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Pinel A, Guillet C, Capel F, Pouget M, De Antonio M, Pereira B, Topinkova E, Eglseer D, Barazzoni R, Cruz-Jentoft AJ, Schoufour JD, Weijs PJM, Boirie Y. Identification of factors associated with sarcopenic obesity development: Literature review and expert panel voting. Clin Nutr 2024; 43:1414-1424. [PMID: 38701709 DOI: 10.1016/j.clnu.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/09/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024]
Abstract
Sarcopenic obesity (SO) is defined as the combination of excess fat mass (obesity) and low skeletal muscle mass and function (sarcopenia). The identification and classification of factors related to SO would favor better prevention and diagnosis. The present article aimed to (i) define a list of factors related with SO based on literature analysis, (ii) identify clinical conditions linked with SO development from literature search and (iii) evaluate their relevance and the potential research gaps by consulting an expert panel. From 4746 articles screened, 240 articles were selected for extraction of the factors associated with SO. Factors were classified according to their frequency in the literature. Clinical conditions were also recorded. Then, they were evaluated by a panel of expert for evaluation of their relevance in SO development. Experts also suggested additional factors. Thirty-nine unique factors were extracted from the papers and additional eleven factors suggested by a panel of experts in the SO field. The frequency in the literature showed insulin resistance, dyslipidemia, lack of exercise training, inflammation and hypertension as the most frequent factors associated with SO whereas experts ranked low spontaneous physical activity, protein and energy intakes, low exercise training and aging as the most important. Although literature and expert panel presented some differences, this first list of associated factors could help to identify patients at risk of SO. Further work is needed to confirm the contribution of factors associated with SO among the population overtime or in randomized controlled trials to demonstrate causality.
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Affiliation(s)
- A Pinel
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France.
| | - C Guillet
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France.
| | - F Capel
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France
| | - M Pouget
- CHU Clermont-Ferrand, Clinical Nutrition Department, Clermont-Ferrand, France.
| | - M De Antonio
- CHU Clermont-Ferrand, Biostatistics Unit, Clermont-Ferrand, France.
| | - B Pereira
- CHU Clermont-Ferrand, Biostatistics Unit, Clermont-Ferrand, France.
| | - E Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - D Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria.
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | | | - J D Schoufour
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - P J M Weijs
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Amsterdam Public Health Institute, VU University, Department of Nutrition and Dietetics, Amsterdam, the Netherlands.
| | - Y Boirie
- University of Clermont Auvergne, Human Nutrition Unit, INRAe, CRNH Auvergne, Clermont-Ferrand, France; CHU Clermont-Ferrand, Clinical Nutrition Department, Clermont-Ferrand, France.
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2
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Ploegmakers KJ, Linn AJ, Medlock S, Seppälä LJ, Bahat G, Caballero-Mora MA, Ilhan B, Landi F, Masud T, Morrissey Y, Ryg J, Topinkova E, van der Velde N, van Weert JCM. A European survey of older peoples' preferences, and perceived barriers and facilitators to inform development of a medication-related fall-prevention patient portal. Eur Geriatr Med 2024:10.1007/s41999-024-00951-w. [PMID: 38587614 DOI: 10.1007/s41999-024-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/23/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Falls are a major and growing health care problem in older adults. A patient portal has the potential to provide older adults with fall-prevention advice to reduce fall-risk. However, to date, the needs and preferences regarding a patient portal in older people who have experienced falls have not been explored. This study assesses content preferences, potential barriers and facilitators with regard to using a patient portal, as perceived by older people who have experienced falls, and explores regional differences between European participants. METHODS We conducted a survey of older adults attending an outpatient clinic due to a fall or fall-related injury, to explore their content preferences, perceived barriers, and facilitators with respect to a fall-prevention patient portal. Older adults (N = 121, 69.4% female, mean age: 77.9) were recruited from seven European countries. RESULTS Almost two-thirds of respondents indicated they would use a fall-prevention patient portal. The portal would preferably include information on Fall-Risk-Increasing Drugs (FRIDs), and ways to manage other related/relevant medical conditions. Facilitators included a user-friendly portal, with easily accessible information and physician recommendations to use the portal. The most-commonly-selected barriers were privacy issues and usage fees. A family member's recommendation to use the portal was seemingly more important for Southern and Eastern European participants compared to the other regions. CONCLUSION The majority of older people with lived falls experience expressed an interest in a fall-prevention patient portal providing personalized treatment advice to prevent further falls. The results will be used to inform the development of a fall-prevention patient portal. The fall-prevention patient portal is intended to be used in addition to a consultation with a physician. Future research is needed to explore how to prevent falls in older patients who are not interested in a fall-prevention patient portal.
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Affiliation(s)
- Kim J Ploegmakers
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - A J Linn
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - S Medlock
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - L J Seppälä
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - G Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M A Caballero-Mora
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - B Ilhan
- Division of Geriatrics, Department of Internal Medicine, Liv Hospital Vadistanbul, Istanbul, Turkey
| | - F Landi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - T Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Y Morrissey
- Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - J Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - E Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | - N van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - J C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
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3
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Benz E, Pinel A, Guillet C, Capel F, Pereira B, De Antonio M, Pouget M, Cruz-Jentoft AJ, Eglseer D, Topinkova E, Barazzoni R, Rivadeneira F, Ikram MA, Steur M, Voortman T, Schoufour JD, Weijs PJM, Boirie Y. Sarcopenia and Sarcopenic Obesity and Mortality Among Older People. JAMA Netw Open 2024; 7:e243604. [PMID: 38526491 DOI: 10.1001/jamanetworkopen.2024.3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Importance Sarcopenia and obesity are 2 global concerns associated with adverse health outcomes in older people. Evidence on the population-based prevalence of the combination of sarcopenia with obesity (sarcopenic obesity [SO]) and its association with mortality are still limited. Objective To investigate the prevalence of sarcopenia and SO and their association with all-cause mortality. Design, Setting, and Participants This large-scale, population-based cohort study assessed participants from the Rotterdam Study from March 1, 2009, to June 1, 2014. Associations of sarcopenia and SO with all-cause mortality were studied using Kaplan-Meier curves, Cox proportional hazards regression, and accelerated failure time models fitted for sex, age, and body mass index (BMI). Data analysis was performed from January 1 to April 1, 2023. Exposures The prevalence of sarcopenia and SO, measured based on handgrip strength and body composition (BC) (dual-energy x-ray absorptiometry) as recommended by current consensus criteria, with probable sarcopenia defined as having low handgrip strength and confirmed sarcopenia and SO defined as altered BC (high fat percentage and/or low appendicular skeletal muscle index) in addition to low handgrip strength. Main Outcome and Measure The primary outcome was all-cause mortality, collected using linked mortality data from general practitioners and the central municipal records, until October 2022. Results In the total population of 5888 participants (mean [SD] age, 69.5 [9.1] years; mean [SD] BMI, 27.5 [4.3]; 3343 [56.8%] female), 653 (11.1%; 95% CI, 10.3%-11.9%) had probable sarcopenia and 127 (2.2%; 95% CI, 1.8%-2.6%) had confirmed sarcopenia. Sarcopenic obesity with 1 altered component of BC was present in 295 participants (5.0%; 95% CI, 4.4%-5.6%) and with 2 altered components in 44 participants (0.8%; 95% CI, 0.6%-1.0%). An increased risk of all-cause mortality was observed in participants with probable sarcopenia (hazard ratio [HR], 1.29; 95% CI, 1.14-1.47) and confirmed sarcopenia (HR, 1.93; 95% CI, 1.53-2.43). Participants with SO plus 1 altered component of BC (HR, 1.94; 95% CI, 1.60-2.33]) or 2 altered components of BC (HR, 2.84; 95% CI, 1.97-4.11) had a higher risk of mortality than those without SO. Similar results for SO were obtained for participants with a BMI of 27 or greater. Conclusions and Relevance In this study, sarcopenia and SO were found to be prevalent phenotypes in older people and were associated with all-cause mortality. Additional alterations of BC amplified this risk independently of age, sex, and BMI. The use of low muscle strength as a first step of both diagnoses may allow for early identification of individuals at risk for premature mortality.
