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Hunold KM, Schwaderer AL, Exline M, Hebert C, Lampert BC, Southerland LT, Stephens JA, Boyer EW, Gure TR, Mion LC, Hill M, Chu CMB, Lee G, Caterino JM. Functional decline in older adults with suspected pneumonia at emergency department presentation. J Am Geriatr Soc 2024; 72:1532-1535. [PMID: 38366347 PMCID: PMC11090742 DOI: 10.1111/jgs.18798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/18/2024]
Affiliation(s)
| | | | - Matthew Exline
- Department of Internal Medicine, The Ohio State University, Columbus OH
| | - Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus OH
- Division of Infectious Disease, The Ohio State University, Columbus OH
| | - Brent C. Lampert
- Division of Cardiovascular Medicine, The Ohio State University, Columbus OH
| | | | - Julie A. Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus OH
| | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Tanya R. Gure
- Division of General Internal Medicine & Geriatrics, The Ohio State University, Columbus, OH
| | | | - Michael Hill
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Ching-Min B. Chu
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Gabriel Lee
- Department of Emergency Medicine, The Ohio State University, Columbus OH
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Egbujie BA, Turcotte LA, Heckman GA, Morris JN, Hirdes JP. Functional Decline in Long-Term Care Homes in the First Wave of the COVID-19 Pandemic: A Population-based Longitudinal Study in Five Canadian Provinces. J Am Med Dir Assoc 2024; 25:282-289. [PMID: 37839468 DOI: 10.1016/j.jamda.2023.09.007] [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: 03/23/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to examine whether functional decline accelerated during the first wave of the COVID-19 pandemic (March to June 2020) for persons in long-term care facilities (LTCs) in Canada compared with the pre-pandemic period. DESIGN We conducted a population-based longitudinal study of persons receiving care in LTC homes in 5 Canadian provinces before and during the COVID-19 pandemic. SETTING AND PARTICIPANTS Residents in 1326 LTC homes within the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland & Labrador, and Ontario between January 31, 2019, and June 30, 2020, with activities of daily living Hierarchy scale less than 6 and so, who still have potential for decline (6 being the worst of the 0-6 scale). METHODS We fit a generalized estimating equation model with adjustment for repeated measures to obtain the adjusted odds of functional decline between COVID period exposed and unexposed pre-pandemic residents. RESULTS LTC residents experienced slightly higher rates of functional decline during the first wave of the COVD-19 pandemic compared with the pre-pandemic period (23.3% vs 22.3%; P < .0001). The adjusted odds of functional decline were slightly greater during the pandemic (odds ratio [OR], 1.17; 95% CI, 1.15-1.20). Likewise, residents receiving care in large homes (OR, 1.20; 95% CI, 1.17-1.24) and urban-located LTC homes (OR, 1.20; 95% CI, 1.17-1.23), were more likely to experience functional decline during the COVID-19 pandemic. The odds of functional decline were also only significantly higher during the pandemic for LTC home residents in British Columbia (OR, 1.17; 95% CI, 1.11-1.23) and Ontario (OR, 1.25; 95% CI, 1.21-1.29). CONCLUSIONS AND IMPLICATIONS This study provides evidence that the odds of experiencing functional decline were somewhat greater during the first wave of the COVID-19 pandemic. It highlights the need to maintain physical activity and improve nutrition among older adults during periods of stress. The information would be helpful to health administrators and decision-makers seeking to understand how the COVID-19 pandemic and associated public health measures affected LTC residents' health outcomes.
