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Shulyaev K, Spielberg Y, Gur-Yaish N, Zisberg A. Family Support During Hospitalization Buffers Depressive Symptoms Among Independent Older Adults. Clin Gerontol 2024; 47:341-351. [PMID: 37493087 DOI: 10.1080/07317115.2023.2236097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Hospitalization is a stressful event that may lead to deterioration in older adults' mental health. Drawing on the stress-buffering hypothesis, we examined whether family support during hospitalization would moderate the relations between level of independence and in-hospital depressive symptoms. METHOD This research was a secondary analysis of a cohort study conducted with a sample of 370 hospitalized older adults. Acutely ill older adults reported their level of independence at time of hospitalization and their level of depressive symptoms three days into the hospital stay. Family support was estimated by a daily report of hours family members stayed with the hospitalized older adult. RESULTS Independent older adults whose family members stayed longer hours in the hospital had fewer depressive symptoms than independent older adults with shorter family visits. Relations between depressive symptoms and family support were not apparent for dependent older adults, even though their family members stayed more hours. CONCLUSIONS This study partially supports the stress-buffering hypothesis, in that social support ameliorated depressive symptoms among hospitalized independent older adults. CLINICAL IMPLICATIONS Assessing depressive symptoms and functional ability and creating an environment conducive to family support for older adults may be beneficial to hospitalized older adults' mental health.
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Affiliation(s)
- Ksenya Shulyaev
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
- The Minerva Centre on Intersectionality in Aging (MCIA), Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
| | - Yochy Spielberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
| | - Nurit Gur-Yaish
- The Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
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Missell-Gray R, Van Orden K, Simning A. Hospitalization's association with depression in adults over 50 years old: does living arrangement matter? Findings from the Health and Retirement Study. Aging Ment Health 2023; 27:1684-1691. [PMID: 36591606 PMCID: PMC10314961 DOI: 10.1080/13607863.2022.2163978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To examine how living arrangements are associated with depressive symptoms in late middle-life and older adults following hospitalization within the last two years. DESIGN We used the 2016 wave of the Health and Retirement Study (HRS), a nationally representative survey of adults over 50 years old living in the United States. METHODS The dependent variable was whether HRS participants screened positive for having depressive symptoms. The primary independent variable was self-reported hospitalization in the prior two years. We stratified bivariate analyses and multivariate logistic regressions by living arrangement to examine hospitalizations' association with depressive symptoms. RESULTS Depressive symptoms were less prevalent among participants who were married or partnered and living with a partner (14.0%) compared to those who were not married or partnered and were living with others (31.7%) and were not married or partnered and were living alone (27.8%). In multivariate analyses stratified by living arrangement, however, hospitalization was associated with depressive symptoms for those married or partnered and living with a partner (OR = 1.39, 95% CI: 1.14-1.69) but not for those who were not married and living with other(s) (OR = 0.88, 95% CI: 0.65-1.18) and not married or partnered and living alone (OR = 1.06, 95% CI: 0.82-1.36). CONCLUSIONS Late middle-life and older adults residing with spouses or cohabitating appear at risk for having depressive symptoms following a hospitalization. A better understanding of how relationships and living arrangements may affect depression risk in the context of an acute medical illness is needed to identify points of intervention.
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Affiliation(s)
- Rachel Missell-Gray
- Department of Psychiatry, University of Rochester (U.R.), Rochester, NY, United States of America (USA)
- University of Rochester, Margaret Warner School of Education and Human Development, Rochester, NY, USA
| | - Kimberly Van Orden
- Department of Psychiatry, University of Rochester (U.R.), Rochester, NY, United States of America (USA)
| | - Adam Simning
- Department of Psychiatry, University of Rochester (U.R.), Rochester, NY, United States of America (USA)
- Department of Public Health Sciences, U.R., Rochester, NY, USA
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Rahman HH, Akinjobi Z, Morales JB, Munson-McGee SH, Gard C. Prevalence of associated factors on depression during COVID 19 in students in a minority serving institution: A cross sectional study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 13:100605. [PMID: 37333941 PMCID: PMC10263221 DOI: 10.1016/j.jadr.2023.100605] [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: 10/17/2022] [Revised: 02/08/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The COVID-19 pandemic changed the learning style of university students in the US, affecting their mental health of students. This study aims to understand the factors that influenced depression during the COVID-19 pandemic in the New Mexico State University (NMSU) student population. Methods A questionnaire assessing mental health and lifestyle factors was delivered to NMSU students by using QualtricsXM software. Depression was assessed using the Patient Health Questionnaire- 9 (PHQ-9); depression was defined as a score ≥10. Single and multifactor logistic regression was performed using R software. Results This study determined that the prevalence of depression among female students was 72% and 56.30% among male students. Several covariates were significant for increased odds of depression in students, including decreased diet quality (OR: 5.126, 95% CI: 3.186-8.338), annual household income $10,000 - $20,000 (OR: 3.161, 95% CI: 1.444-7.423), increased alcohol consumption (OR: 2.362, 95% CI: 1.504-3.787), increased smoking (OR: 3.581, 95% CI:1.671-8.911), quarantining due to COVID (OR: 2.001, 95% CI: 1.348-2.976), and family member dying of COVID (OR: 1.916, 95% CI: 1.072-3.623). Covariates of being male (OR: 0.501, 95% CI: 0.324-0.776), married (OR: 0.499, 95% CI: 0.318-0.786), eating a balanced diet (OR: 0.472, 95% CI: 0.316-0.705), and sleeping 7-8 h per night (OR: 0.271, 95% CI: 0.175-0.417) were all protective factors for depression in NMSU students. Limitation This is a cross-sectional study, and therefore, causation cannot be determined. Conclusion Several factors regarding demographics, lifestyle, living arrangements, alcohol and tobacco use, sleeping behavior, family vaccination, and COVID status were significantly associated with depression in students during the COVID-19 pandemic.
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Affiliation(s)
| | - Zainab Akinjobi
- Department of Economics, Applied Statistics & International Business, New Mexico State University. Las Cruces, NM 88003, USA
| | | | | | - Charlotte Gard
- Department of Economics, Applied Statistics and International Business, New Mexico State University. Las Cruces, NM 88003, USA
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Liu Y, O’Grady MA. A cross-sectional study of the relationship between depression status, health care coverage, and sexual orientation. DISCOVER MENTAL HEALTH 2023; 3:13. [PMID: 37861944 PMCID: PMC10501004 DOI: 10.1007/s44192-023-00039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 10/21/2023]
Abstract
Health care coverage is an important factor in receipt of behavioral healthcare. This study uses data from the New York City Community Health Survey to examine how sexual minority status impacts the relationship between depression status and having health care coverage. Approximately 10% of the sample (n = 9571; 47% 45+ years old; 35% White Non-Hispanic; 7% sexual minority) reported probable depression and low health care coverage. Compared to heterosexual participants, a greater proportion of sexual minority participants had low health care coverage (17% vs. 9%) and probable depression (19% vs. 9%). Logistic regression examining the association between probable depression status and health care coverage showed that those with probable depression have odds of low health care coverage that are were 3.08 times those who did not have probable depression; this relationship was not modified by sexual orientation. Continued research to understand the interplay of health care coverage, mental health, and sexual orientation is needed.
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Affiliation(s)
- Yang Liu
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, USA
| | - Megan A. O’Grady
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, USA
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Martinez M, Falvey JR, Cifu A. Deconditioned, disabled, or debilitated? Formalizing management of functional mobility impairments in the medical inpatient setting. J Hosp Med 2022; 17:843-846. [PMID: 35818341 PMCID: PMC9796863 DOI: 10.1002/jhm.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Maylyn Martinez
- Department of Medicine, Section of Hospital MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Jason R. Falvey
- Department of Physical Therapy and Rehabilitation ScienceUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Adam Cifu
- Department of Medicine, Section of General Internal MedicineUniversity of ChicagoChicagoIllinoisUSA
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Nguyen TTP, Nguyen TT, Dam VTA, Vu TTM, Do HT, Vu GT, Tran AQ, Latkin CA, Hall BJ, Ho RCM, Ho CSH. Mental wellbeing among urban young adults in a developing country: A Latent Profile Analysis. Front Psychol 2022; 13:834957. [PMID: 36118453 PMCID: PMC9480491 DOI: 10.3389/fpsyg.2022.834957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/04/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction This study aimed to explore the mental wellbeing profiles and their related factors among urban young adults in Vietnam. Methods A cross-sectional study was conducted in Hanoi, which is the capital of Vietnam. There were 356 Vietnamese who completed the Mental Health Inventory-5 (MHI-5) questionnaire. The Latent Profile Analysis (LPA) was used to identify the subgroups of mental wellbeing through five items of the MHI-5 scale as the continuous variable. Multinomial logistic regression was used to determine factors related to subgroups. Results Three classes represented three levels of MHI-5 score, which included “Poor mental health,” “Fair mental health,” and “Good mental health,” were, respectively, 14.3, 46.6, and 39.0%. Compared to a low household economy, participants with an average household economy had 2.11 and 4.79 times higher odds of being in a good mental health class relative to fair and poor mental health classes. Respondents with more than two acute symptoms had 3.85 times higher odds of being in a good mental health class relative to a poor mental health class, as compared to those without acute symptoms. Regarding the measurement of the Perceived Social Support Scale (MSPSS), people having support from their family had 1.80 and 2.23 times higher odds of being in classes of fair and good mental health relative to the poor mental health class; and participants having friend support also had 1.87 times higher odds of being in a good mental health class compared with the fair mental health class, as the MSPSS score increased by 1 unit. People with Rosenberg’s self-esteem scale increased by 1 score, those who had 1.17, 1.26, and 1.47 times higher odds of being in a good compared to fair mental health class, fair compared to poor mental health class, and good compared to poor mental health class, respectively. Conclusion Our findings were given to promote a new classification method for mental health screening among the general population. The current findings could be used as evidence to develop policies and plans that focus on encouraging early screening for mental health problems among the general young population in the future.