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Affiliation(s)
- Elizabeth Benz
- Human Nutrition Unit, Clermont Auvergne University, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine, Clermont-Ferrand, France
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alexandre Pinel
- Human Nutrition Unit, Clermont Auvergne University, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine, Clermont-Ferrand, France
| | - Christelle Guillet
- Human Nutrition Unit, Clermont Auvergne University, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine, Clermont-Ferrand, France
| | - Frederic Capel
- Human Nutrition Unit, Clermont Auvergne University, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine, Clermont-Ferrand, France
| | - Bruno Pereira
- Unit of Biostatistics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marie De Antonio
- Unit of Biostatistics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Melanie Pouget
- Department of Clinical Nutrition, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marinka Steur
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Josje D Schoufour
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Peter J M Weijs
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Yves Boirie
- Human Nutrition Unit, Clermont Auvergne University, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine, Clermont-Ferrand, France
- Department of Clinical Nutrition, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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4
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Beaudart C, Tilquin N, Abramowicz P, Baptista F, Peng DJ, de Souza Orlandi F, Drey M, Dzhus M, Fábrega-Cuadros R, Fernandez-Garrido J, Laurindo LF, Gasparik AI, Geerinck A, Emin G, Iacob S, Kilaitė J, Kumar P, Lee SC, Lou VWQ, Mahmoodi M, Matijevic R, Matveeva MV, Merle B, Montero-Errasquín B, Bhattoa HP, Safonova Y, Şimşek H, Topinkova E, Tsekoura M, Erdoğan T, Yoo JI, Yu R, Hiligsmann M, Reginster JY, Bruyère O. Quality of life in sarcopenia measured with the SarQoL questionnaire: A meta-analysis of individual patient data. Maturitas 2024; 180:107902. [PMID: 38142467 DOI: 10.1016/j.maturitas.2023.107902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
Age-related sarcopenia, resulting from a gradual loss in skeletal muscle mass and strength, is pivotal to the increased prevalence of functional limitation among the older adult community. The purpose of this meta-analysis of individual patient data is to investigate the difference in health-related quality of life between sarcopenic individuals and those without the condition using the Sarcopenia Quality of Life (SarQoL) questionnaire. A protocol was published on PROSPERO. Multiple databases and the grey literature were searched until March 2023 for studies reporting quality of life assessed with the SarQoL for patients with and without sarcopenia. Two researchers conducted the systematic review independently. A two-stage meta-analysis was performed. First, crude (mean difference) and adjusted (beta coefficient) effect sizes were calculated within each database; then, a random effect meta-analysis was applied to pool them. Heterogeneity was measured using the Q-test and I2 value. Subgroup analyses were performed to investigate the source of potential heterogeneity. The strength of evidence of this association was assessed using GRADE. From the 413 studies identified, 32 were eventually included, of which 10 were unpublished data studies. Sarcopenic participants displayed significantly reduced health-related quality of life compared with non-sarcopenic individuals (mean difference = -12.32; 95 % CI = [-15.27; -9.37]). The model revealed significant heterogeneity. Subgroup analyses revealed a substantial impact of regions, clinical settings, and diagnostic criteria on the difference in health-related quality of life between sarcopenic and non-sarcopenic individuals. The level of evidence was moderate. This meta-analysis of individual patient data suggested that sarcopenia is associated with lower health-related quality of life measured with SarQoL.
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Affiliation(s)
- Charlotte Beaudart
- Departement of Biomedical Sciences, Namur Research Institute for Life Sciences (NARILIS), Faculty of Medicine, University of Namur, Namur, Belgium; WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands.
| | - Noémie Tilquin
- Department of Biomedical Sciences, Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Pawel Abramowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Fátima Baptista
- Department of Sports and Health, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Dao Juan Peng
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Dalian Road, Huichuan District, Zunyi, Guizhou, China
| | | | - Michael Drey
- Department of Medicine IV, LMU University Hospital, LMU Munich, Germany
| | - Marta Dzhus
- Bogomolets National Medical University, Department of Internal Medicine, Kyiv, Ukraine
| | | | | | - Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, São Paulo, Brazil; Department of Biochemistry and Pharmacology, School of Medicine, Faculdade de Medicina de Marília (FAMEMA), Marília 17519-030, São Paulo, Brazil
| | - Andrea-Ildiko Gasparik
- Department of Public Health and Health Management, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania
| | - Anton Geerinck
- Departement of Biomedical Sciences, Namur Research Institute for Life Sciences (NARILIS), Faculty of Medicine, University of Namur, Namur, Belgium
| | - Gyulnaz Emin
- Yeni Yüzyıl University Gaziosmanpaşa Hospital, Physical Medicine and Rehabilitation Department, Istanbul, Turkey
| | - Speranta Iacob
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Fundeni Clinical Institute, Bucharest, Romania
| | - Justina Kilaitė
- Clinic of Internal Diseases, Family Medicine and Oncology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Prabal Kumar
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104, India
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taiwan
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Marzieh Mahmoodi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Radmila Matijevic
- University of Novi Sad, Faculty of Medicine in Novi Sad, Serbia, Orthopaedic and Trauma Clinic, Novi Sad, Serbia
| | - Mariia V Matveeva
- Siberian State Medical University, Department of Pediatrics with Course of Enoccrinology, Department of Outpatient Therapy, Tomsk, Russian Federation
| | - Blandine Merle
- INSERM UMR 1033-Université de Lyon, 5 Place d'Arsonval, 69437 Lyon, France
| | | | - Harjit Pal Bhattoa
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Yuliya Safonova
- Department of Geriatrics, North Western State Medical University, named after I.I. Mechnikov, Russian Federation
| | - Hilal Şimşek
- Hilal Simsek: Department of Nutrition and Dietetics, Graduate School of Health Sciences, Ankara University, Ankara, Turkey
| | - Eva Topinkova
- Department of Geriatric Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Tsekoura
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Rio, Greece
| | - Tuğba Erdoğan
- Internal Medicine and Geriatrics Clinic, Tekirdağ Dr. Ismail Fehmi Cumalıoğlu City Hospital, Tekirdağ, Turkey
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, 27, Inhang-Ro, Jun-Gu, Incheon 22332, Republic of Korea
| | - Ruby Yu
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Mickael Hiligsmann
- Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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5
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Korkatti-Puoskari N, Tiihonen M, Caballero-Mora MA, Topinkova E, Szczerbińska K, Hartikainen S. Therapeutic dilemma's: antipsychotics use for neuropsychiatric symptoms of dementia, delirium and insomnia and risk of falling in older adults, a clinical review. Eur Geriatr Med 2023; 14:709-720. [PMID: 37495836 PMCID: PMC10447285 DOI: 10.1007/s41999-023-00837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Because of the common and increasing use of antipsychotics in older adults, we aim to summarize the current knowledge on the causes of antipsychotic-related risk of falls in older adults. We also aim to provide information on the use of antipsychotics in dementia, delirium and insomnia, their adverse effects and an overview of the pharmacokinetic and pharmacodynamic mechanisms associated with antipsychotic use and falls. Finally, we aim to provide information to clinicians for weighing the benefits and harms of (de)prescribing. METHODS A literature search was executed in CINAHL, PubMed and Scopus in March 2022 to identify studies focusing on fall-related adverse effects of the antipsychotic use in older adults. We focused on the antipsychotic use for neuropsychiatric symptoms of dementia, insomnia, and delirium. RESULTS Antipsychotics increase the risk of falls through anticholinergic, orthostatic and extrapyramidal effects, sedation, and adverse effects on cardio- and cerebrovascular system. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antipsychotics without current indication. CONCLUSIONS Deprescribing of antipsychotics should be considered and encouraged in older people at risk of falling, especially when prescribed for neuropsychiatric symptoms of dementia, delirium or insomnia. If antipsychotics are still needed, we recommend that the benefits and harms of antipsychotic use should be reassessed within two to four weeks of prescription. If the use of antipsychotic causes more harm than benefit, the deprescribing process should be started.