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Affiliation(s)
- Bonaventure A Egbujie
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Luke A Turcotte
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John N Morris
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Schafthuizen L, van Dijk M, van Rosmalen J, Ista E. Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms. BMC Nurs 2024; 23:11. [PMID: 38163905 PMCID: PMC10759502 DOI: 10.1186/s12912-023-01648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Although stimulating patients' mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. METHODS Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. RESULTS Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9-93.6). The median total daily step count was 1326 (range 22-5362). CONCLUSION We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
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Singhal S, Walter LC, Smith AK, Loh KP, Cohen HJ, Zeng S, Shi Y, Boscardin WJ, Presley CJ, Williams GR, Magnuson A, Mohile SG, Wong ML. Change in four measures of physical function among older adults during lung cancer treatment: A mixed methods cohort study. J Geriatr Oncol 2023; 14:101366. [PMID: 36058839 PMCID: PMC9974579 DOI: 10.1016/j.jgo.2022.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Functional outcomes during non-small cell lung cancer (NSCLC) treatment are critically important to older adults. Yet, data on physical function and which measures best capture functional change remain limited. MATERIALS AND METHODS This multisite, mixed methods cohort study recruited adults ≥65 years with advanced NSCLC starting systemic treatment (i.e., chemotherapy, immunotherapy, and/or targeted therapy) with non-curative intent. Participants underwent serial geriatric assessments prior to starting treatment and at one, two, four, and six months, which included the Karnofsky Performance Scale (KPS, range: 0-100%), instrumental activities of daily living (IADL, range: 0-14), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Physical Functioning subscale (EORTC QLQ-C30 PF, range: 0-100), and Life-Space Assessment (LSA, range: 0-120). For all measures, higher scores represent better functioning. In a qualitative substudy, 20 patients completed semi-structured interviews prior to starting treatment and at two and six months to explore how treatment affected their daily functioning. We created joint displays for each interview participant that integrated their longitudinal KPS, IADL, EORTC QLQ-C30 PF, and LSA scores with patient quotes describing their function. RESULTS Among 87 patients, median age was 73 years (range 65-96). Mean pretreatment KPS score was 79% (standard deviation [SD] 13), EORTC QLQ-C30 PF was 69 (SD 23), and LSA was 67 (SD 28); median IADL was 13 (interquartile range [IQR] 10-14). At two months after treatment initiation, 70% of patients experienced functional decline on at least one measure, with only 13% of these patients recovering at six months. At two and six months, decline in LSA was the most common (48% and 35%, respectively). Joint displays revealed heterogeneity in how well each quantitative measure of physical function captured the qualitative patient experience. DISCUSSION Functional decline during NSCLC treatment is common among older adults. LSA is a useful measure to detect subtle functional decline that may be missed by other measures. Given heterogeneity in how well each quantitative measure captures changes in physical function, there is value to including more than one functional measure in geriatric oncology research studies.
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Affiliation(s)
- Surbhi Singhal
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Louise C Walter
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging & Human Development and Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Sandra Zeng
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Ying Shi
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Grant R Williams
- Divisions of Hematology/Oncology and Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Melisa L Wong
- Division of Geriatrics, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
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Verreckt E, Grimm E, Agrigoroaei S, de Saint Hubert M, Philippot P, Cremer G, Schoevaerdts D. Investigating the relationship between specific executive functions and functional decline among community-dwelling older adults: results from a prospective pilot study. BMC Geriatr 2022; 22:976. [PMID: 36529736 PMCID: PMC9762049 DOI: 10.1186/s12877-022-03559-6] [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: 12/23/2021] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As cognitive functions and, more specifically, executive functions (EF) seem to influence autonomy among the elderly, we investigated the role of each of the five EF sub-components (inhibition, spontaneous flexibility, reactive flexibility, planning, and updating in working memory) for the risk of functional decline. METHOD A total of 137 community-dwelling participants over 75 years of age were included in a prospective cohort study and assigned to three groups: individuals with neuro-degenerative cognitive disorders, those having cognitive disorders with non-degenerative aetiology, and a control group without any cognitive problems. We measured each EF sub-component and assessed functional decline by evaluating basic (b-ADL) and instrumental activities of daily living (i-ADL) at baseline and 6 months later. We conducted three separate multiple logistic regression models to examine the extent to which the five EF facets predicted overall functional decline at the end of the follow-up period. RESULTS We found that people who exhibited a decline in b-ADLs or/and i-ADLs over 6 months had worse performance on inhibition and two flexibility tasks than those who did not experience a decline. The results suggest that decliners have more difficulties in managing unforeseen events. Inhibition and updating in working memory predicted a decline in b-ADL while spontaneous and reactive flexibilities predicted a decline in i-ADL. CONCLUSION In our sample, specific executive dysfunctions were associated with a decline in functional status. With respect to the risk of decline in b-ADL, deficits in inhibition may represent a risk factor, as it regulates over-learned activities. Bothtypes of flexibility, which allow the shifting and generating of adaptive responses, predicted decline in i-ADL. In sum, paying more attention to particular EF profiles would help clinicians to anticipate some aspects of functional decline.