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Affiliation(s)
- Thao Thi Phuong Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Pharmacy, Duy Tan University, Da Nang, Vietnam
- *Correspondence: Thao Thi Phuong Nguyen,
| | - Tham Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Pharmacy, Duy Tan University, Da Nang, Vietnam
| | - Vu Trong Anh Dam
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Pharmacy, Duy Tan University, Da Nang, Vietnam
| | | | - Hoa Thi Do
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Anh Quynh Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Brian J. Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, China
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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van Andel M, van Schoor NM, Korten NC, Heijboer AC, Drent ML. Ghrelin, leptin and high-molecular-weight adiponectin in relation to depressive symptoms in older adults: Results from the Longitudinal Aging Study Amsterdam. J Affect Disord 2022; 296:103-110. [PMID: 34600170 DOI: 10.1016/j.jad.2021.09.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Ghrelin, leptin and high-molecular-weight (HMW) adiponectin have been linked to depression in middle-aged adults. Pathophysiological mechanisms of depression change as age progresses and it is unclear whether the same associations exist in older adults. METHODS We analyzed the associations between ghrelin, leptin and HMW adiponectin and depressive symptoms (Center for Epidemiologic Studies Depression (CES-D) score ≥ 16) in a community-dwelling cohort of 898 participants in a multivariable logistic regression analysis at baseline and after three years of follow-up, were applicable stratified by sex, age and waist-hip-ratio (WHR). RESULTS At baseline no significant associations were found. After three years of follow-up ghrelin was associated with higher odds for depressive symptoms (fully adjusted continuous analysis OR 2.27, 95% CI 1.42 - 3.61). There was effect modification for age and WHR, with significant associations in participants younger than 69.7 years (median) and with a WHR below 0.9554 (mean). In the sex-stratified analysis for leptin we found significant associations in men (fully adjusted continuous analysis OR 1.07, 95% CI 1.02 - 1.12). For HMW adiponectin there were no significant associations in the multivariable analysis. LIMITATIONS As our cohort consisted of relatively healthy participants with intact cognitive function, selection bias may have contributed to lack of significant baseline associations. CONCLUSIONS Our results show significant associations between ghrelin and - for men only - leptin and depressive symptoms after three years of follow up. This may provide a new therapeutic window for treatment of depressive symptoms in older adults, as both ghrelin and leptin are positively influenced by weight loss.
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Affiliation(s)
- Merel van Andel
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, De Boelelaan 1117, Amsterdam 1081 HV, Netherlands.
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam 1081 HV, Netherlands.
| | - Nicole C Korten
- Department of Old Age Psychiatry, GGZ inGeest, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Oldenaller 1, Amsterdam 1081 HJ, Netherlands.
| | - Annemieke C Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HZ, Netherlands; Department of Clinical Chemistry, Endocrine Laboratory, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands.
| | - Madeleine L Drent
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, De Boelelaan 1117, Amsterdam 1081 HV, Netherlands; Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorstraat 7, Amsterdam 1081 BT, Netherlands.
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Ley L, Khaw D, Duke M, Botti M. Low dose mobility and functional status outcomes in hospitalized older general medicine patients. Geriatr Nurs 2021; 43:7-14. [PMID: 34798311 DOI: 10.1016/j.gerinurse.2021.10.020] [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: 08/24/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/01/2022]
Abstract
Emerging evidence suggests hospitalized older adults should walk at least 20-minutes daily to minimize functional decline. A single-institution case study conducted in a tertiary-referral centre in Melbourne, Australia, aimed to examine functional change and describe characteristics of older patients' in-hospital mobility. From 526 older patients vulnerable to functional decline, a sample of 41 patients (Mean age = 83.6, SD = 6.1 years) participated in 6-hour naturalistic observations. Functional change was measured at 2-weeks preadmission, admission and discharge with the revised Measurement System of Functional Autonomy (SMAF). Nearly 25% (n = 10) of observed patients functionally declined between preadmission and discharge and five patients died (12.2%). Thirty-two patients (78%) mobilized in 133 episodes accounting for 3.1% of the 246-hours observed. A daily walking-exercise dose equivalent to 20-min was associated with less functional decline in older adults with moderate to high walking capability supporting the effectiveness of this daily walking-exercise dose in minimizing functional decline.
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Affiliation(s)
- Lenore Ley
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research - Alfred Health, Deakin University, Locked Bag 22000, Geelong, Australia.
| | - Damien Khaw
- Centre for Quality and Patient Safety Research - Epworth Health, Deakin University, Locked Bag 22000, Geelong, Australia
| | - Maxine Duke
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia
| | - Mari Botti
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia
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Andrews JS, Gold LS, Reed MJ, Garcia JM, McClelland RL, Fitzpatrick AL, Hough CL, Cawthon PM, Covinsky KE. Appendicular Lean Mass, Grip Strength, and the Development of Hospital-Associated Activities of Daily Living Disability among Older Adults in the Health ABC Study. J Gerontol A Biol Sci Med Sci 2021; 77:1398-1404. [PMID: 34734252 PMCID: PMC9255680 DOI: 10.1093/gerona/glab332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with development of hospital-associated ADL disability in older adults in the Health ABC Study. METHODS Individuals hospitalized during the first 5 years of follow-up (n=1,724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of pre-hospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability. RESULTS Each standard deviation decrement in pre-hospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared to not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death. CONCLUSIONS Pre-hospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.
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Affiliation(s)
| | - Laura S Gold
- Department of Radiology, University of Washington
| | - May J Reed
- Department of Medicine, University of Washington
| | - Jose M Garcia
- Department of Medicine, University of Washington.,GRECC, VA Puget Sound Health Care System
| | | | - Annette L Fitzpatrick
- Department Family Medicine, Epidemiology, and Global Health, University of Washington
| | | | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, University of California San Francisco
| | - Ken E Covinsky
- Department of Medicine, University of California San Francisco
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Mracek J, Earp M, Sinnarajah A. Palliative home care and emergency department visits in the last 30 and 90 days of life: a retrospective cohort study of patients with cancer. BMJ Support Palliat Care 2021:bmjspcare-2021-002889. [PMID: 34187877 DOI: 10.1136/bmjspcare-2021-002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Evaluate the association of specialist palliative home care (HC) on emergency department (ED) visits in the 30 and 90 days prior to death. METHODS This retrospective cohort study using administrative data identified 6976 adults deceased from cancer between 2008 and 2015, living ≥180 days after diagnosis of cancer, and residing in the urban Calgary Zone of Alberta Health Services. All palliative HC and generalist HC services were examined. Regression analyses examined the relationships of HC type to ED visits in the last 30 or 90 days of life. RESULTS In the last 30 days of life, compared with patients receiving palliative HC, patients receiving only generalist HC, or no HC, were more likely to visit the ED (OR)generalist-HC 1.19; 95% CI 1.06 to 1.34; ORno-HC 1.54; 95% CI 1.31 to 1.82). In the last 90 days of life, compared with patients receiving palliative HC, those receiving generalist HC (OR 1.48; 95% CI 1.32 to 1.67) and no HC (OR 1.66; 95% CI 1.39 to 1.99) had increased odds of visiting the ED. CONCLUSIONS Receiving generalist HC and no HC was associated with increased odds of visiting the ED in the last 30 and 90 days of life, when compared with patients receiving palliative HC. Improving access to palliative HC for patients at high risk of visiting the ED may reduce ED visits and acute care costs and improve quality of life in the last 90 days of life.