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Affiliation(s)
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | | | - Eva Topinkova
- Geriatric Department, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague and Faculty of Health and Social Sciences, South Bohemian University, Ceske Budejovice, Czech Republic
| | - Katarzyna Szczerbińska
- Medical Faculty, Epidemiology and Preventive Medicine Chair, Laboratory for Research on Ageing Society, Jagiellonian University Medical College, Kraków, Poland
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6
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Kraaijkamp JJM, Persoon A, Aurelian S, Bachmann S, Cameron ID, Choukou MA, Dockery F, Eruslanova K, Gordon AL, Grund S, Kim H, Maier AB, Pérez Bazan LM, Pompeu JE, Topinkova E, Vassallo MA, Chavannes NH, Achterberg WP, Van Dam van Isselt EF. eHealth in Geriatric Rehabilitation: An International Survey of the Experiences and Needs of Healthcare Professionals. J Clin Med 2023; 12:4504. [PMID: 37445545 DOI: 10.3390/jcm12134504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
While eHealth can help improve outcomes for older patients receiving geriatric rehabilitation, the implementation and integration of eHealth is often complex and time-consuming. To use eHealth effectively in geriatric rehabilitation, it is essential to understand the experiences and needs of healthcare professionals. In this international multicentre cross-sectional study, we used a web-based survey to explore the use, benefits, feasibility and usability of eHealth in geriatric rehabilitation settings, together with the needs of working healthcare professionals. Descriptive statistics were used to summarize quantitative findings. The survey was completed by 513 healthcare professionals from 16 countries. Over half had experience with eHealth, although very few (52 of 263 = 20%) integrated eHealth into daily practice. Important barriers to the use or implementation of eHealth included insufficient resources, lack of an organization-wide implementation strategy and lack of knowledge. Professionals felt that eHealth is more complex for patients than for themselves, and also expressed a need for reliable information concerning available eHealth interventions and their applications. While eHealth has clear benefits, important barriers hinder successful implementation and integration into healthcare. Tailored implementation strategies and reliable information on effective eHealth applications are needed to overcome these barriers.
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Affiliation(s)
- Jules J M Kraaijkamp
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- ZZG Zorggroep, 6561 LE Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, 6525 GA Nijmegen, The Netherlands
| | - Sorina Aurelian
- Department of Geriatric, University of Medicine and Pharmacy "Carol Davila"-Chronic Disease Hospital "Sf. Luca", 041915 Bucharest, Romania
| | - Stefan Bachmann
- Department of Internistic and Musculoskeletal Rehabilitation, Kliniken Valens, 7317 Valens, Switzerland
- Department of Geriatrics, Faculty of Medicine, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
| | - Mohamed-Amine Choukou
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T6, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Frances Dockery
- Beaumont Hospital & Royal College of Surgeons in Ireland, D09 V2NO Dublin, Ireland
| | - Kseniia Eruslanova
- Russian Clinical and Research Center of Gerontology, 129226 Moscow, Russia
| | - Adam L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69117 Heidelberg, Germany
| | - Hyub Kim
- Department of Occupational Therapy, Far East University, 76-32, Daehak-gil, Gamgok-myeon, Eumseong 27601, Republic of Korea
| | - Andrea B Maier
- Healthy Longevity Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 117456, Singapore
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands
| | - Laura M Pérez Bazan
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), 08023 Barcelona, Spain
| | - José E Pompeu
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo 05360-160, Brazil
| | - Eva Topinkova
- Department of Geriatric Medicine, First Faculty of Medicine and General Faculty Hospital, 120 00 Prague, Czech Republic
- Faculty of Health and Social Sciences, South Bohemian University, 370 11 České Budějovice, Czech Republic
| | - Mark A Vassallo
- Geriatric Medicine Society of Malta, Karin Grech Hospital, PTA 1312 Pieta, Malta
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Wilco P Achterberg
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eléonore F Van Dam van Isselt
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Custodero C, Veronese N, Topinkova E, Michalkova H, Polidori MC, Cella A, Cruz-Jentoft AJ, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Zieschang T, Padovani A, Sanchez-Garcia E, Pilotto A. The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study. Drugs Aging 2023:10.1007/s40266-023-01036-2. [PMID: 37310575 DOI: 10.1007/s40266-023-01036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. OBJECTIVE The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. METHODS This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. RESULTS Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. CONCLUSIONS MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.
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Affiliation(s)
- Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127, Palermo, Italy.
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | | | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central/Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Tania Zieschang
- Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
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Pilotto A, Custodero C, Palmer K, Sanchez-Garcia EM, Topinkova E, Polidori MC. A multidimensional approach to older patients during COVID-19 pandemic: a position paper of the Special Interest Group on Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS). Eur Geriatr Med 2023; 14:33-41. [PMID: 36656486 PMCID: PMC9851592 DOI: 10.1007/s41999-022-00740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The COVID-19 pandemic has been a dramatic trigger that has challenged the intrinsic capacity of older adults and of society. Due to the consequences for the older population worldwide, the Special Interest Group on Comprehensive Geriatric Assessment (CGA) of the European Geriatric Medicine Society (EuGMS) took the initiative of collecting evidence on the usefulness of the CGA-based multidimensional approach to older people during the COVID-19 pandemic. METHODS A narrative review of the most relevant articles published between January 2020 and November 2022 that focused on the multidimensional assessment of older adults during the COVID-19 pandemic. RESULTS Current evidence supports the critical role of the multidimensional approach to identify older adults hospitalized with COVID-19 at higher risk of longer hospitalization, functional decline, and short-term mortality. This approach appears to also be pivotal for the adequate stratification and management of the post-COVID condition as well as for the adoption of preventive measures (e.g., vaccinations, healthy lifestyle) among non-infected individuals. CONCLUSION Collecting information on multiple health domains (e.g., functional, cognitive, nutritional, social status, mobility, comorbidities, and polypharmacy) provides a better understanding of the intrinsic capacities and resilience of older adults affected by SARS-CoV-2 infection. The EuGMS SIG on CGA endorses the adoption of the multidimensional approach to guide the clinical management of older adults during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Katie Palmer
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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Veronese N, Fazzari A, Caudal M, Polidori MC, Topinkova E, Mattace Raso F, Barbagelata M, Barbagallo M, Pilotto A. The role of comprehensive geriatric assessment in older patients affected by knee osteoarthritis: a systematic review. Geriatr Care 2022. [DOI: 10.4081/gc.2022.11049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Osteoarthritis (OA) is one of the most common musculoskeletal diseases and highly prevalent in older people. Whilst the management of knee OA is usually multidisciplinary, the use of comprehensive geriatric assessment (CGA) for this condition is still limited. Given this background, with this systematic review, we summarized the current literature regarding the importance of CGA in people affected by knee OA. A systematic search across several databases was run until 10th April 2022 and updated on 21st November 2022 for any study investigating the use of CGA in patients with knee OA. The data were summarized descriptively. Among 295 articles initially included, three studies made in the context of the osteoarthritis initiative (OAI) were included. All the three studies used the OAI multidimensional prognostic index (MPI), a composite score derived from the CGA. Higher MPI values were associated with a higher risk of falls, cardiovascular conditions, and fractures across a follow-up period of 8 years and after adjusting for potential confounders. In conclusion, in this systematic review we summarized the current evidence of CGA in knee OA, finding that the MPI, a CGA derived tool, could be useful to early find people at higher risk of conditions that are associated with knee OA and therefore that can be the target of personalized interventions for preventing these conditions.