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Affiliation(s)
- Emilie Verreckt
- Geriatric Department, CHU UCL Namur, Site Godinne, Av. Dr. G. Therasse, 1, 5530 Yvoir, Belgium
| | - Elise Grimm
- grid.7942.80000 0001 2294 713XPsychological Sciences Research Institute, UCLouvain, Louvain-La-Neuve, Belgium
| | - Stefan Agrigoroaei
- grid.7942.80000 0001 2294 713XPsychological Sciences Research Institute, UCLouvain, Louvain-La-Neuve, Belgium
| | - Marie de Saint Hubert
- Geriatric Department, CHU UCL Namur, Site Godinne, Av. Dr. G. Therasse, 1, 5530 Yvoir, Belgium
| | - Pierre Philippot
- grid.7942.80000 0001 2294 713XPsychological Sciences Research Institute, UCLouvain, Louvain-La-Neuve, Belgium
| | - Gérald Cremer
- Geriatric Department, CHU UCL Namur, Site Godinne, Av. Dr. G. Therasse, 1, 5530 Yvoir, Belgium
| | - Didier Schoevaerdts
- Geriatric Department, CHU UCL Namur, Site Godinne, Av. Dr. G. Therasse, 1, 5530 Yvoir, Belgium
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Soh CH, Lim WK, Maier AB. Predictors for the Transitions of Poor Clinical Outcomes Among Geriatric Rehabilitation Inpatients. J Am Med Dir Assoc 2022; 23:1800-1806. [PMID: 35760091 DOI: 10.1016/j.jamda.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the associations of morbidity burden and frailty with the transitions between functional decline, institutionalization, and mortality. DESIGN REStORing health of acutely unwell adulTs (RESORT) is an ongoing observational, longitudinal inception cohort and commenced on October 15, 2017. Consented patients were followed for 3 months postdischarge. SETTING AND PARTICIPANTS Consecutive geriatric rehabilitation inpatients admitted to geriatric rehabilitation wards. METHODS Patients' morbidity burden was assessed at admission using the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale (CIRS). Frailty was assessed using the Clinical Frailty Scale (CFS) and modified Frailty Index based on laboratory tests (mFI-lab). A multistate model was applied at 4 time points: 2 weeks preadmission, admission, and discharge from geriatric rehabilitation and 3 months postdischarge, with the following outcomes: functional decline, institutionalization, and mortality. Cox proportional hazards regression was applied to investigate the associations of morbidity burden and frailty with the transitions between outcomes. RESULTS The 1890 included inpatients had a median age of 83.4 (77.6-88.4) years, and 56.3% were female. A higher CCI score was associated with a greater risk of transitions from preadmission and declined functional performance to mortality [hazard ratio (HR) 1.28, 95% CI 1.03-1.59; HR 1.32, 95% CI 1.04-1.67]. A higher CIRS score was associated with a higher risk of not recovering from functional decline (HR 0.80, 95% CI 0.69-0.93). A higher CFS score was associated with a greater risk of transitions from preadmission and declined functional performance to institutionalization (HR 1.28, 95% CI 1.10-1.49; HR 1.23, 95% CI 1.04-1.44) and mortality (HR 1.12, 95% CI 1.01-1.33; HR 1.11, 95% CI 1.003-1.31). The mFI-lab was not associated with any of the transitions. None of the morbidity measures or frailty assessment tools were associated with the transitions from institutionalization to other outcomes. CONCLUSIONS AND IMPLICATIONS This study demonstrates that greater frailty severity, assessed using the CFS, is a significant risk factor for poor clinical outcomes and demonstrates the importance of implementing it in the geriatric rehabilitation setting.