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Affiliation(s)
| | - Madalene Earp
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Palliative & End of Life Care, Alberta Health Services, Calgary, Alberta, Canada
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Alqarni MA, Mattoo K, Dhingra S, Baba SM, Al Sanabani F, Al Makramani BMA, Akkam HM. Sensitizing Family Caregivers to Influence Treatment Compliance among Elderly Neglected Patients-A 2-Year Longitudinal Study Outcome in Completely Edentulous Patients. Healthcare (Basel) 2021; 9:healthcare9050533. [PMID: 34063316 PMCID: PMC8147452 DOI: 10.3390/healthcare9050533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
Healthcare workers have reported a certain segment of geriatric patients that are suffering from abuse/neglect, which in turn has been associated with anxiety, depression, and helplessness in the individual. Family caregivers (blood relations), being the most common perpetrators of elder abuse and neglect (EAN), have also been shown to respond to sensitization if the type of EAN and the interventions are appropriate. This study was aimed to comparatively analyze the influence of intervention (psychotherapeutic sensitization of FCG) upon long-term (24 months) treatment maintenance and satisfaction in elderly neglected patients. One hundred and fifty patients (aged 41–80 years) suffering from elder neglect (EN) (self-confession) and their respective FCGs, fulfilling the study criteria, participated in this longitudinal 2-year study. The patients were randomly distributed (simple random, convenient) in two equal groups (75 each), namely Group (GP) A (control) and GP B (test). A standardized, complete denture treatment was initiated for all the participants. Both the FCGs and the patients of GP B were sensitized (psychotherapeutic education) for EN, while there was no such intervention in GP A. The influence of such intervention was measured for denture maintenance [denture plaque index (DPI) scores] and treatment satisfaction (10-point visual analog scale). Absolute/relative frequencies and means were major calculations during data analysis. Differences between the groups for any treatment compliance parameter was done through the unpaired t-test, while Karl Pearson’s test determined the level of relationship between variables (p-value < 0.05). Decrease in mean DPI scores (suggesting improvement) was seen among patients in GP A from 1 month (m = 2.92) to 24 months (m = 2.77). A negligible increase in DPI scores was observed among patients of GP B from 1 month (m = 1.38) to 24 months (m = 1.44). Differences in mean values between the two groups were statistically significant at 24-month intervals, while the relationship between the variables was nonsignificant. FCG sensitization through psychotherapeutic education shows a long-term positive influence on the treatment compliance (maintenance and satisfaction). Identifying the existence of EAN among geriatric patients, followed by psychotherapeutic education of FCGs is recommended for routine medical and dental long-duration treatment procedures.
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Affiliation(s)
- Mohammed A. Alqarni
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (M.A.A.); (S.M.B.)
| | - Khurshid Mattoo
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (F.A.S.); (B.M.A.A.M.); (H.M.A.)
- Correspondence: ; Tel.: +966-595-086-078
| | - Surbhi Dhingra
- Department of Oral Maxillofacial Prosthetics, Subharti Dental College, Swami Vivekananda Subharti Univeristy, Meerut 250001, India;
| | - Suheel Manzoor Baba
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia; (M.A.A.); (S.M.B.)
| | - Fuad Al Sanabani
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (F.A.S.); (B.M.A.A.M.); (H.M.A.)
| | - Bandar M. A. Al Makramani
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (F.A.S.); (B.M.A.A.M.); (H.M.A.)
| | - Hadeel Mohammed Akkam
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (F.A.S.); (B.M.A.A.M.); (H.M.A.)
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Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect. Healthcare (Basel) 2021; 9:healthcare9020226. [PMID: 33670706 PMCID: PMC7922918 DOI: 10.3390/healthcare9020226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.
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McMahan RD, Barnes DE, Ritchie CS, Jin C, Shi Y, David D, Walker EJ, Tang VL, Sudore RL. Anxious, Depressed, and Planning for the Future: Advance Care Planning in Diverse Older Adults. J Am Geriatr Soc 2020; 68:2638-2642. [PMID: 32783199 DOI: 10.1111/jgs.16754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine whether depression and anxiety are associated with advance care planning (ACP) engagement or values concerning future medical care. DESIGN Cross-sectional. PARTICIPANTS English- and Spanish-speaking patients, aged 55 years and older, from a San Francisco, CA, county hospital. MEASURES Depression was measured by the Patient Health Questionnaire 8-item scale, and anxiety was measured by the Generalized Anxiety Disorder 7-item scale, using standardized cutoffs of 10 or more for moderate-to-severe symptoms. ACP engagement was measured using validated surveys of ACP behavior change (e.g., self-efficacy and readiness; mean five-point Likert score) and ACP actions (e.g., ask, discuss, and document wishes; 0- to 25-point scale), with higher scores representing higher engagement. In addition, we asked a question about valuing life extension ("some health situations would make life not worth living"). We used adjusted linear and logistic regression. RESULTS Mean age of 986 participants was 63 years, 81% were non-White, 39% had limited health literacy, 45% were Spanish speaking, 13% had depression, and 10% had anxiety. After adjustment for demographic and health status variables, participants who were depressed versus not depressed had higher ACP behavior change scores (0.2 points; 95% confidence interval (CI) = 0.06-0.38; P = .007), higher ACP action scores (1.5 points; 95% CI = 0.51-2.57; P = .003), and higher odds of not valuing life extension (odds ratio (OR) = 2.5; 95% CI = 1.5-4.3; P < .001). Results were similar in participants with versus without anxiety (ACP behavior change: 0.2 points; 95% CI = 0.05-0.40; P = .01; ACP action scores: 1.2 points; 95% CI = 0.14-2.32; P = .028; odds of not valuing life extension: OR = 2.3; 95% CI = 1.3-3.9; P = .004). CONCLUSION Depression and anxiety were associated with greater ACP engagement and not valuing life extension. Although the direction of association between ACP engagement and values with anxiety and depression cannot be determined in this cross-sectional study, these conditions may influence ACP preferences. Future studies should assess whether changes in anxiety or depression affect ACP preferences over time.
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Affiliation(s)
- Ryan D McMahan
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Deborah E Barnes
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Ying Shi
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Daniel David
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Evan J Walker
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Victoria L Tang
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca L Sudore
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
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14
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Albanese AM, Bartz-Overman C, Parikh Md T, Thielke SM. Associations Between Activities of Daily Living Independence and Mental Health Status Among Medicare Managed Care Patients. J Am Geriatr Soc 2020; 68:1301-1306. [PMID: 32196634 DOI: 10.1111/jgs.16423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/29/2020] [Accepted: 02/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Although there is a strong cross-sectional association between dependence in activities of daily living (ADLs) and decreased mental health, it is largely unknown how the loss of specific ADLs, or the combination of ADLs, influences mental health outcomes. We examined the effect of ADL independence on mental health among participants in a large survey of Medicare managed care recipients. DESIGN/SETTING Retrospective cohort study. PARTICIPANTS A total of 104,716 participants in cohort 17 of the Medicare Health Outcomes Survey, who completed the baseline and follow-up surveys in 2014 and 2016. MEASUREMENTS Linear regression models estimated the effects of loss of ADL independence on change in Mental Component Summary (MCS) score. RESULTS In an adjusted model, loss of independence in eating, bathing, dressing, and toileting were associated with three- to four-point declines in MCS, suggesting meaningful worsening. In a model that also included all six ADLs, loss of independence in each ADL was associated with declines in MCS, with the largest effects for eating and bathing. MCS decreased by 1.3 per each additional summative loss of ADL independence (P < .001). CONCLUSION Loss of ADL independence was associated with large declines in mental health, with personal care activities showing the largest effects. Additional research can help to characterize the causes of ADL loss, to explore how older adults cope with it, and to identify ways of maximizing resilience. J Am Geriatr Soc 68:1301-1306, 2020.
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Affiliation(s)
- Anita M Albanese
- University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | | | - Toral Parikh Md
- University of Washington School of Medicine, Seattle, Washington, USA
- Health Services Research and Development, Puget Sound Veterans Affairs Medical Center, Seattle, Washington, USA
| | - Stephen M Thielke
- University of Washington School of Medicine, Seattle, Washington, USA
- Geriatric Research, Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, Washington, USA
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15
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Jing R, Xu T, Rong H, Lai X, Fang H. Longitudinal Association Between Sleep Duration and Depressive Symptoms in Chinese Elderly. Nat Sci Sleep 2020; 12:737-747. [PMID: 33117009 PMCID: PMC7569072 DOI: 10.2147/nss.s269992] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
AIM This study aimed to evaluate the longitudinal association between sleep duration and depressive symptoms among the elderly in China. METHODS A data set from China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013 and 2015 was adopted with a total of 22,847 respondents aged ≥60-years-old. A linear regression analysis with generalized estimating equations was employed to examine the longitudinal associations between duration of total sleep, nighttime sleep and daytime nap, and depressive symptoms. RESULTS An extra hour of total sleep including nighttime sleep and daytime nap was associated with lower incidence of depressive symptoms among the elderly after adjusting all confounders (OR=0.83, 95% CI: 0.82-0.84). In addition, an extra hour of nighttime sleep (OR=0.82, 95% CI: 0.80-0.83) or daytime nap (OR=0.93, 95% CI: 0.89-0.97) was also negatively associated with depressive symptoms among the elderly. After controlling the total sleep time, an extra hour of nighttime sleep was negatively associated with depressive symptoms (OR=0.88, 95% CI: 0.84 to 0.92), while an extra hour of daytime nap displayed a positive association with depressive symptoms (OR=0.88, 95% CI: 0.84 to 0.92). Compared with the moderate nappers, only extended nappers had significantly higher incidence of depressive symptoms (OR=1.32, 95% CI: 1.19 to 1.45). CONCLUSION For the elderly in China, increasing their total sleep, nighttime sleep, and/or daytime nap duration would reduce the incidence of depressive symptoms. Moreover, after fixing the total sleep time, increasing nighttime sleep was more beneficial to the decrease of the incidence of depressive symptoms than daytime nap.