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Pilotto A, Veronese N, Polidori MC, Strandberg T, Topinkova E, Cruz-Jentoft AJ, Custodero C, Maggi S. The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation: a multicenter, observational, prospective European study (EUROSAF). Ann Med 2022; 54:2411-2419. [PMID: 36062815 PMCID: PMC9448408 DOI: 10.1080/07853890.2022.2117407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Literature suggests that different risks of mortality could influence physicians in prescribing or not anticoagulants in older patients with atrial fibrillation (AF). The Multidimensional Prognostic Index (MPI) can be considered a tool for the detection of multidimensional frailty. The aim of this cross-sectional study was to evaluate whether prescription patterns of oral anticoagulants exist, based on MPI values. METHODS Older hospitalised patients (age ≥ 65 years) with non-valvular AF were included across 24 European centres. MPI was calculated using validated and standardised tools derived from a comprehensive geriatric assessment. Other functional and clinical information were collected to calculate indexes specific for haemorrhagic and thromboembolic risk in AF. RESULTS Altogether, 2,012 participants affected by AF (mean age was 83.2 ± 7.5, range: 65-104 years), with a higher presence of women (57.0%), were included. Overall, 440 took vitamin K antagonists VKAs (22.0%), 667 (33.4%) direct oral anticoagulants (DOACs), whilst 44.6% did not take any anticoagulant treatment. Prescription of anticoagulants was associated with MPI values, with people taking anticoagulants having lower mean MPI values. Anticoagulant therapy was not used in 53.1% of the group with the highest risk of mortality, compared with 32.3% of those in the group with the lowest mortality risk. People with higher scores in MPI were less frequently treated with anticoagulant therapy, after adjusting for several potential confounders. CONCLUSIONS The EURopean study of Older Subjects with Atrial Fibrillation (EUROSAF) suggested that almost half of the older persons with AF do not receive anticoagulants and that MPI is an important determinant in prescribing or not anticoagulants. Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02973984KEY POINTSAtrial fibrillation is a common condition in older people. The data regarding the use of anticoagulants is mainly derived from randomised controlled trials that do not include a sufficient number of older frail people.Our study suggests that a consistent part of older people affected by atrial fibrillation was not treated with anticoagulants, in particular, older frail patients; however, it is unclear if this choice is supported or not by evidence.The prognostic evaluation through the multidimensional prognostic index could be useful information for the choice in the prescription of anticoagulants in older people affected by atrial fibrillation.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy.,Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eva Topinkova
- First Faculty of Medicine, Charles University in Prague, Czech Republic
| | | | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Section, Padova, Italy
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Pilotto A, Topinkova E, Michalkova H, Polidori MC, Cella A, Cruz-Jentoft A, von Arnim CAF, Azzini M, Gruner H, Castagna A, Cenderello G, Custureri R, Custodero C, Zieschang T, Padovani A, Sanchez-Garcia E, Veronese N. Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An observational, prospective, multicenter study. J Am Med Dir Assoc 2022; 23:1608.e1-1608.e8. [PMID: 35934019 PMCID: PMC9247233 DOI: 10.1016/j.jamda.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/13/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
Objective Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. Design Longitudinal, multicenter study. Settings and Participants 502 older people hospitalized for COVID-19 in 10 European hospitals. Methods MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). Results Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. Conclusions and Implications MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Helena Michalkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Margherita Azzini
- Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
| | - Heidi Gruner
- Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central / Universidade Nova de Lisboa Lisbon, Portugal
| | | | | | - Romina Custureri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Tania Zieschang
- Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Italy.
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12
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Veronese N, Custodero C, Demurtas J, Smith L, Barbagallo M, Maggi S, Cella A, Vanacore N, Aprile PL, Ferrucci L, Pilotto A, Alberto P, Maria Cristina P, Alves M, Benzinger P, Berg N, Brach J, Cardoso I, Cella A, Chefi B, Ciurea A, Cornejo Lingan Ana M, Cotobal Rodeles S, Cruz-Jentoft A, Curiale V, Custodero C, Danielova L, Davies F, De Groot A, De Groot C, De Lepeleire J, De Vries B, Decock AM, Denkinger M, Dikmeer A, Dini S, Durand A, Fatin A, Fernandes M, Ferrara N, Francis B, Fratiglioni L, Freiberger E, Galvin R, Garmendia B, Gillain S, Gomez Pavon J, Goudzwaard J, Greco A, Gruner H, Gunther B, Happe L, Hermush V, Huibregtse Bimmel JK, Indiano I, Isaak J, Jaramillo J, Kerminen H, Laocha Aoife N, Lau S, Lozano I, Madeira Sarmento Ana T, Mangoni A, Marques da Silva P, Mars P, Matejovska-Kubesova H, Mattace Raso F, Moeskops S, Molnar A, Musacchio C, Nagaratnam K, Nieminen U, O’Connor M, Özge Kayhan Koçak F, Paccalin M, Palikhe A, Pavic T, Per Nordnes R, Platon I, Polinder H, Prada G, Ragnheim R, Ramsawak L, Rewiuk K, Rodrigues C, Roller-Wirnsberger R, Rossinen J, Ruotolo G, Ruppe G, Ryan D, Sabba C, Sanchez E, Savas S, Schmid V, Schroderus K, Siegrist M, Smedberg D, Smit O, Soulis G, Tampaki M, Tenkattelaar N, Thiem U, Topinkova E, Tromp J, Van Beek M, Van Heijningen L, Vandeelen B, Vanderhulst H, Vankova H, Verissimo R, Vonk M, Vrabie C, Wearing P, Weiss M, Welmer AK, Werle B, Ylmaz O, Shoaib Muhammad Z, Zamfir M, Zanom I, Zuidhof J, Nicola V, Lee S, Alves M, Avcy S, Bahat-Ozturk G, Balci C, Beaudart C, Bruyère O, Cherubini A, Da Cruz Alves M, Firth J, Goisser S, Hursitoglu M, Hurst C, Kemmler W, Kiesswetter E, Kotsani M, Koyanagi A, Locquet M, Marengoni A, Nida M, Obretin Florian A, O’Hanlon S, Okpe A, Pedone C, Petrovic M, Pizzol D, Prokopidis K, Rempe H, Sanchez Rodrigues D, Schoene D, Schwingshackl L, Shenkin S, Solmi M, Soysal P, Stubbs B, Thompson T, Torbahn G, Unim B. Comprehensive geriatric assessment in older people: an umbrella review of health outcomes. Age Ageing 2022; 51:6581610. [PMID: 35524746 DOI: 10.1093/ageing/afac104] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. METHODS Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75-0.89), risk of falls (RR = 0.51; 95%CI: 0.29-0.89), and pressure sores (RR = 0.46; 95%CI: 0.24-0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54-0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64-0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. CONCLUSIONS CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, Università di Modena e Reggio Emilia, Modena, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Mario Barbagallo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, CNR, Padua, Italy
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institute of Health, MD, USA
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
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Ploegmakers KJ, Medlock S, Linn AJ, Lin Y, Seppälä LJ, Petrovic M, Topinkova E, Ryg J, Mora MAC, Landi F, Thaler H, Szczerbińska K, Hartikainen S, Bahat G, Ilhan B, Morrissey Y, Masud T, van der Velde N, van Weert JCM. Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people: a European survey. Eur Geriatr Med 2022; 13:395-405. [PMID: 35032323 DOI: 10.1007/s41999-021-00599-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. METHODS We examined and compared the relative importance and the occurrence of regional differences of a literature-based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. RESULTS We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. CONCLUSION When designing a CDSS for Geriatric Medicine, the patient's medical complexity must be addressed whilst maintaining the doctor's decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.
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Affiliation(s)
- Kim J Ploegmakers
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
| | - Stephanie Medlock
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Yumin Lin
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands.,Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Lotta J Seppälä
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics (Section of Geriatrics), Ghent University, Ghent, Belgium
| | - Eva Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, South Bohemian University, Ceske Budejovice, Czech Republic
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Francesco Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Heinrich Thaler
- Trauma Center Wien-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Şişli Hamidiye Etfal Training and Research Hospital, University of Medical Sciences, Istanbul, Turkey
| | - Yvonne Morrissey
- Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
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14
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Seppala LJ, Petrovic M, Ryg J, Bahat G, Topinkova E, Szczerbińska K, van der Cammen TJM, Hartikainen S, Ilhan B, Landi F, Morrissey Y, Mair A, Gutiérrez-Valencia M, Emmelot-Vonk MH, Mora MÁC, Denkinger M, Crome P, Jackson SHD, Correa-Pérez A, Knol W, Soulis G, Gudmundsson A, Ziere G, Wehling M, O’Mahony D, Cherubini A, van der Velde N. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs. Age Ageing 2021; 50:1189-1199. [PMID: 33349863 PMCID: PMC8244563 DOI: 10.1093/ageing/afaa249] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.
