). Appetite (SNAQ), handgrip strength (Jamar), muscle mass (BIA), mobility (DEMMI), and physical performance (SPPB) were assessed within 48 h of admission, at discharge, and at one and three months post-discharge. The course of decreased appetite was analysed by Generalised Estimating Equations. Linear Mixed Model was used to analyse the associations between decreased appetite and the sarcopenia-related outcomes. Decreased appetite was reported by 51% at hospital admission, 34% at discharge, 28% one month post-discharge, and 17% three months post-discharge. Overall, decreased appetite was associated with lower muscle strength (β = -1.089, p = 0.001), lower mobility skills (β = -3.893, p < 0.001), and lower physical performance (β = -0.706, p < 0.001) but not with muscle mass (β = -0.023, p = 0.920). In conclusion, decreased appetite was highly prevalent among acute hospitalized older adults and remained prevalent, although less, after discharge. Decreased appetite was significantly associated with negative sarcopenia-related outcomes, which underlines the need for assessment and monitoring of decreased appetite during and post hospitalization.
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Affiliation(s)
- Carliene van Dronkelaar
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067SM Amsterdam, The Netherlands.
| | - Michael Tieland
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067SM Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, 1056 AB Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands.
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
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Agosti P, Tettamanti M, Vella FS, Suppressa P, Pasina L, Franchi C, Nobili A, Mannucci PM, Sabbà C. Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients. Eur J Intern Med 2018; 57:25-31. [PMID: 29934241 DOI: 10.1016/j.ejim.2018.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
Affiliation(s)
- P Agosti
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - M Tettamanti
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - F S Vella
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - P Suppressa
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - L Pasina
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Sabbà
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
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van Seben R, Reichardt LA, Aarden JJ, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. The Course of Geriatric Syndromes in Acutely Hospitalized Older Adults: The Hospital-ADL Study. J Am Med Dir Assoc 2018; 20:152-158.e2. [PMID: 30270027 DOI: 10.1016/j.jamda.2018.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To establish the prevalence and course of geriatric syndromes from hospital admission up to 3 months postdischarge and to determine the probability to retain geriatric syndromes over the period from discharge until 3 months postdischarge, once they are present at admission. DESIGN Prospective multicenter cohort study conducted between October 2015 and June 2017. SETTING AND PARTICIPANTS Acutely hospitalized patients aged 70 years and older recruited from internal, cardiology, and geriatric wards of 6 Dutch hospitals. MEASURES Cognitive impairment, depressive symptoms, apathy, pain, malnutrition, incontinence, dizziness, fatigue, mobility impairment, functional impairment, fall risk, and fear of falling were assessed at admission, discharge, and 1, 2, and 3 months postdischarge. Generalized estimating equations analysis were performed to analyze the course of syndromes and to determine the probability to retain syndromes. RESULTS A total of 401 participants [mean age (standard deviation) 79.7 (6.7)] were included. At admission, a median of 5 geriatric syndromes were present. Most prevalent were fatigue (77.2%), functional impairment (62.3%), apathy (57.5%), mobility impairment (54.6%), and fear of falling (40.6%). At 3 months postdischarge, an average of 3 syndromes were present, of which mobility impairment (52.7%), fatigue (48.1%), and functional impairment (42.5%) were most prevalent. Tracking analysis showed that geriatric syndromes that were present at admission were likely to be retained. The following 6 geriatric syndromes were most likely to stay present postdischarge: mobility impairment, incontinence, cognitive impairment, depressive symptoms, functional impairment, and fear of falling. IMPLICATIONS Acutely hospitalized older adults exhibit a broad spectrum of highly prevalent geriatric syndromes. Moreover, patients are likely to retain symptoms that are present at admission postdischarge. Our study underscores the need to address a wide range of syndromes at admission, the importance of communication on syndromes to the next care provider, and the need for adequate follow-up care and syndrome management postdischarge.
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Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
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Farjam M, Sharafi M, Bahramali E, Rezaei S, Hassanzadeh J, Rezaeian S. Socioeconomic Inequalities in Gastroesophageal Reflux Disorder: Results from an Iranian Cohort Study. Middle East J Dig Dis 2018; 10:180-187. [PMID: 30186582 PMCID: PMC6119839 DOI: 10.15171/mejdd.2018.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite progress in the health indexes in recent years, health inequalities remain as a global challenge within and between regions and countries. This study is the first to quantify the socioeconomic inequity in gastroesophageal reflux disease (GERD) using the concentration index. METHODS In this cross-sectional study, we used baseline data (7012 subjects) from the Fasa Cohort Study (the Southern Iran). The principal component analysis was used to construct socioeconomic status of the participants. The concentration index and concentration curve were used to measure socioeconomic-related inequality in GERD. Decomposition of concentration index was also done to identify the contribution of each explanatory variable to the wealth-related inequality in GERD prevalence. RESULTS The prevalence of GERD was 16.9% (95% CI: 15.9-17.7%). The overall concentration index for GERD was 0.093 (95% CI: 0.062-0.166]. Correspondingly, this figure for men and women were 0.116 (95% CI: 0.062-0.171%) and 0.091 (95% CI: 0.044-0.137%), respectively. The main contributors of socioeconomic-related inequality in GERD prevalence were socioeconomic status (64.4%), alcohol drinking (29%), and age (8.4%). CONCLUSION GERD is significantly more concentrated among richest people. There was significant socioeconomic inequality in GERD according to some individual factors. These inequalities need to be addressed by policy makers to identify the vulnerable subgroups and to reduce the disease burden in the community.
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Affiliation(s)
- Mojtaba Farjam
- Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mehdi Sharafi
- Center for Diseases Control and Prevention, Deputy of Health Services, Fasa University of Medical Sciences, Fasa, Iran
| | - Ehsan Bahramali
- Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jafar Hassanzadeh
- Research Centre for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahab Rezaeian
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Henriksen A, Haugen Mikalsen M, Woldaregay AZ, Muzny M, Hartvigsen G, Hopstock LA, Grimsgaard S. Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables. J Med Internet Res 2018; 20:e110. [PMID: 29567635 PMCID: PMC5887043 DOI: 10.2196/jmir.9157] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/18/2017] [Accepted: 01/06/2018] [Indexed: 01/05/2023] Open
Abstract
Background New fitness trackers and smartwatches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile apps. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects. Objective The objective of this study was to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the study was designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research. Methods We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand websites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year, and supported sensors relevant for fitness tracking. In addition, we conducted a Medical Literature Analysis and Retrieval System Online (MEDLINE) and ClinicalTrials search to determine brand usage in research projects. Finally, we investigated developer accessibility to the health data collected by identified brands. Results We identified 423 unique devices from 132 different brands. Forty-seven percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year, and in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple, and Polar. Fitbit is used in twice as many validation studies as any other brands and is registered in ClinicalTrials studies 10 times as often as other brands. Conclusions The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer market for various reasons. Advances in device quality offer new opportunities for research. However, only a few well-established brands are frequently used in research projects, and even less are thoroughly validated.
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Affiliation(s)
- André Henriksen
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Martin Haugen Mikalsen
- Department of Computer Science, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | | | - Miroslav Muzny
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.,Spin-Off Company and Research Results Commercialization Center, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Gunnar Hartvigsen
- Department of Computer Science, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Laila Arnesdatter Hopstock
- Department of Health and Care Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
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