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Affiliation(s)
- Rize Jing
- School of Public Health, Peking University, Beijing 100083, People's Republic of China.,China Center for Health Development Studies, Peking University, Beijing 100083, People's Republic of China
| | - Tingting Xu
- School of Public Health, Peking University, Beijing 100083, People's Republic of China.,Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA
| | - Hongguo Rong
- China Center for Health Development Studies, Peking University, Beijing 100083, People's Republic of China
| | - Xiaozhen Lai
- School of Public Health, Peking University, Beijing 100083, People's Republic of China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100083, People's Republic of China.,Peking University Health Science Center- Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Peking University, Beijing 100083, People's Republic of China.,Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing 10083, People's Republic of China
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16
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Lau BC, Scribani M, Wittstein J. The Effect of Preexisting and Shoulder-Specific Depression and Anxiety on Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair. Am J Sports Med 2019; 47:3073-3079. [PMID: 31585048 DOI: 10.1177/0363546519876914] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have considered the potential effect of depression or anxiety on outcomes after rotator cuff repair. PURPOSE To evaluate the effect of a preexisting diagnosis of depression or anxiety, as well as the feeling of depression and anxiety directly related to the shoulder, on the American Shoulder and Elbow Surgeons (ASES) score. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study is a retrospective review of prospectively collected data on patients who underwent arthroscopic rotator cuff repair and were evaluated by the ASES score preoperatively and at a minimum 12 months postoperatively as part of the senior author's shoulder registry. Preexisting diagnoses of depression and/or anxiety were recorded, and questions from the Western Ontario Rotator Cuff Index directed at feelings of depression or anxiety related to the shoulder were also evaluated. The Wilcoxon rank sum test was used to compare ASES scores between patients with and without anxiety and/or depression. Spearman correlation was used to correlate questions on depression and anxiety with ASES scores. RESULTS A total of 187 patients (63 females, 124 males; mean age, 58.6 years, SD, 8.7 years) undergoing arthroscopic rotator cuff repair were evaluated with a mean follow-up of 47.5 months (SD, 17.4 months; range, 12-77 months). Fifty-three patients (mean age, 60 years; SD, 8.6 years) had preexisting diagnoses of depression and/or anxiety and 134 patients (mean age, 58.1 years; SD, 8.7 years) did not. Patients with depression and/or anxiety had significantly lower preoperative and postoperative ASES scores (60.7 vs 67.8, P = .014; and 74.6 vs 87.1, P = .008, respectively). The change in ASES scores from preoperative to postoperative, however, was not significantly different (18.0 vs 14.9). A higher score of depression or anxiety related to the shoulder had a negative correlation with the preoperative (r = -0.76, P < .0001; and r = -0.732, P < .0001, respectively) and postoperative (r = -0.31, P = .0001; and r = -0.31, P = .0003, respectively) ASES scores, but a positive correlation (r = 0.50, P < .0001; and r = 0.43, P < .0001, respectively) with the change in ASES scores. CONCLUSION Patients with a history of depression and/or anxiety have lower outcome scores preoperatively and postoperatively; however, they should expect the same amount of relief from arthroscopic rotator cuff repair as those without a history of depression or anxiety. Stronger feelings of depression or anxiety directly related to the shoulder correlated with lower preoperative and postoperative outcome scores, but a greater amount of improvement from surgery. The results from this study suggest that a preexisting diagnosis of depression or anxiety, as well as feelings of depression or anxiety directly related to the shoulder, should be considered during the management of patients with rotator cuff tears.
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Affiliation(s)
- Brian C Lau
- Duke Sport Science Institute, Department of Orthopaedics, Duke University Medical Center, North Carolina, USA
| | | | - Jocelyn Wittstein
- Duke Sport Science Institute, Department of Orthopaedics, Duke University Medical Center, North Carolina, USA
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17
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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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18
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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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19
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Abstract
PURPOSE/OBJECTIVES The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. PRIMARY PRACTICE SETTING(S) This article focuses on case management of older adults transitioning from hospital to home. FINDINGS/CONCLUSIONS There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.
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20
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Curcio N, Philpot L, Bennett M, Felius J, Powers MB, Edgerton J, Warren AM. Anxiety, depression, and healthcare utilization 1 year after cardiac surgery. Am J Surg 2018; 218:335-341. [PMID: 30573157 DOI: 10.1016/j.amjsurg.2018.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND While it is known that depression and anxiety influence cardiac surgery recovery, the mechanisms of such remain unclear. We examined the influence of anxiety and/or depression on health care utilization and quality of life (QOL) in the 12 months following cardiac surgery. METHODS (N = 306) patients at two North Texas hospitals were assessed pre-operatively, at 30 days, and one year post-operatively using the Hospital Anxiety and Depression Scale and Kansas City Cardiomyopathy Quality of Life measures. Patient healthcare utilization metrics included length of stay, outpatient visits, hospital stays, emergency department (ED) visits, and home healthcare. RESULTS At 12 months post-surgery, anxious patients sustained more outpatient visits (p = 0.0129) than those without anxiety. Depressed patients differed significantly from non-depressed patients with significantly lower QOL (p < 0.01), as well as more readmissions, ED visits, home healthcare use, and a longer length of stay (all p < 0.05). CONCLUSIONS Depressed patients utilized more expensive healthcare services and had lower QOL at 12 months follow up compared to non-depressed patients. Targeting depressed patients for intervention may foster a faster recovery and reduce excessive healthcare burden.
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Affiliation(s)
- Nicholas Curcio
- Baylor University Medical Center, Division of Trauma, Critical Care and Acute Care Surgery, Baylor Scott & White Health, USA.
| | - Lindsey Philpot
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA
| | - Monica Bennett
- Center for Clinical Effectiveness, Baylor Scott & White Health, USA
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, USA
| | - Mark B Powers
- Baylor University Medical Center, Division of Trauma, Critical Care and Acute Care Surgery, Baylor Scott & White Health, USA; University of Texas at Austin, USA
| | - James Edgerton
- Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano, Plano, TX, USA
| | - Ann Marie Warren
- Baylor University Medical Center, Division of Trauma, Critical Care and Acute Care Surgery, Baylor Scott & White Health, USA
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21
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Palmer RM. The Acute Care for Elders Unit Model of Care. Geriatrics (Basel) 2018; 3:E59. [PMID: 31011096 PMCID: PMC6319242 DOI: 10.3390/geriatrics3030059] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 11/16/2022] Open
Abstract
Older patients are at risk for loss of self-care abilities during the course of an acute medical illness that results in hospitalization. The Acute Care for Elders (ACE) Unit is a continuous quality improvement model of care designed to prevent the patient's loss of independence from admission to discharge in the performance of activities of daily living (hospital-associated disability). The ACE unit intervention includes principles of a prepared environment that encourages safe patient self-care, a set of clinical guidelines for bedside care by nurses and other health professionals to prevent patient disability and restore self-care lost by the acute illness, and planning for transitions of care and medical care. By applying a structured process, an interdisciplinary team completes a geriatric assessment, follows clinical guidelines, and initiates plans for care transitions in concert with the patient and family. Three randomized clinical trials and systematic reviews of ACE or related interventions demonstrate reduced functional disability among patients, reduced risk of nursing home admission, and lower costs of hospitalization. ACE principles could improve elderly care in any acute setting. The aim of this commentary is to describe the ACE model and the basis of its effectiveness.
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Affiliation(s)
- Robert M Palmer
- Internal Medicine, Eastern Virginia Medical School 825 Fairfax Avenue, Suite 201 Norfolk, VA 23507, USA.
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22
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Measurement of function in older adults transitioning from hospital to home: an integrative review. Geriatr Nurs 2017; 39:336-343. [PMID: 29249631 DOI: 10.1016/j.gerinurse.2017.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Abstract
Older adults often experience decline in functional status during the transition from hospital to home. In order to determine the effectiveness of interventions to prevent functional decline, researchers must have instruments that are reliable and valid for use with older adults. The purpose of this integrative review is to: (1) summarize the research uses and methods of administering functional status instruments when investigating older adults transitioning from hospital to home, (2) examine the development and existing psychometric testing of the instruments, and (3) discuss gaps and implications for future research. The authors conducted an integrative review of forty research studies that assessed functional status in older adults transitioning from hospital to home. This review reveals important gaps in the functional status instruments' psychometric testing, including limited testing to support their validity and reliability when administered by self-report and limited evidence supporting their ability to detect change over time.
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Pre-admission functional decline in hospitalized persons with dementia: The influence of family caregiver factors. Arch Gerontol Geriatr 2017; 74:49-54. [PMID: 28957688 DOI: 10.1016/j.archger.2017.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/03/2017] [Accepted: 09/15/2017] [Indexed: 01/16/2023]
Abstract
Older adults with dementia are more likely than those who do not have dementia to be hospitalized. Admission functional (ADL) performance is a salient factor predicting functional performance in older adults at discharge. The days preceding hospitalization are often associated with functional loss related to the acute illness. An understanding of functional changes during this transition will inform interventions to prevent functional decline. This secondary analysis examined data from a study that evaluated a family educational empowerment model and included 136 dyads (persons with dementia and their family caregiver). AMOS structural equation modeling examined the effects of family caregiver factors upon change in patient ADL performance (Barthel Index) from baseline (two week prior to hospitalization) to the time of admission, controlling for patient characteristics. Eighty-two percent of the patients had decline prior to admission. Baseline function, depression, and dementia severity, as well as Family caregiver strain, were significantly associated with change in pre-admission ADL performance and explained 40% of the variance. There was a good fit of the model to the data (Χ2=12.9, p=0.305, CFI=0.97, TLI=0.90, RMSEA=0.05). Findings suggest the need for a function-focused approach when admitting patients with dementia to the hospital. FCG strain prior to hospitalization may be a factor impacting trajectory of functional changes in older person with dementia, especially in those with advanced dementia. FCG strain is an important assessment parameter in the risk assessment for functional decline, to be considered when engaging the FCG in the plan for functional recovery.