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Affiliation(s)
- Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - 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, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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Functional Decline After Nonhospitalized Injuries in Older Patients: Results From the Canadian Emergency Team Initiative Cohort in Elders. Ann Emerg Med 2022; 80:154-164. [DOI: 10.1016/j.annemergmed.2022.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/23/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022]
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Alfaraidhy MA, Regan C, Forman DE. Cardiac rehabilitation for older adults: current evidence and future potential. Expert Rev Cardiovasc Ther 2022; 20:13-34. [PMID: 35098848 PMCID: PMC8858649 DOI: 10.1080/14779072.2022.2035722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Growth of the older adult demographic has resulted in an increased number of older patients with cardiovascular disease (CVD) in combination with comorbid diseases and geriatric syndromes. Cardiac rehabilitation (CR) is utilized to promote recovery and improve outcomes, but remains underutilized, particularly by older adults. CR provides an opportunity to address the distinctive needs of older adults, with focus on CVD as well as geriatric domains that often dominate management and outcomes. AREAS COVERED Utility of CR for CVD in older adults as well as pertinent geriatric syndromes (e.g. multimorbidity, frailty, polypharmacy, cognitive decline, psychosocial stress, and diminished function) that affect CVD management. EXPERT OPINION Mounting data substantiate the importance of CR as part of recovery for older adults with CVD. The application of CR as a standard therapy is especially important as the combination of CVD and geriatric syndromes catalyzes functional decline and can trigger progressive clinical deterioration and dependency. While benefits of CR for older adults with CVD are already evident, further reengineering of CR is necessary to better address the needs of older candidates who may be frail, especially as remote and hybrid formats of CR are becoming more widespread.
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Affiliation(s)
- Maha A. Alfaraidhy
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,Department of Medicine, King Abdulaziz University School of Medicine, Jeddah, KSA
| | - Claire Regan
- University of Maryland School of Nursing, Baltimore, MD
| | - Daniel E. Forman
- Department of Medicine (Geriatrics and Cardiology), Section of Geriatric Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, PA,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA
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Montreal Cognitive Assessment: Seeking a Single Cutoff Score May Not Be Optimal. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9984419. [PMID: 34616484 PMCID: PMC8487840 DOI: 10.1155/2021/9984419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/03/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
Background Cutoff scores of the Montreal cognitive assessment (MoCA) for screening mild cognitive impairment in older adults differ across the world and within the Chinese culture. It is argued that to seek a cutoff score is essential to classify test participants. It was unknown how taking a classifying approach might reveal the cutoff score for identifying mildly cognitively impaired older adults. Methods Participants, selected from 13 communities in Wuhan, China, were tested with the Chinese version of MoCA and rated with the Activities of Daily Living and the Clinical Dementia Rating scales. Mixture modeling was applied to the data with certain covariates and MoCA sum scores as the outcome of the latent class. Models with different numbers of classes were compared in terms of information criteria, likelihood ratio test, entropy, and interpretability. Results A 3-class model (normal, mildly impaired, and severely impaired) was found to fit the data best. The normal class averaged a MoCA score of 24, while the severely impaired class averaged a score below 18. For those cases with MoCA scores above 18 and below 24, it is not certain if they are in the normal or the severely impaired classes. Conclusion Latent variable classification modeling provides another option to identify MCI in older adults. Some categorically different cases of MCI cannot be captured with any single MoCA sum score. A range of 18–24 MoCA scores might serve as a better screening criterion of MCI. Older adults who scored within this gray zone should be monitored for potential interventions.