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Affiliation(s)
- Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics (section of Geriatrics), Ghent University, Ghent, Belgium
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark and Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gulistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, Istanbul, Turkey
| | - Eva Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic and Faculty of Health and Social Sciences, South Bohemian University, Česke Budějovice, Czech Republic
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Şişli Hamidiye Etfal Training and Research Hospital, University of Medical Sciences, Istanbul, Turkey
| | - Francesco Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Yvonne Morrissey
- Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | | | - Marielle H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - María Ángeles Caballero Mora
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real and CIBER de Fragilidad y Envejecimiento Saludable, Spain
| | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Centre Ulm, Ulm, Germany
| | - Peter Crome
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Adalsteinn Gudmundsson
- Landspitali University Hospital, Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gijsbertus Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands and Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Martin Wehling
- Institute for Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany
| | - Denis O’Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland and Department of Medicine, University College Cork, Cork, Ireland
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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15
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Billot M, Calvani R, Urtamo A, Sánchez-Sánchez JL, Ciccolari-Micaldi C, Chang M, Roller-Wirnsberger R, Wirnsberger G, Sinclair A, Vaquero-Pinto N, Jyväkorpi S, Öhman H, Strandberg T, Schols JMGA, Schols AMWJ, Smeets N, Topinkova E, Michalkova H, Bonfigli AR, Lattanzio F, Rodríguez-Mañas L, Coelho-Júnior H, Broccatelli M, D'Elia ME, Biscotti D, Marzetti E, Freiberger E. Preserving Mobility in Older Adults with Physical Frailty and Sarcopenia: Opportunities, Challenges, and Recommendations for Physical Activity Interventions. Clin Interv Aging 2020; 15:1675-1690. [PMID: 32982201 PMCID: PMC7508031 DOI: 10.2147/cia.s253535] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.
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Affiliation(s)
- Maxime Billot
- Clinical Gerontology, University Hospital of Limoges, Limoges, France.,PRISMATICS (Predictive Research in Spine/Neurostimulation Management and Thoracic Innovation in Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Riccardo Calvani
- Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Annele Urtamo
- University of Helsinki, Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
| | | | | | - Milan Chang
- Faculty of Health Promotion, Sports and Leisure Studies, School of Education, University of Iceland, Reykjavik, Iceland.,The Icelandic Gerontological Research Center, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | | | - Gerhard Wirnsberger
- Medical University of Graz, Division of Nephrology, Department of Internal Medicine, Graz, Austria
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd., Luton, UK
| | | | - Satu Jyväkorpi
- University of Helsinki, Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Hanna Öhman
- University of Helsinki, Department of General Practice and Primary Health Care, Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Timo Strandberg
- University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland.,University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nick Smeets
- Department of Health & Fitness, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Eva Topinkova
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Helena Michalkova
- Faculty of Social and Health Sciences, South Bohemian University, Ceske Budejovice, Czech Republic
| | | | | | | | | | | | - Maria Elena D'Elia
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Damiano Biscotti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Emanuele Marzetti
- Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nürnberg, Germany
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16
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Giovannini S, Onder G, van der Roest HG, Topinkova E, Gindin J, Cipriani MC, Denkinger MD, Bernabei R, Liperoti R. Use of antidepressant medications among older adults in European long-term care facilities: a cross-sectional analysis from the SHELTER study. BMC Geriatr 2020; 20:310. [PMID: 32854659 PMCID: PMC7457305 DOI: 10.1186/s12877-020-01730-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/23/2020] [Indexed: 11/12/2022] Open
Abstract
Background Late-life depression is common among older adults living in nursing homes (NHs). Over the last 30 years there has been an increase in the rates of prescription of antidepressant medications across all ages, with the largest rise reported in older adults. This study aimed to describe the pattern of antidepressant medication use among NH residents from 7 European countries and Israel and to examine patient and facilities characteristics that may account for it. Methods We conducted a cross-sectional analysis of data from the SHELTER study, an observational longitudinal cohort study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument in 7 European Countries and Israel. Descriptive statistics were used to examine sample characteristics. Potential correlates of antidepressant medication use were identified using multiple logistic regression modeling. Results Among 4023 residents entering the study, 32% had depressive symptoms and nearly half of these individuals used antidepressants. Antidepressant medication use varied by country, with a prevalence in the overall sample of 35.6% (n = 1431). Among antidepressant users, 59.9% were receiving selective serotonin reuptake inhibitors (SSRI). The strongest correlates of antidepressant use included reported diagnosis of anxiety, depression, bipolar disorder, pain, falls and high level of social engagement. Age over 85 years, living in facilities located in rural areas and a diagnosis of schizophrenia reduced the likelihood of being prescribed with an antidepressant. Conclusions A large proportion of residents in European long-term care facilities receive antidepressant medications. The decision to prescribe antidepressants to NH residents seems to be influenced by both patient and facility characteristics. Future longitudinal studies should evaluate the efficacy and safety of antidepressant use in NHs thus providing evidence for recommendations for clinical practice.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | | | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jacob Gindin
- The Centre for Standards in Health and Disability, Research Authority, University of Haifa, Haifa, Israel
| | - Maria Camilla Cipriani
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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17
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Pilotto A, Veronese N, Daragjati J, Cruz-Jentoft AJ, Polidori MC, Mattace-Raso F, Paccalin M, Topinkova E, Siri G, Greco A, Mangoni AA, Maggi S, Ferrucci L. Using the Multidimensional Prognostic Index to Predict Clinical Outcomes of Hospitalized Older Persons: A Prospective, Multicenter, International Study. J Gerontol A Biol Sci Med Sci 2020; 74:1643-1649. [PMID: 30329033 DOI: 10.1093/gerona/gly239] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. METHODS This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. RESULTS Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79-6.17; p < .001) and severe risk (OR = 10.72, 95% CI: 5.70-20.18, p < .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. CONCLUSIONS In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | - Nicola Veronese
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | | | | | | | - Francesco Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc Paccalin
- Geriatrics Department, Poitiers University Hospital, France.,Centre Investigation Clinique 1402, University of Poitiers, France
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Giacomo Siri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | - Antonio Greco
- Geriatrics Unit, IRCCS CSS, San Giovanni Rotondo, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide, Australia
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18
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Cruz-Jentoft AJ, Daragjati J, Fratiglioni L, Maggi S, Mangoni AA, Mattace-Raso F, Paccalin M, Polidori MC, Topinkova E, Ferrucci L, Pilotto A. Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project. Aging Clin Exp Res 2020; 32:861-868. [PMID: 32180170 DOI: 10.1007/s40520-020-01516-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients.
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19
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Rodriguez-Mañas L, Laosa O, Vellas B, Paolisso G, Topinkova E, Oliva-Moreno J, Bourdel-Marchasson I, Izquierdo M, Hood K, Zeyfang A, Gambassi G, Petrovic M, Hardman TC, Kelson MJ, Bautmans I, Abellan G, Barbieri M, Peña-Longobardo LM, Regueme SC, Calvani R, De Buyser S, Sinclair AJ. Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus. J Cachexia Sarcopenia Muscle 2019; 10:721-733. [PMID: 31016897 PMCID: PMC6711410 DOI: 10.1002/jcsm.12432] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged ≥70 years with type 2 diabetes mellitus. METHODS The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention. RESULTS After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. CONCLUSIONS We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus.
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Affiliation(s)
| | - Olga Laosa
- Foundation for Biomedical Research-Hospital Universitario de Getafe, Madrid, Spain
| | - Bruno Vellas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Eva Topinkova
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Mikel Izquierdo
- IdiSNA, Navarra Institute for Health Research, Public University of Navarra, Pamplona, Spain
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Mark J Kelson
- Department of Mathematics, University of Exeter, Exeter, UK
| | - Ivan Bautmans
- Gerontology Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gabor Abellan
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | | | | | | | | | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
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20
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Veronese N, Cella A, Cruz-Jentoft AJ, Polidori MC, Mattace-Raso F, Paccalin M, Topinkova E, Greco A, Mangoni AA, Daragjati J, Siri G, Pilotto A. Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study. Clin Nutr 2019; 39:1608-1612. [PMID: 31378515 DOI: 10.1016/j.clnu.2019.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/07/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. METHODS Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. RESULTS 1064 patients were included, with 79 (13 in MPI 1-2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19-3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09-3.76), but not in MPI 1-2 class patients (OR = 1.51; 95%CI: 0.44-5.25). The use of propensity score confirmed these findings. CONCLUSIONS ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.
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Affiliation(s)
- Nicola Veronese
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy.