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Snyder CR, Tennen H, Affleck G, Cheavens J. Social, Personality, Clinical, and Health Psychology Tributaries: The Merging of a Scholarly “River of Dreams”. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2016. [DOI: 10.1207/s15327957pspr0401_3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Results of a survey from the contents of six 1998 journals in social, clinical, personality, and health psychology allow one to conclude that interface research in these fields is grounded in theory, focuses more on understanding weaknesses than strengths, has personality variables playing major roles, and often involves correlation-based studies using related self-report variables. It is also suggested that promising future interface research would include the psychological predictors of medical outcomes, stress-related growth, enhancing psychotherapy outcomes, and the effects of social comparisons, as well as a methodological paradigm that involves the analyses of multilevel daily processes. The article closes with exhortations for enhancing the viability and potential impact of interface research.
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Affiliation(s)
- C. R. Snyder
- Department of Psychology, University of Kansas, Lawrence
| | | | - Glenn Affleck
- Department of Community Medicine, University of Connecticut Health Center
| | - Jen Cheavens
- Department of Psychology, University of Kansas, Lawrence
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Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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Thai JN, Barnhart CE, Cagle J, Smith AK. "It Just Consumes Your Life": Quality of Life for Informal Caregivers of Diverse Older Adults With Late-Life Disability. Am J Hosp Palliat Care 2016; 33:644-50. [PMID: 25948041 PMCID: PMC4636480 DOI: 10.1177/1049909115583044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Little is known about the quality of life (QoL) for informal caregivers of disabled older adults aged 65+ with diverse backgrounds. Forty-two caregivers were interviewed in English and Cantonese about their caregiving experiences, their recollections of QoL over time, and the factors influencing their appraisals. Overall, 52% of caregivers experienced a decline in QoL. Factors associated with decreased QoL were less time for self, competing financial demands, and the physical and emotional impact of the patient's illness. Factors associated with no change in QoL were minimal caregiving responsibilities, a sense of filial duty, and QoL being consistently poor over time. Factors associated with improved QoL were perceived rewards in caregiving, receiving institutional help, and increased experience. Chinese caregivers were more likely to cite filial duty as their motivator for continued caregiving than were Caucasian caregivers. In conclusion, informal caregivers take on a huge burden in enabling older adults to age in the community. These caregivers need more support in maintaining their QoL.
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Affiliation(s)
- Julie N Thai
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Caroline E Barnhart
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, CA, USA
| | - John Cagle
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, CA, USA
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Barbera L, Seow H, Sutradhar R, Chu A, Burge F, Fassbender K, McGrail K, Lawson B, Liu Y, Pataky R, Potapov A. Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data. Curr Oncol 2015; 22:341-55. [PMID: 26628867 PMCID: PMC4608400 DOI: 10.3747/co.22.2636] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The quality of data comparing care at the end of life (eol) in cancer patients across Canada is poor. This project used identical cohorts and definitions to evaluate quality indicators for eol care in British Columbia, Alberta, Ontario, and Nova Scotia. METHODS This retrospective cohort study of cancer decedents during fiscal years 2004-2009 used administrative health care data to examine health service quality indicators commonly used and previously identified as important to quality eol care: emergency department use, hospitalizations, intensive care unit admissions, chemotherapy, physician house calls, and home care visits near the eol, as well as death in hospital. Crude and standardized rates were calculated. In each province, two separate multivariable logistic regression models examined factors associated with receiving aggressive or supportive care. RESULTS Overall, among the identified 200,285 cancer patients who died of their disease, 54% died in a hospital, with British Columbia having the lowest standardized rate of such deaths (50.2%). Emergency department use at eol ranged from 30.7% in Nova Scotia to 47.9% in Ontario. Of all patients, 8.7% received aggressive care (similar across all provinces), and 46.3% received supportive care (range: 41.2% in Nova Scotia to 61.8% in British Columbia). Lower neighbourhood income was consistently associated with a decreased likelihood of supportive care receipt. INTERPRETATION We successfully used administrative health care data from four Canadian provinces to create identical cohorts with commonly defined indicators. This work is an important step toward maturing the field of eol care in Canada. Future work in this arena would be facilitated by national-level data-sharing arrangements.
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Affiliation(s)
- L. Barbera
- Odette Cancer Centre, Department of Radiation Oncology, Toronto, ON
- Department of Radiation Oncology, University of Toronto, Toronto, ON
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - H. Seow
- Institute for Clinical Evaluative Sciences, Toronto, ON
- Department of Oncology, McMaster University, Hamilton, ON
| | - R. Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - A. Chu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - F. Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - K. Fassbender
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, AB
| | - K. McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - B. Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Y. Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - R. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer Research Centre, Vancouver, BC
| | - A. Potapov
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, AB
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St John PD, Mackenzie C, Menec V. Does life satisfaction predict five-year mortality in community-living older adults? Aging Ment Health 2015; 19:363-70. [PMID: 25048721 DOI: 10.1080/13607863.2014.938602] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Depression and depressive symptoms predict death, but it is less clear if more general measures of life satisfaction (LS) predict death. Our objectives were to determine: (1) if LS predicts mortality over a five-year period in community-living older adults; and (2) which aspects of LS predict death. METHOD 1751 adults over the age of 65 who were living in the community were sampled from a representative population sampling frame in 1991/1992 and followed five years later. Age, gender, and education were self-reported. An index of multimorbidity and the Older American Resource Survey measured health and functional status, and the Terrible-Delightful Scale assessed overall LS as well as satisfaction with: health, finances, family, friends, housing, recreation, self-esteem, religion, and transportation. Cox proportional hazards models examined the influence of LS on time to death. RESULTS 417 participants died during the five-year study period. Overall LS and all aspects of LS except finances, religion, and self-esteem predicted death in unadjusted analyses. In fully adjusted analyses, LS with health, housing, and recreation predicted death. Other aspects of LS did not predict death after accounting for functional status and multimorbidity. CONCLUSION LS predicted death, but certain aspects of LS are more strongly associated with death. The effect of LS is complex and may be mediated or confounded by health and functional status. It is important to consider different domains of LS when considering the impact of this important emotional indicator on mortality among older adults.
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Affiliation(s)
- Philip D St John
- a Department of Medicine , University of Manitoba , Winnipeg , Canada
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Barbera L, Seow H, Sutradhar R, Chu A, Burge F, Fassbender K, McGrail K, Lawson B, Liu Y, Pataky R, Potapov A. Quality Indicators of End-of-Life Care in Patients With Cancer: What Rate Is Right? J Oncol Pract 2015; 11:e279-87. [PMID: 25922219 DOI: 10.1200/jop.2015.004416] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To develop data-driven and achievable benchmark rates for end-of-life quality indicators using administrative data from four provinces in Canada. METHODS Indicators of end-of-life care were defined and measured using linked administrative data for 33 health regions across British Columbia, Alberta, Ontario, and Nova Scotia. These were emergency department use, intensive care unit admission, physician house calls and home care visits before death, and death in hospital. An empiric benchmark was defined using indicator rates from the top-ranked regions to include the top decile of patients overall. Funnel plots were used to graph each region's age- and sex-adjusted indicator rates along with the overall rate and 95% confidence limits. RESULTS Rates varied approximately two- to four-fold across the regions, with physician house calls showing the greatest variation. Benchmark rates based on the top decile performers were emergency department use, 34%; intensive care unit admission, 2%; physician house calls, 34%; home care visits, 63%; and death in hospital, 38%. With the exception of intensive care unit admission, funnel plots demonstrated that overall indicator rates and their confidence limits were uniformly worse than benchmarks even after adjusting for age and sex. Few regions met the benchmark rates. CONCLUSION There is significant variation in end-of-life quality indicators across regions in four provinces in Canada. Using this study's methods-deriving empiric benchmarks and funnel plots-regions can determine their relative performance with greater context that facilitates priority setting and resource deployment. Applying this study's methods can support quality improvement by decreasing variation and striving for a target.
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Affiliation(s)
- Lisa Barbera
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Hsien Seow
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Rinku Sutradhar
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Anna Chu
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Fred Burge
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Konrad Fassbender
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Kim McGrail
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Beverley Lawson
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Ying Liu
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Reka Pataky
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Alex Potapov
- Odette Cancer Centre, University of Toronto; Institute for Clinical Evaluative Sciences, Toronto; McMaster University, Hamilton, Ontario; Dalhousie University, Halifax, Nova Scotia; University of Alberta, Edmonton, Alberta; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia; and Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
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Sourdet S, Lafont C, Rolland Y, Nourhashemi F, Andrieu S, Vellas B. Preventable Iatrogenic Disability in Elderly Patients During Hospitalization. J Am Med Dir Assoc 2015; 16:674-81. [PMID: 25922117 DOI: 10.1016/j.jamda.2015.03.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 03/10/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or "iatrogenic disability." METHODS A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline. RESULTS Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%-15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%-90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%). CONCLUSIONS The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care.