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Abstract
Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient's aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient's function and quality of life at a time in life when these often become foremost therapeutic priorities.
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Affiliation(s)
| | - Daniel E Forman
- University of Pittsburgh, University of Pittsburgh Medical Center and VA Pittsburgh Geriatric, Research, Education and Clinical Center (GRECC), Pittsburgh, PA, USA
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Daoust R, Paquet J, Boucher V, Pelletier M, Gouin É, Émond M. Relationship Between Pain, Opioid Treatment, and Delirium in Older Emergency Department Patients. Acad Emerg Med 2020; 27:708-716. [PMID: 32441414 DOI: 10.1111/acem.14033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Emergency department (ED) stay and its associated conditions (immobility, inadequate hydration and nutrition, lack of stimulation) increase the risk of delirium in older patients. Poorly controlled pain and paradoxically opioid pain treatment have also been identified as triggers for delirium. The aim of this study was to assess the relationship between pain, opioid treatment, and delirium in older ED patients. METHODS A multicenter prospective cohort study was conducted in four hospitals across the province of Québec (Canada). Patients aged ≥ 65 years old, waiting for hospital admission between March and July 2015, who were nondelirious upon ED arrival, who were independent or semi-independent in their daily living activities, and who had an ED stay of at least 8 hours were included. Delirium assessments were conducted twice a day during the patient's entire ED stay and their first 24 hours on the hospital ward using the Confusion Assessment Method. Pain intensity was evaluated using a visual analog scale (VAS = 0-100) during the initial interview, and all opioid treatments were documented. RESULTS A total of 338 patients were included; 51% were female, and mean (±SD) age was 77 (±8) years. Forty-one patients (12%) experienced delirium during their hospital stay occurring within a mean (±SD) delay of 47 (±19) hours after ED admission. Among patients with pain intensity ≥ 65 from VAS (0-100), 26% experienced delirium compared to 11% for patients with pain < 65 (p < 0.01), and no significant association was found between opioid consumption and delirium (p = 0.31). Logistic regression controlling for confounding factors showed that patients with pain intensity ≥ 65 are 3.3 (95% confidence interval = 1.4 to 7.9) times more likely to develop delirium than patients who had pain intensity of <65. CONCLUSIONS Severe pain, not opioids, is associated with the development of delirium during ED stay. Adequate pain control during the hospital stay may contribute to a decrease in delirium episodes.
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Affiliation(s)
- Raoul Daoust
- From the Centre d’Étude en Médecine d’Urgence Hôpital du Sacré‐Cœur de Montréal Montréal Québec Canada
- the Faculté de Médecine Département Médecine Familiale et Médecine d’Urgence Université de Montréal Montréal Québec Canada
| | - Jean Paquet
- the Faculté de Médecine Département Médecine Familiale et Médecine d’Urgence Université de Montréal Montréal Québec Canada
| | - Valérie Boucher
- CHU de Québec–Université Laval Québec Québec Canada
- the Centre d’Excellence du Vieillissement de Québec Québec Québec Canada
| | - Mathieu Pelletier
- the Faculté de Médecine Université Laval Québec Québec Canada
- the Centre Intégré de Santé et de Services Sociaux de Lanaudière Joliette Québec Canada
| | - Émilie Gouin
- and the Centre Hospitalier Régional de Trois‐Rivières Trois‐Rivières Québec Canada
| | - Marcel Émond
- CHU de Québec–Université Laval Québec Québec Canada
- the Centre d’Excellence du Vieillissement de Québec Québec Québec Canada
- the Faculté de Médecine Université Laval Québec Québec Canada