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy
| | | | | | - Francesco Mattace-Raso
- Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc Paccalin
- Geriatrics Department University Hospital Poitiers, France
| | - Eva Topinkova
- First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Antonio Greco
- Geriatrics Unit, IRCCS CSS, San Giovanni Rotondo, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Julia Daragjati
- Geriatrics Unit, AULSS 6 Euganea, San Antonio Hospital, Padova, Italy
| | - Giacomo Siri
- Scientific Coordination Unit, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Department of Interdisciplinary Medicine, 'Aldo Moro' University of Bari, Italy
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21
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Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48:601. [PMID: 31081853 PMCID: PMC6593317 DOI: 10.1093/ageing/afz046] [Citation(s) in RCA: 984] [Impact Index Per Article: 196.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 12/13/2022] Open
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22
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Roller-Wirnsberger R, Masud T, Vassallo M, Zöbl M, Reiter R, Van Den Noortgate N, Petermans J, Petrov I, Topinkova E, Andersen-Ranberg K, Saks K, Nuotio M, Bonin-Guillaume S, Lüttje D, Mestheneos E, Szekacs B, Jonsdottir AB, O’Neill D, Cherubini A, Macijauskiene J, Leners JC, Fiorini A, van Iersel M, Ranhoff AH, Kostka T, Duque S, Prada GI, Davidovic M, Krajcik S, Kolsek M, del Nozal JM, Ekdahl AW, Münzer T, Savas S, Knight P, Gordon A, Singler K. European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing 2019; 48:291-299. [PMID: 30423032 PMCID: PMC6424375 DOI: 10.1093/ageing/afy173] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. METHODS under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. RESULTS the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). CONCLUSION the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.
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Affiliation(s)
| | - Tahir Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK
| | - Michael Vassallo
- Royal Bournemouth and Christchurch NHS Hospitals Foundation Trust, Castle Lane East, Bournemouth, UK
| | - Martina Zöbl
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Raphael Reiter
- Department of Geriatric Medicine, Paracelsus Medical University Strubergasse 22, Salzburg, Austria
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital Corneel Heymanslaan 10, Gent, Belgium
| | - Jean Petermans
- Geriatric Department, CHU Rue de Gaillarmont 600, Liège, Belgium
| | - Ignat Petrov
- Clinical Centre of Endocrinology and Gerontology, Medical University of SofiaBoulevard “Akademik Ivan Evstratiev Geshov” 15, Sofia Center, Sofia, Bulgaria
| | - Eva Topinkova
- Department of Gerontology and Geriatrics, 1st Faculty of Medicine, Charles University and General Faculty HospitalOvocný trh 3-5, Staré Město, Czechia
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, Odense, Denmark
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Ülikooli 18, Tartu, Estonia
| | - Maria Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, Finland
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Sylvie Bonin-Guillaume
- Department of Geriatric Medicine, Hopital de la Timone, 264 Rue Saint Pierre, 13005 Marseille 05, Provence-Alpes-Côte d'Azur, France
| | - Dieter Lüttje
- Medizinische Klinik IV, Geriatrie und Palliativmedizin, Klinikum Osnabrück, Germany
| | - Elizabeth Mestheneos
- Hellenic Association of Gerontology and Geriatrics, Past President Age Platform Europe, Greece
| | - Bela Szekacs
- Hungarian Association of Gerontology and Geriatrics (HAGG)
| | - Anna Björg Jonsdottir
- Department of Geriatric Medicine, The National University Hospital of Iceland Landakoti, 101, Reykjavík Iceland
| | - Desmond O’Neill
- Department of Clinical Gerontology, College Green, Dublin 2, Ireland
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italia
| | - Jurate Macijauskiene
- Department of Geriatrics, The Faculty of Nursing, Medical Academy Lithuanian, University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania
| | - Jean-Claude Leners
- House Omega & LTCF Alzheimer, University of Luxembourg, 2, avenue de l'Université, Esch-sur-Alzette, Luxembourg
| | - Anthony Fiorini
- The Geriatric Medicine Society of Malta, Karin Grech Hospital, Telghat Gwardamangia, Pieta' Malta PTA, Malta
| | - Marianne van Iersel
- Department of Geriatric Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, Netherlands
| | | | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, plac Hallera 1, Łódź, Poland
| | - Sofia Duque
- Internal Medicine Specialist with Geriatrics Competence, Orthogeriatric Unit Coordinator, Internal Medicine Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa, Ocidental, Invited Lecturer of Geriatrics, Faculdade de Medicina, Universidade de Lisboa, Estr. Forte do Alto Duque, Lisboa, Portugal
| | - Gabriel Ioan Prada
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Ana Aslan National Institute of Gerontology and Geriatrics, Romania
| | - Mladen Davidovic
- Serbian Association of Geriatricians and Gerontologist, Udruženje gerijatara i gerontologa Srbije, Preševska 31, Beograd, Serbia
| | - Stefan Krajcik
- Geriatric Department, Slovak Medical University, 831 01 Bratislava, Slovakia
| | - Marko Kolsek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana Korytkova ulica 2, Ljubljana, Slovenia
| | | | - Anne W Ekdahl
- Department of Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Svartbrödragränden 3-5, Helsingborg, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics, Solnavägen 1, Solna, Sweden
| | - Thomas Münzer
- Department of Geriatrics, Geriatrische Klinik St. Gallen and University of Zürich, Zürich, Switzerland
| | - Sumru Savas
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Ege University Erzene Mahallesi, Bornova/İzmir, Turkey
| | - Paul Knight
- Department Geriatric Medicine, Royal Infirmary, Glasgow, UK
| | - Adam Gordon
- CLAHRC-East Midlands ‘Caring for Older People and Stroke Survivors’ (COPSS), Nottingham Biomedical Research Centre (BRC)
| | - Katrin Singler
- Institute of Biomedicine of Ageing, Friedrich Alexander University Erlangen, Schloßplatz 4, Erlangen, Germany
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private Medical University, Prof.-Ernst-Nathan-Straße 1, Nürnberg, Germany
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23
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van Lier LI, van der Roest HG, Oosten BS, Garms-Homolová V, Onder G, Finne-Soveri H, V Jónsson P, Ljunggren G, Henrard JC, Topinkova E, Sørbye LW, Bernabei R, van Hout HP, Bosmans JE. Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries. Health Serv Insights 2019; 12:1178632918820947. [PMID: 30718960 PMCID: PMC6348544 DOI: 10.1177/1178632918820947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background: The objective was to identify predictors of societal costs covering formal and informal care utilization by older home care clients in 11 European countries. Methods: Societal costs of 1907 older clients receiving home care for 12 months from the Aged in Home care (AdHoc) study were estimated using the InterRAI Minimum Data Set for Home Care’s (MDS-HC) resource use items. Predictors (medical, functional, and psychosocial domains) of societal costs were identified by performing univariate and multivariate generalized linear model analyses. Results: Mean societal costs per participant were €36 442, ranging from €14 865 in Denmark to €78 836 in the United Kingdom. In the final multivariate model, country, being married, activities of daily living (ADL) dependency, cognitive impairment, limitations of going out, oral conditions, number of medications, arthritis, and cerebro vascular accident (CVA) were significantly associated with societal costs. Conclusions: Of the predictors, ADL dependency and limitations of going out may be modifiable. Developing interventions targeted at improving these conditions may create opportunities to curtail societal costs.
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Affiliation(s)
- Lisanne I van Lier
- Department of General Practice & Elderly care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Henriëtte G van der Roest
- Department of General Practice & Elderly care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Babette Sh Oosten
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Vjenka Garms-Homolová
- Department III, Economy and Law, Hochschule für Technik und Wirtschaft Berlin, Berlin, Germany
| | - Graziano Onder
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Harriet Finne-Soveri
- Department of Wellbeing, National Institute for Health and Welfare, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pálmi V Jónsson
- Icelandic Gerontologica Research Institute, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gunnar Ljunggren
- Public Healthcare Services Committee Administration, Stockholm County Council, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Jean-Claude Henrard
- Laboratoire Universitaire Santé-Environment-Vieillissement, Versailles Saint-Quentin-en-Yvelines (UVSQ) University, Paris, France
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | | | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hein Pj van Hout
- Department of General Practice & Elderly care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
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24
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Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48:16-31. [PMID: 30312372 PMCID: PMC6322506 DOI: 10.1093/ageing/afy169] [Citation(s) in RCA: 5721] [Impact Index Per Article: 1144.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023] Open
Abstract
Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.