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Affiliation(s)
| | | | - Yves Rolland
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
| | - Fati Nourhashemi
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
| | - Sandrine Andrieu
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, Hôpital La Grave-Casselardit, Toulouse, France; Inserm Unit 1027, Toulouse, France; Department of Medicine, University of Toulouse III, Toulouse, France
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Ortuño N, Cobo J, González E, García I, Ferrer MD, Campos C, Planet N, Oliva JC, Suárez M, Iglesias-Lepine ML, García-Parés G. Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 9:210-218. [PMID: 25749624 DOI: 10.1016/j.rpsm.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/06/2014] [Accepted: 01/03/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. OBJECTIVE To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. METHOD All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. RESULTS A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). CONCLUSIONS In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population.
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Affiliation(s)
- Noèlia Ortuño
- Servei de Salut Mental, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Jesús Cobo
- Servei de Salut Mental, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España; Departament de Psiquiatría i Medicina Legal, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España.
| | - Espe González
- Servei d'Urgències, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Imma García
- Servei d'Urgències, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - María-Dolores Ferrer
- Servei d'Urgències, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Carmen Campos
- Servei d'Urgències, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Núria Planet
- Servei de Salut Mental, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Joan-Carles Oliva
- Unitat d'Estadística, Fundació Parc Taulí, Sabadell, Barcelona, España
| | - Mónica Suárez
- Hospital Monte Naranco, Hospital Universitario Central de Asturias , Oviedo, Asturias, España
| | | | - Gemma García-Parés
- Servei de Salut Mental, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España; Departament de Psiquiatría i Medicina Legal, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
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Boltz M, Resnick B, Chippendale T, Galvin J. Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults. J Am Geriatr Soc 2014; 62:2398-407. [PMID: 25481973 DOI: 10.1111/jgs.13139] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A comparative trial using a repeated-measures design was designed to evaluate the feasibility and outcomes of the Family-Centered Function-Focused-Care (Fam-FFC) intervention, which is intended to promote functional recovery in hospitalized older adults. A family-centered resource nurse and a facility champion implemented a three-component intervention (environmental assessment and modification, staff education, individual and family education and partnership in care planning with follow-up after hospitalization for an acute illness). Control units were exposed to function-focused-care education only. Ninety-seven dyads of medical patients aged 65 and older and family caregivers (FCGs) were recruited from three medical units of a community teaching hospital. Fifty-three percent of patients were female, 89% were white, 51% were married, and 40% were widowed, and they had a mean age of 80.8 ± 7.5. Seventy-eight percent of FCGs were married, 34% were daughters, 31% were female spouses or partners, and 38% were aged 46 to 65. Patient outcomes included functional outcomes (activities of daily living (ADLs), walking performance, gait, balance) and delirium severity and duration. FCG outcomes included preparedness for caregiving, anxiety, depression, role strain, and mutuality. The intervention group demonstrated less severity and shorter duration of delirium and better ADL and walking performance but not better gait and balance performance than the control group. FCGs who participated in Fam-FFC showed a significant increase in preparedness for caregiving and a decrease in anxiety and depression from admission to 2 months after discharge but no significant differences in strain or quality of the relationship with the care recipient from FCGs in the control group. Fam-FFC is feasible and has the potential to improve outcomes for hospitalized older adults and their caregivers.
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Affiliation(s)
- Marie Boltz
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
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Boockvar K. Impact of Depression and Mental Illness on Outcomes of Medical Illness in Older Adults. Clin Ther 2014; 36:1486-8. [DOI: 10.1016/j.clinthera.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Seow H, Brazil K, Sussman J, Pereira J, Marshall D, Austin PC, Husain A, Rangrej J, Barbera L. Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis. BMJ 2014; 348:g3496. [PMID: 24906901 PMCID: PMC4048125 DOI: 10.1136/bmj.g3496] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the pooled effect of exposure to one of 11 specialist palliative care teams providing services in patients' homes. DESIGN Pooled analysis of a retrospective cohort study. SETTING Ontario, Canada. PARTICIPANTS 3109 patients who received care from specialist palliative care teams in 2009-11 (exposed) matched by propensity score to 3109 patients who received usual care (unexposed). INTERVENTION The palliative care teams studied served different geographies and varied in team composition and size but had the same core team members and role: a core group of palliative care physicians, nurses, and family physicians who provide integrated palliative care to patients in their homes. The teams' role was to manage symptoms, provide education and care, coordinate services, and be available without interruption regardless of time or day. MAIN OUTCOME MEASURES Patients (a) being in hospital in the last two weeks of life; (b) having an emergency department visit in the last two weeks of life; or (c) dying in hospital. RESULTS In both exposed and unexposed groups, about 80% had cancer and 78% received end of life homecare services for the same average duration. Across all palliative care teams, 970 (31.2%) of the exposed group were in hospital and 896 (28.9%) had an emergency department visit in the last two weeks of life respectively, compared with 1219 (39.3%) and 1070 (34.5%) of the unexposed group (P<0.001). The pooled relative risks of being in hospital and having an emergency department visit in late life comparing exposed versus unexposed were 0.68 (95% confidence interval 0.61 to 0.76) and 0.77 (0.69 to 0.86) respectively. Fewer exposed than unexposed patients died in hospital (503 (16.2%) v 887 (28.6%), P<0.001), and the pooled relative risk of dying in hospital was 0.46 (0.40 to 0.52). CONCLUSIONS Community based specialist palliative care teams, despite variation in team composition and geographies, were effective at reducing acute care use and hospital deaths at the end of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario L8V 5C2, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, Ontario L8V 5C2, Canada
| | - José Pereira
- Division of Palliative Care, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Denise Marshall
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Peter C Austin
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jagadish Rangrej
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Lisa Barbera
- Department of Radiation Oncology, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Covinsky KE, Cenzer IS, Yaffe K, O’Brien S, Blazer DG. Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression. Am J Geriatr Psychiatry 2014; 22:606-13. [PMID: 23602308 PMCID: PMC3766414 DOI: 10.1016/j.jagp.2012.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 11/28/2012] [Accepted: 12/10/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Either dysphoria (sadness) or anhedonia (loss of interest in usually pleasurable activities) is required for a diagnosis of major depression. Although major depression is a known risk factor for disability in older persons, few studies have examined the relationship between the two core symptoms of major depression and disability or mortality. Our objective was to examine the relationship between these two core symptoms and time to disability or death. METHODS In a longitudinal cohort study, we used the nationally representative Health and Retirement Study to examine this relationship in 11,353 persons older than 62 years (mean: 73 years) followed for up to 13 years. Dysphoria and anhedonia were assessed with the Short Form Composite International Diagnostic Interview. Our outcome measure was time to either death or increased disability, defined as the new need for help in a basic activity of daily living. We adjusted for a validated disability risk index and other confounders. RESULTS Compared with subjects without either dysphoria or anhedonia, the risk for disability or death was not elevated in elders with dysphoria without anhedonia (adjusted hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.91-1.36). The risk was elevated in those with anhedonia without dysphoria (HR: 1.30; 95% CI: 1.06-1.60) and those with both anhedonia and dysphoria (HR: 1.28; 95% CI: 1.13-1.46). CONCLUSION Our results highlight the need for clinicians to learn whether patients have lost interest in usually pleasurable activities, even if they deny sadness.
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Osuna-Pozo CM, Ortiz-Alonso J, Vidán M, Ferreira G, Serra-Rexach JA. [Review of functional impairment associated with acute illness in the elderly]. Rev Esp Geriatr Gerontol 2014; 49:77-89. [PMID: 24529877 DOI: 10.1016/j.regg.2013.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 06/03/2023]
Abstract
Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.
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Affiliation(s)
| | - Javier Ortiz-Alonso
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Maite Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Guillermo Ferreira
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Albrecht JS, Gruber-Baldini AL, Hirshon JM, Brown CH, Goldberg R, Rosenberg JH, Comer AC, Furuno JP. Depressive symptoms and hospital readmission in older adults. J Am Geriatr Soc 2014; 62:495-9. [PMID: 24512099 DOI: 10.1111/jgs.12686] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To quantify the risk of 30-day unplanned hospital readmission in adults aged 65 and older with depressive symptoms. DESIGN Prospective cohort study. SETTING University of Maryland Medical Center. PARTICIPANTS Individuals aged 65 and older admitted between July 1, 2011, and August 9, 2012, to the general medical and surgical units and followed for 31 days after hospital discharge (N = 750). MEASUREMENTS Primary exposure was depressive symptoms at admission, defined as a score of 6 or more on the 15-item Geriatric Depression Scale. Primary outcome was unplanned 30-day hospital readmission, defined as an unscheduled overnight stay at any inpatient facility not occurring in the emergency department. RESULTS Prevalence of depressive symptoms was 19% and incidence of 30-day unplanned hospital readmission was 19%. Depressive symptoms were not significantly associated with hospital readmission (relative risk (RR) = 1.20, 95% confidence interval (CI) = 0.83-1.72). Age, Charlson Comorbidity Index score, and number of hospitalizations within the past 6 months were significant predictors of unplanned 30-day hospital readmission. CONCLUSION Although not associated with hospital readmission, depressive symptoms were associated with other poor outcomes and may be underdiagnosed in hospitalized older adults. Hospitals interested in reducing readmission should focus on older adults with more comorbid illness and recent hospitalizations.