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McKenzie GAG, Bullock AF, Greenley SL, Lind MJ, Johnson MJ, Pearson M. Implementation of geriatric assessment in oncology settings: A systematic realist review. J Geriatr Oncol 2020; 12:22-33. [PMID: 32680826 DOI: 10.1016/j.jgo.2020.07.003] [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: 03/26/2020] [Revised: 05/04/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Older adults with cancer are more likely to have worse clinical outcomes than their younger counterparts, and shared decision-making can be difficult, due to both complexity from adverse ageing and under-representation in clinical trials. Geriatric assessment (GA) has been increasingly recognised as a predictive and prehabilitative tool for older adults with cancer. However, GA has been notoriously difficult to implement in oncological settings due to workforce, economic, logistical, and practical barriers. We aimed to review the heterogenous literature on implementation of GA in oncology settings to understand the different implementation context configurations of GA and the mechanisms they trigger to enable successful implementation. A systematic realist review was undertaken in two stages: i) systematic searches with structured data extraction combined with iterative key stakeholder consultations to develop programme theories for implementing GA in oncology settings; ii) synthesis to refine programme theories. Medline, Embase, PsycInfo, Cochrane Library, CINAHL, Web of Science, Scopus, ASSIA, Epistemonikos, JBI Database of Systematic Reviews and Implementation Reports, DARE and Health Technology Assessment were searched. Four programme theories were developed from 53 included articles and 20 key stakeholder consultations addressing the major barriers of GA implementation in oncology practice: time (leveraging non-specialists), funding (creating favourable health economics), practicalities (establishing the use of GA in cancer care), and managing limited resources. We demonstrate that a whole system approach is required to improve the implementation of GA in cancer settings. This review will help inform policy decisions regarding implementation of GA and provide a basis for further implementation research.
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Affiliation(s)
- Gordon A G McKenzie
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom.
| | - Alex F Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Sarah L Greenley
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Michael J Lind
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom
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13
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Rasheedy D, Abou-Hashem RM. Overestimated functional dependency in older patients: Can we blame gender difference, unneeded assistance or assessment tools? Arch Gerontol Geriatr 2020; 88:104018. [PMID: 32044523 DOI: 10.1016/j.archger.2020.104018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The population is aging in Egypt and hence functional limitation is increasing. Thus finding the best measures for its detection is mandated. OBJECTIVES The aim of this study was to assess whether Katz ADL (activities of daily living) and Lawton IADL (instrumental activities of daily living) were suitable measures to represent the functional abilities of older Egyptians of both genders during hospital admission and to determine the dimensionality of both tools. METHODS Functional status was assessed during hospital admission as a part of the comprehensive geriatric assessment for 786 older patients (aged 60 years and older). 150 of them were randomly interviewed to collect data regarding the difficulty during each task of Katz ADL and Lawton IADL performance, unnecessary and unmet needed assistance, barriers to get needed assistance and the type of care providers. RESULTS The prevalence of ADL and IADL dependency was 61.80 % and 85.87 %, respectively. Functional limitation in both scales was found to be significantly associated with increasing age, marital status other than married, cognitive impairment. Both scales showed a bi-dimensional factor structure, removing continence from Katz ADL resulted in a uni-dimensional scale. Females were more dependent than males in all tasks except household tasks of IADL. CONCLUSIONS Katz ADL and Lawton IADL did not capture the actual dependency level among older Egyptians. The household tasks in Lawton IADL and continence in Katz ADL mislabeled dependency in the studied sample.