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Affiliation(s)
| | - Gülistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Jürgen Bauer
- Center for Geriatric Medicine, University Heidelberg, Agaplesion Bethanien Krankenhaus, Heidelberg, Germany
| | - Yves Boirie
- Research Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton, UK; and Department of Epidemiology, University of Oxford, OX, UK
| | - Francesco Landi
- Instituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Yves Rolland
- Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
| | - Avan Aihie Sayer
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Stéphane M Schneider
- Department of Gastroenterology and Clinical Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Cornel C Sieber
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine and Ageing, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Maurits Vandewoude
- Department Geriatrics, University of Antwerp, Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam; and the Amsterdam Public Health Research Institute; Amsterdam, The Netherlands
| | - Mauro Zamboni
- Department of Medicine, Geriatric section, University of Verona, Verona, Italy
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25
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Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, Denkinger M, Gutiérrez-Valencia M, Guðmundsson A, Knol W, Mak DV, O'Mahony D, Pazan F, Petrovic M, Rajkumar C, Topinkova E, Trevisan C, van der Cammen TJM, van Marum RJ, Wehling M, Ziere G, Bernabei R, Onder G. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med 2018; 10:9-36. [PMID: 32720270 DOI: 10.1007/s41999-018-0124-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic and publication bias with Egger's and Begg's tests. RESULTS Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. CONCLUSIONS Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. PROSPERO REGISTRATION NUMBER CRD42018104756.
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Affiliation(s)
- Katie Palmer
- Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, 30126, Venezia, Italia.
| | - Emanuele R Villani
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L Vetrano
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.,Aging Research Center, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Denis Curtin
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau and Geriatric Research Unit, Ulm University, Ulm, Germany
| | - Marta Gutiérrez-Valencia
- Department of Pharmacy, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Navarra, Spain
| | - Adalsteinn Guðmundsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Department of Geriatrics, Landspitali University Hospital, Reykjavík, Iceland
| | - Wilma Knol
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diane V Mak
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Farhad Pazan
- Institute for Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
| | - Chakravarthi Rajkumar
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - Catarina Trevisan
- Department of Medicine, Geriatrics Division, University of Padova, Padua, Italy
| | - Tischa J M van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, East Sussex, UK
| | - Rob J van Marum
- Department of General Practice and Old Age Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Martin Wehling
- Medical Faculty Mannheim, Clinical Pharmacology, University of Heidelberg, Heidelberg, Germany
| | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roberto Bernabei
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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26
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Marzetti E, Cesari M, Calvani R, Msihid J, Tosato M, Rodriguez-Mañas L, Lattanzio F, Cherubini A, Bejuit R, Di Bari M, Maggio M, Vellas B, Dantoine T, Cruz-Jentoft AJ, Sieber CC, Freiberger E, Skalska A, Grodzicki T, Sinclair AJ, Topinkova E, Rýznarová I, Strandberg T, Schols AMWJ, Schols JMGA, Roller-Wirnsberger R, Jónsson PV, Ramel A, Del Signore S, Pahor M, Roubenoff R, Bernabei R, Landi F. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial: Case finding, screening and characteristics of eligible participants. Exp Gerontol 2018; 113:48-57. [PMID: 30261246 DOI: 10.1016/j.exger.2018.09.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees. METHODS The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding. RESULTS During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy. CONCLUSION PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods.
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Affiliation(s)
- Emanuele Marzetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Matteo Tosato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Geriatric Rehabilitation, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Vellas
- Gérontopôle, University Hospital of Toulouse, Toulouse, France
| | | | | | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Limited, Worcestershire, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Timo Strandberg
- University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pálmi V Jónsson
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Ronenn Roubenoff
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Roberto Bernabei
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Onder G, Giovannini S, Sganga F, Manes-Gravina E, Topinkova E, Finne-Soveri H, Garms-Homolová V, Declercq A, van der Roest HG, Jónsson PV, van Hout H, Bernabei R. Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects. Aging Clin Exp Res 2018; 30:1015-1021. [PMID: 29340963 DOI: 10.1007/s40520-018-0893-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/04/2018] [Indexed: 02/07/2023]
Abstract
AIM Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. METHODS We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Exposure to interactions between drugs and geriatric syndromes was assessed by 2015 Beers criteria. RESULTS 790/4023 (19.6%) residents in the Shelter Project and 179/1469 (12.2%) home care patients in the IBenC Project presented with one or more drug interactions with geriatric syndromes. In the Shelter project, 288/373 (77.2%) residents experiencing a fall, 429/659 (65.1%) presenting with delirium and 180/2765 (6.5%) with urinary incontinence were on one or more interacting drugs. In the IBenC project, 78/172 (45.3%) participants experiencing a fall, 80/182 (44.0%) presenting with delirium and 36/504 (7.1%) with urinary incontinence were on one or more interacting drugs. CONCLUSION Drug-geriatric syndromes interactions are common in long-term care patients. Future studies and interventions aimed at improving pharmacological prescription in the long-term care setting should assess not only drug-drug and drug-disease interactions, but also interactions involving geriatric syndromes.
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Affiliation(s)
- Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
| | - Silvia Giovannini
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Federica Sganga
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Ester Manes-Gravina
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | | | - Vjenka Garms-Homolová
- Department of Economics and Law, HTW Berlin University of Applied Sciences, Berlin, Germany
| | - Anja Declercq
- LUCAS & Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Pálmi V Jónsson
- Department of Geriatrics, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hein van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Bernabei
- Department of Gerontology, Neuroscience and Orthopedics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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ten Koppel M, Onwuteaka-Philipsen BD, Pasman HR, Bernabei R, Carpenter I, Denkinger MD, Onder G, van der Roest HG, Topinkova E, van Hout HPJ. Are older long term care residents accurately prognosticated and consequently informed about their prognosis? Results from SHELTER study data in 5 European countries. PLoS One 2018; 13:e0200590. [PMID: 30020976 PMCID: PMC6051611 DOI: 10.1371/journal.pone.0200590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Informing residents in long term care facilities (LTCFs) about their prognosis can help them prepare for the end of life. This study aimed to examine which proportion of European LTCF residents, close to death, are accurately prognosticated and consequently informed about their prognosis; and to examine factors related to accurate prognostication and discussion of prognosis. METHODS A subsample of SHELTER study data was used, consisting of: 500 residents from 5 European countries, who died within 6 months after their last assessment, and had a valid answer on the item 'End stage disease, 6 or fewer months to live'. This item was used to indicate whether an accurate prognosis was established and discussed with residents. Generalized estimating equations were used to examine factors related to establishment and discussion of accurate prognosis. RESULTS 86.4% of residents close to death did not receive an accurate prognosis. Residents with cancer; fatigue; dehydration; and normal mode of nutritional intake were more likely to have an accurate prognosis established and discussed. Accurate prognostication and prognosis discussion was less likely for residents who: had a diagnosis under 'other'; initiated interactions; and residents from Germany, Italy and the Netherlands. CONCLUSIONS The great majority of residents close to death did not receive an accurate prognosis. Prognostication tools might help clinicians to increase their prognostic accuracy and communication training might help to discuss prognosis with residents.
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Affiliation(s)
- Maud ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - H. Roeline Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Bernabei
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Iain Carpenter
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Michael D. Denkinger
- Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Graziano Onder
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Henriëtte G. van der Roest
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hein P. J. van Hout
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
BACKGROUND This paper describes an integrated series of functional, clinical, and discharge post-acute care (PAC) quality indicators (QIs) and an examination of the distribution of the QIs in skilled nursing facilities (SNF) across the US. The indicators use items available in interRAI based assessments including the MDS 3.0 and are designed for use in in-patient post-acute environments that use the assessments. METHODS Data Source: MDS 3.0 computerized assessments mandated for all patients admitted to US skilled nursing facilities (SNF) in 2012. In total, 2,380,213 patients were admitted to SNFs for post-acute care. Definition of the QI numerator, denominator and covariate structures were based on MDS assessment items. A regression strategy modeling the "discharge to the community" PAC QI as the dependent variable was used to identify how to bring together a subset of seven candidate PAC QIs for inclusion in a summary scale. Finally, the distributional property of the summary scale (the PAC QI Summary Scale) across all facilities was explored. RESULTS The risk-adjusted PAC QIs include indicators of improved status, including measures of early, middle, and late-loss functional performance, as well as measures of walking and changed clinical status and an overall summary functional scale. Many but not all patients demonstrated improvement from baseline to follow-up. However, there was substantial inter-state variation in the summary QI scores across the SNFs. CONCLUSIONS The set of PAC QIs consist of five functional, two discharge and eight clinical measures, and one summary scale. All QIs can be derived from multiple interRAI assessment tools, including the MDS 2.0, interRAI-LTCF, MDS 3.0, and the interRAI-PAC-Rehab. These measures are appropriate for wide distribution in and out of the United States, allowing comparison and discussion of practices associated with better outcomes.