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Affiliation(s)
- Jennifer S Albrecht
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Mayland; Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Mayland
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Blozik E, Scherer M, Lacruz ME, Ladwig KH. Diagnostic utility of a one-item question to screen for depressive disorders: results from the KORA F3 study. BMC FAMILY PRACTICE 2013; 14:198. [PMID: 24359193 PMCID: PMC3906912 DOI: 10.1186/1471-2296-14-198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
Background Screening for depressive disorders in the general adult population is recommended, however, it is unclear which instruments combine user friendliness and diagnostic utility. We evaluated the test performance of a yes/no single item screener for depressive disorders (“Have you felt depressed or sad much of the time in the past year?”) in comparison to the depressive disorder module of the Patient Health Questionnaire (PHQ-9). Methods Data from 3184 participants of the population-based KORA F3 survey in Augsburg/ Germany were used to analyse sensitivity, specificity, ROC area, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), and negative predictive value (NPV) of the single item screener in comparison with “depressive mood” and “major depressive disorder” defined according to PHQ-9 (both interviewer-administered versions). Results In comparison to PHQ-9 “depressive mood”, sensitivity was low (46%) with an excellent specificity (94%), (PPV 76%; NPV 82%; LR + 8.04; LR- .572, ROC area .702). When using the more conservative definition for “major depressive disorder”, sensitivity increased to 83% with a specificity of 88%. The PPV under the conservative definition was low (32%), but NPV was 99% (LR + 6.65; LR- .196; ROC area .852). Results varied across age groups and between males and females. Conclusions The single item screener is able to moderately decrease post-test probability of major depressive disorders and to identify populations that should undergo additional, more detailed evaluation for depression. It may have limited utility in combination with additional screening tests or for selection of at-risk populations, but cannot be recommended for routine use as a screening tool in clinical practice.
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Affiliation(s)
- Eva Blozik
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Hoppe S, Rainfray M, Fonck M, Hoppenreys L, Blanc JF, Ceccaldi J, Mertens C, Blanc-Bisson C, Imbert Y, Cany L, Vogt L, Dauba J, Houédé N, Bellera CA, Floquet A, Fabry MN, Ravaud A, Chakiba C, Mathoulin-Pélissier S, Soubeyran P. Functional Decline in Older Patients With Cancer Receiving First-Line Chemotherapy. J Clin Oncol 2013; 31:3877-82. [DOI: 10.1200/jco.2012.47.7430] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To determine factors associated with early functional decline during first-line chemotherapy in older patients. Patients and Methods Patients age ≥ 70 years receiving first-line chemotherapy for cancer were prospectively considered for inclusion across 12 centers in France. Functional decline was defined as a decrease of ≥ 0.5 points on the Activities of Daily Living (ADL) scale between the beginning of chemotherapy and the second cycle. Factors associated with functional decline were sought from pretreatment abbreviated comprehensive geriatric assessment, including ADL, Instrumental ADL (IADL), Mini-Nutritional Assessment (MNA), Mini–Mental State Examination (MMSE), Geriatric Depression Scale (GDS15), and Timed Get Up and Go (GUG) test, and from comorbidities (Cumulative Illness Rating Scale–Geriatrics), MAX2 index, and baseline biologic and clinical information. Results Of 364 included patients, 50 experienced functional decline (16.7%; median, 0.5 points). Abnormal preadmission performance status, IADL, GDS15, MMSE, GUG, and MNA were associated with increased likelihood of functional decline (univariate analysis). In the multivariate model adjusted for baseline ADL and MAX2 index, high baseline GDS (odds ratio [OR], 2.16; 95% CI, 1.09 to 4.30; P = .03) and low IADL scores (OR, 2.87; 95% CI, 1.06 to 7.79; P = .04) were independently associated with increased risk of functional decline. Conclusion Our results outline associations between baseline depression, instrumental dependencies, and early functional decline during chemotherapy for older patients. ADL should be sequentially evaluated early during treatment. Baseline evaluation of GDS15 and IADL may be proposed to anticipate this event.
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Affiliation(s)
- Stéphanie Hoppe
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Muriel Rainfray
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Marianne Fonck
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Laurent Hoppenreys
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Jean-Frédéric Blanc
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Joël Ceccaldi
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Cécile Mertens
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Christèle Blanc-Bisson
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Yves Imbert
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Laurent Cany
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Luc Vogt
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Jérôme Dauba
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Nadine Houédé
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Carine A. Bellera
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Anne Floquet
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Marie-Noëlle Fabry
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Alain Ravaud
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Camille Chakiba
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Simone Mathoulin-Pélissier
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
| | - Pierre Soubeyran
- Stéphanie Hoppe, Marianne Fonck, Laurent Hoppenreys, Cécile Mertens, Nadine Houédé, Carine A. Bellera, Anne Floquet, Marie-Noëlle Fabry, Camille Chakiba, Simone Mathoulin-Pélissier, and Pierre Soubeyran, Institut Bergonié; Muriel Rainfray, Jean-Frédéric Blanc, Cécile Mertens, and Alain Ravaud, Centre Hospitalier Universitaire; Muriel Rainfray, Christèle Blanc-Bisson, Alain Ravaud, Simone Mathoulin-Pélissier, and Pierre Soubeyran, University of Bordeaux, Bordeaux; Joël Ceccaldi, Centre Hospitalier,
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Conde Martel A, Hemmersbach-Miller M, Anía Lafuente BJ, Sujanani Afonso N, Serrano-Fuentes M. [Prevalence of depressive symptoms in hospitalized elderly medical patients]. Rev Esp Geriatr Gerontol 2013; 48:224-227. [PMID: 23473777 DOI: 10.1016/j.regg.2012.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 09/30/2012] [Accepted: 10/01/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Depressive symptoms in hospitalized patients are very common, and they have been related to higher mortality. The aim of the study was to estimate the prevalence of depressive symptoms in hospitalized elderly patients and its relationship to various diseases, as well as their functional and mental status and mortality. MATERIAL AND METHODS A total of 115 patients over 64 years of age were prospectively studied. The validated Spanish version of the Geriatric Depression Scale of Yesavage (15-item version) was used. Patients were considered to have depressive symptoms if ≥6 points were obtained. The demographic characteristics, the Charlson comorbidity index, the diagnosis at admission, the functional status assessed by the Barthel and Lawton-Brodie index, the mental capacity assessed by the Pfeiffer questionnaire, the length of the hospital stay, and hospital mortality were recorded. RESULTS Out of the 115 patients studied, with a mean age of 70.5 years, 71 (61.7%) were female. Depressive symptoms were observed in 46 patients (40%, 95% CI:34.8-43.9). Patients who died showed a significantly higher score on the Yesavage scale (P=.04). The multivariate analysis showed a significantly independent association between depressive symptoms and functional capacity (P=.026), mental status (P=.021), renal failure (P=.001), liver disease (P=.018), and osteoarthritis (P=.017), but losing the previously seen significant association with diabetes (P=.43). CONCLUSIONS The prevalence of depressive symptoms in hospitalized elderly patients is high, and is associated with the diagnoses of renal failure, liver disease and osteoarthritis, with a higher comorbidity and especially with a poorer functional capacity.
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Affiliation(s)
- Alicia Conde Martel
- Departamento de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España; Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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Seow H, Bainbridge D, Bryant D. Palliative care programs for patients with breast cancer: the benefits of home-based care. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
SUMMARY Improving breast cancer care means enhancing end-of-life care with specialized palliative care services. Palliative care embodies a holistic approach to care that focuses on symptom management of individuals with incurable diseases, whereas end-of-life care specifically focuses on a period of time, such as the last 6 months of life, where a rapid state of decline is often evident. The purpose of this article is to explore the benefits and limitations of end-of-life care provided in the hospital and community settings, with an emphasis on the benefits of home-based care. A key strength of home-based palliative care is the ability to expand the reach of palliative care to more cancer patients beyond residential hospice or hospital settings, which are limited in bed availability. The essential features of quality end-of-life services, regardless of setting, are care that offers seamless transitions, around-the-clock access to the same providers and an interdisciplinary, whole-person approach.