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Affiliation(s)
- Doha Rasheedy
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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14
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Kopatsis A, Chetram VK, Kopatsis K, Morin N, Wagner C. A Novel Risk Score to Predict Post-Trauma Mortality in Nonagenarians. J Emerg Trauma Shock 2019; 12:192-197. [PMID: 31543642 PMCID: PMC6735205 DOI: 10.4103/jets.jets_145_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Nonagenarians represent a rapidly growing age group who often have functional limitations and multiple comorbidities, predisposing them to trauma. Aims: The purpose of this study was to identify patient characteristics, hospital complications, and comorbidities that predict in-hospital mortality in the nonagenarian population following trauma. We also sought to create a scoring system using these variables. Settings and Design: This study was a retrospective chart review. Methods: We reviewed the medical records of 548 nonagenarian trauma patients admitted to two Level I trauma centers from 2006 to 2015. Statistical analysis was performed using logistic regression and a machine learning model, which calculated significant variables and computed a scoring system. Results: The in-hospital mortality rate was 7.1% (n = 39). Significant predictors of mortality were cardiac comorbidity, neuro-concussion, New Injury Severity Score (ISS) 16+, striking an object, ISS 25–75, and pulmonary and cardiac complications. Significant variables were assigned a numeric value. A score of 5+ carried a 41.1% mortality risk, 79% sensitivity, and 91% specificity. A score of 10+ had an associated 81.8% mortality risk with 31% specificity and 99% sensitivity. Conclusions: Our findings identified reliable predictors of mortality in nonagenarian population posttrauma. The scoring system performs with good specificity and sensitivity and incrementally correlates with mortality risk.
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Affiliation(s)
- Anthony Kopatsis
- Department of Surgery, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Vishaka K Chetram
- School of Medicine, St. George's University, Grenada, West Indies, Grenada
| | | | - Nicholas Morin
- Department of Surgery, NYU Brooklyn Hospital, Brooklyn, New York, USA
| | - Christine Wagner
- School of Medicine, St. George's University, Grenada, West Indies, Grenada
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15
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Kröger E, Simard M, Sirois MJ, Giroux M, Sirois C, Kouladjian-O'Donnell L, Reeve E, Hilmer S, Carmichael PH, Émond M. Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study. Drugs Aging 2019; 36:73-83. [PMID: 30378088 DOI: 10.1007/s40266-018-0604-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6 months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research. OBJECTIVES We aimed to assess the contribution of the DBI to functional decline in the CETI cohort. METHODS CETI participants were assessed physically and cognitively at baseline during their consultations at emergency departments (EDs) for their injuries and up to 6 months thereafter. The medication data were used to calculate baseline DBI and functional status was measured with the Older Americans Resources and Services (OARS) scale. Multivariate linear regression models assessed the association between baseline DBI and functional status at 6 months, adjusting for age, sex, baseline OARS, frailty level, comorbidity count, and mild cognitive impairment. RESULTS The mean age of the 846 participants was 77 years and their mean DBI at baseline was 0.24. Complete follow-up data at 3 or 6 months was available for 718 participants among whom a higher DBI at the time of injury contributed to a lower functional status at 6 months. Each additional point in the DBI lead to a loss of 0.5 points on the OARS functional scale, p < 0.001. Among those with a DBI ≥ 1, 27.4% were considered 'patients who decline' at 3 or 6 months' follow-up, compared with 16.0% of those with a DBI of 0 (p = 0.06). CONCLUSIONS ED visits are considered missed opportunities for optimal care interventions in seniors; Identifying their DBI and adjusting treatment accordingly may help limit functional decline in those at risk after minor injury.
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Affiliation(s)
- Edeltraut Kröger
- Faculté de pharmacie, Université Laval, Québec, Canada. .,Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada. .,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada.
| | - Marilyn Simard
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada
| | - Marie-Josée Sirois
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Marianne Giroux
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Caroline Sirois
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Lisa Kouladjian-O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
| | - Marcel Émond
- Centre d'excellence sur le vieillissement de Québec du Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Canada.,Faculté de médecine, Université Laval, Québec, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, Canada
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Madden KM. Defining Functional Decline, Characteristics of Admitted Older Adults and Comparing Alternate Versions of the MoCA. Can Geriatr J 2016; 19:1. [PMID: 27076858 PMCID: PMC4815932 DOI: 10.5770/cgj.19.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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