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Affiliation(s)
- Hsien Seow
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, 699 Concession St, 4th Floor, Room 4-229, Hamilton, ON L8V 5C2, Canada
| | - Deanna Bryant
- Department of Oncology, McMaster University, 699 Concession St, 4th Floor, Room 4-229, Hamilton, ON L8V 5C2, Canada
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Helvik AS, Selbæk G, Engedal K. Functional decline in older adults one year after hospitalization. Arch Gerontol Geriatr 2013; 57:305-10. [PMID: 23806790 DOI: 10.1016/j.archger.2013.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 11/29/2022]
Abstract
We studied the change in personal ability to perform the activities of daily living (P-ADL) one year after hospitalization (T2) of patients at least 65 years old at baseline (T1). The study included 363 (175 men) medical inpatients with age range 65-98 (mean 80.2, SD 7.5) years. Information was collected at baseline and at a 12 month follow-up using Lawton and Brody's physical self-maintenance scale (PSMS) (termed the P-ADL score), as the dependent variable, and the mini-mental state examination (MMSE), the hospital anxiety and depression scale (HAD) and the WHOQOL-BREF questionnaire as independent variables. For the total sample, the mean P-ADL was significantly worsened from T1 to T2 (mean change 0.5, SD 2.8; p<0.01). In a fully adjusted linear regression analysis, worsened P-ADL from T1 to T2 was independently associated with cognitive impairment at T1, increasing cognitive impairment from T1 to T2, the tendency to fall between T1 and T2, increase in depressive symptoms from T1 to T2, poor physical QOL at T1 and change toward a poorer QOL from T1 to T2. In conclusion, worse P-ADL at T2 was, independently of age and baseline P-ADL, associated with impaired cognitive function and QOL related to physical ability at baseline, as well as worsening depression, cognition and QOL from T1 to T2. Our findings highlight the importance of applying results from screening measures of cognitive function and emotional health when planning care for older people after hospitalization.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Huang HT, Chang CM, Liu LF, Lin HS, Chen CH. Trajectories and predictors of functional decline of hospitalised older patients. J Clin Nurs 2013; 22:1322-31. [PMID: 23279450 DOI: 10.1111/jocn.12055] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To delineate the trajectories of functional status over four time points and to examine predictors of functional decline (FD) in hospitalised older patients. BACKGROUND About 30-60% of the older patients develop new dependence in activities of daily living (ADL) during a hospital stay, which results in progressive disability after discharge. The functional trajectories and risk factors of FD among hospitalised older patients require identification. DESIGN A cohort study. METHODS The study consecutively recruited 273 patients aged 65 and older admitted to a medical centre in southern Taiwan. Functional trajectory, by ADL score, was observed at four time points: two weeks before admission, admission, discharge and three months after discharge. The ADL score two weeks before admission was used as a baseline functional status. RESULTS Eighty-three (30·4%) patients experienced FD at three months after discharge. Functional trajectory as shown by ADL scores indicated that all 273 patients dropped steeply at admission and that two-thirds were gradually restored three months after discharge. Logistic regression revealed that the number of falls in the past year, Instrument Activities of Daily Living (IADL) status before admission, comorbidity and ADL decline between preadmission and discharge were significant predictors of FD three months after discharge. The ADL score decline during hospitalisation was the mediator of FD three months after discharge. CONCLUSIONS Findings indicate that the ADL function of those hospitalised older patients who reported having fallen more often in the previous year had more comorbidity, had a lower IADL score, and had more ADL score decline before admission and discharge would continue to decline after discharge. RELEVANCE TO CLINICAL PRACTICE Clinical nurses can integrate the finding of this study with Comprehensive Geriatric Assessment to tailor intervention to restore older patient's physical function during hospitalisation.
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Affiliation(s)
- Hui-Tzu Huang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan
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Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease. J Gen Intern Med 2013; 28:74-81. [PMID: 22890622 PMCID: PMC3539035 DOI: 10.1007/s11606-012-2177-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 06/12/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Limited health literacy is associated with poor outcomes in many chronic diseases, but little is known about health literacy in chronic obstructive pulmonary disease (COPD). OBJECTIVE To examine the associations between health literacy and both outcomes and health status in COPD. PARTICIPANTS, DESIGN AND MAIN MEASURES: Structured interviews were administered to 277 subjects with self-report of physician-diagnosed COPD, recruited through US random-digit telephone dialing. Health literacy was measured with a validated three-item battery. Multivariable linear regression, controlling for sociodemographics including income and education, determined the cross-sectional associations between health literacy and COPD-related health status: COPD Severity Score, COPD Helplessness Index, and Airways Questionnaire-20R [measuring respiratory-specific health-related quality of life (HRQoL)]. Multivariable logistic regression estimated associations between health literacy and COPD-related hospitalizations and emergency department (ED) visits. KEY RESULTS Taking socioeconomic status into account, poorer health literacy (lowest tertile compared to highest tertile) was associated with: worse COPD severity (+2.3 points; 95 % CI 0.3-4.4); greater COPD helplessness (+3.7 points; 95 % CI 1.6-5.8); and worse respiratory-specific HRQoL (+3.5 points; 95 % CI 1.8-4.9). Poorer health literacy, also controlling for the same covariates, was associated with higher likelihood of COPD-related hospitalizations (OR = 6.6; 95 % CI 1.3-33) and COPD-related ED visits (OR = 4.7; 95 % CI 1.5-15). Analyses for trend across health literacy tertiles were statistically significant (p < 0.05) for all above outcomes. CONCLUSIONS Independent of socioeconomic status, poor health literacy is associated with greater COPD severity, greater COPD helplessness, worse respiratory-specific HRQoL, and higher odds of COPD-related emergency health-care utilization. These results underscore that COPD patients with poor health literacy may be at particular risk for poor health-related outcomes.
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Pierluissi E, Mehta KM, Kirby KA, Boscardin WJ, Fortinsky RH, Palmer RM, Landefeld CS. Depressive symptoms after hospitalization in older adults: function and mortality outcomes. J Am Geriatr Soc 2012. [PMID: 23176725 DOI: 10.1111/jgs.12008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine the relationship between depressive symptoms after hospitalization and survival and functional outcomes. DESIGN Secondary analysis of a prospective cohort study. SETTING General medical service of two urban, teaching hospitals in Ohio. PARTICIPANTS Hospitalized individuals aged 70 and older. MEASUREMENTS Ten depressive symptoms, instrumental activities of daily living (IADLs), and basic activities of daily living (ADLs) were measured at hospital discharge and 1, 3, 6, and 12 months later. Participant-specific changes in depressive symptoms (slopes) were determined using all data points. Four groups were also defined according to number of depressive symptoms (≤3 symptoms, low; 4-10 symptoms, high) at discharge and follow-up: low-low, low-high, high-low, and high-high. Mortality was measured 3, 6, and 12 months after hospital discharge. RESULTS Participant-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (P < .05) with functional and mortality outcomes. At 1 year, more participants in the low-low depressive symptom group (49%) were alive and independent in IADLs and ADLs than in the low-high group (37%, P = .02), and more participants in the high-low group (39%) were alive and independent in IADLs and ADLs than in the high-high group (19%, P < .001). CONCLUSION Number of depressive symptoms and change in number of depressive symptoms during the year after discharge were associated with functional and mortality outcomes in hospitalized older adults. Fewer participants with persistently high or increasing depressive symptoms after hospitalization were alive and functionally independent 1 year later than participants with decreasing or persistently low symptoms, respectively.
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Affiliation(s)
- Edgar Pierluissi
- Division of Geriatrics, University of California at San Francisco, San Francisco, California 94110, USA.
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Abstract
Major depression in older medical inpatients is frequent, persistent, and disabling (Cole and Bellavance, 1997). The incidence is 20.5%–30.2% during the 12 months following admission to hospital (Fenton et al., 1997; Cole et al., 2008). Up to 73% of patients have a protracted course (Koenig et al., 1992; Cole et al., 2006; Koenig, 2006). Moreover, major depression in older medical inpatients appears to be associated with decreased function (Covinsky et al., 1997), increased use of health care services (Koenig et al., 1989; Büla et al., 2001), increased caregiver burden (McCusker et al., 2007), and possibly increased mortality (Cole, 2007).
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Sandberg M, Kristensson J, Midlöv P, Fagerström C, Jakobsson U. Prevalence and predictors of healthcare utilization among older people (60+): Focusing on ADL dependency and risk of depression. Arch Gerontol Geriatr 2012; 54:e349-63. [DOI: 10.1016/j.archger.2012.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/02/2012] [Accepted: 02/14/2012] [Indexed: 12/21/2022]
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Preyde M, Brassard K. Evidence-based risk factors for adverse health outcomes in older patients after discharge home and assessment tools: a systematic review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2011; 8:445-468. [PMID: 22035470 DOI: 10.1080/15433714.2011.542330] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The current health care system is discharging elderly patients "quicker" and "sicker" from acute care facilities. Consequently, hospital readmission is common; however, readmission may be only one aspect of adverse outcomes of importance to social work discharge planners. The early recognition of risk factors might ensure a successful transition from the hospital to the home. A systematic review was conducted to identify factors associated with adverse outcomes in older patients discharged from hospital to home. Using a content analysis, factors were characterized in five domains: demographic factors, patient characteristics, medical and biological factors, social factors, and discharge factors. The most frequently reported risks were depression, poor cognition, comorbidities, length of hospital stay, prior hospital admission, functional status, patient age, multiple medications, and lack of social support. A systematic search identified four discharge assessment tools for use with the general population of elderly patients. Practice and research implications are offered.
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Affiliation(s)
- Michèle Preyde
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
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