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Affiliation(s)
- John N. Morris
- Institute for Aging Research, Hebrew Senior Life, Boston, USA
| | - Katherine Berg
- University of Toronto, Toronto, Canada
- Physical Therapy Centre of Excellence in Health Services/Health Policy Research and Training (CoHSTAR), Brown University, Providence, USA
| | - Eva Topinkova
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, South Bohemian University, Ceske Budejovice, Czech Republic
| | - Leonard C. Gray
- Geriatric Medicine at the University of Queensland Centre for Research in Geriatric Medicine, Brisbane, Australia
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Poscia A, Collamati A, Carfì A, Topinkova E, Richter T, Denkinger M, Pastorino R, Landi F, Ricciardi W, Bernabei R, Onder G. Influenza and pneumococcal vaccination in older adults living in nursing home: a survival analysis on the shelter study. Eur J Public Health 2018; 27:1016-1020. [PMID: 29069321 DOI: 10.1093/eurpub/ckx150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Influenza and pneumococcal vaccines have been proved to be effective and safe in preventing and controlling infection among elderly, reducing morbidity and mortality. However, some evidences raised health concerns related to these vaccinations. This study aims to identify prevalence and outcomes related to influenza and pneumococcal vaccinations in a large European population of frail old people living in nursing homes (NHs). Methods We conducted a survival analysis of NH residents participating to the Services and Health for Elderly in Long-TERm project, a prospective cohort study collecting information on residents admitted to 57 NH in eight countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands and Israel). Clinical and demographical data were collected using the international resident assessement instrument for long-term care facilities. Incident mortality was recorded during 1-year follow-up. A shared-frailty Cox regression model was used to assess the impact of vaccination status on mortality. Results Mean age of 3510 participants was 84.6 years (SD = 7.7). In total, 81.7 and 27.0% received influenza and pneumococcal vaccination, respectively. Overall, 727 (20.7%) residents died during the follow-up period. After adjusting for potential confounders, which included age, sex, number of diseases, depression, cognitive and functional status, influenza (HR = 0.80; 95% CI 0.66-0.97) and the combination of influenza and pneumococcal vaccination (HR = 0.72; 95% CI 0.57-0.91), but not pneumococcal vaccination alone (HR = 0.52; 95% CI 0.25-1.06), were associated with a statistically significant reduction in mortality in respect of no vaccinations. Conclusion In a population of older adult living in NH influenza and the combination of influenza and pneumococcal vaccination were associated with a reduction in all-cause mortality respect to no vaccination.
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Affiliation(s)
- Andrea Poscia
- Institute of Public Health, Università Cattolica del Sacro Cuore of Rome, Rome, Italy
| | - Agnese Collamati
- Department of Geriatrics, Neurosciences, and Orthopedics, Università Cattolica del Sacro Cuore of Rome, Rome, Italy
| | - Angelo Carfì
- Department of Geriatrics, Neurosciences, and Orthopedics, Università Cattolica del Sacro Cuore of Rome, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Richter
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael Denkinger
- GAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Roberta Pastorino
- Institute of Public Health, Università Cattolica del Sacro Cuore of Rome, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences, and Orthopedics, Università Cattolica del Sacro Cuore of Rome, Rome, Italy
| | - Walter Ricciardi
- Institute of Public Health, Università Cattolica del Sacro Cuore of Rome, Rome, Italy.,National Institute of Health, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences, and Orthopedics, Università Cattolica del Sacro Cuore of Rome, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Neurosciences, and Orthopedics, Università Cattolica del Sacro Cuore of Rome, Rome, Italy
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Morris JN, Declercq A, Hirdes JP, Finne-Soveri H, Fries BE, James ML, Geffen L, Kehyayan V, Saks K, Szczerbińska K, Topinkova E. Hearing the Voice of the Resident in Long-Term Care Facilities-An Internationally Based Approach to Assessing Quality of Life. J Am Med Dir Assoc 2017; 19:207-215. [PMID: 29030309 DOI: 10.1016/j.jamda.2017.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES interRAI launched this study to introduce a set of standardized self-report measures through which residents of long-term care facilities (LTCFs) could describe their quality of life and services. This article reports on the international development effort, describing measures relative to privacy, food, security, comfort, autonomy, respect, staff responsiveness, relationships with staff, friendships, and activities. First, we evaluated these items individually and then combined them in summary scales. Second, we examined how the summary scales related to whether the residents did or did not say that the LTCFs in which they lived felt like home. DESIGN Cross-sectional self-report surveys by residents of LTCFs regarding their quality of life and services. SETTING/PARTICIPANTS Resident self-report data came from 16,017 individuals who resided in 355 LTCFs. Of this total, 7113 were from the Flanders region of Belgium, 5143 residents were from Canada, and 3358 residents were from the eastern and mid-western United States. Smaller data sets were collected from facilities in Australia (20), the Czech Republic (72), Estonia (103), Poland (118), and South Africa (87). MEASUREMENTS The interRAI Self-Report Quality of Life Survey for LTCFs was used to assess residents' quality of life and services. It includes 49 items. Each area of inquiry (eg, autonomy) is represented by multiple items; the item sets have been designed to elicit resident responses that could range from highly positive to highly negative. Each item has a 5-item response set that ranges from "never" to "always." RESULTS Typically, we scored individual items scored based on the 2 most positive categories: "sometimes" and "always." When these 2 categories were aggregated, among the more positive items were: being alone when wished (83%); decide what clothes to wear (85%); get needed services (87%); and treated with dignity by staff (88%). Areas with a less positive response included: staff knows resident's life story (30%); resident has enjoyable things to do on weekends (32%); resident has people to do things with (33%); and resident has friendly conversation with staff (45%). We identified 5 reliable scales; these scales were positively associated with the resident statement that the LTCF felt like home. Finally, international score standards were established for the items and scales. CONCLUSIONS This study establishes a set of standardized, self-report items and scales with which to assess the quality of life and services for residents in LTCFs. The study also demonstrates that these scales are significantly related to resident perception of the home-like quality of the facilities.
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Affiliation(s)
| | - Anja Declercq
- LUCAS and Faculty of Social Sciences the Katholieke Universiteit Leuven, Belgium
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Harriet Finne-Soveri
- Hospital, Rehabilitation, and Care Department, City of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Brant E Fries
- Division of Geriatrics and Palliative Care, University of Michigan, Ann Arbor, MI; Ann Arbor VA Healthcare Center, Ann Arbor, MI
| | - Mary L James
- Division of Geriatrics and Palliative Care, University of Michigan, Ann Arbor, MI
| | - Leon Geffen
- Sampson Institute for Ageing Research, Cape Town, South Africa; Institute of Ageing in Africa, Faculty of Health Sciences at University of Cape Town, Cape Town, South Africa
| | | | - Kai Saks
- Department of Internal Medicine, University of Tartu, Estonia
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Krakow, Poland
| | - Eva Topinkova
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Faculty of Health and Social Sciences, South Bohemian University, Ceske Budejovice, Czech Republic
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Vetrano DL, Collamati A, Magnavita N, Sowa A, Topinkova E, Finne-Soveri H, van der Roest HG, Tobiasz-Adamczyk B, Giovannini S, Ricciardi W, Bernabei R, Onder G, Poscia A. Health determinants and survival in nursing home residents in Europe: Results from the SHELTER study. Maturitas 2017; 107:19-25. [PMID: 29169575 DOI: 10.1016/j.maturitas.2017.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/14/2017] [Accepted: 09/29/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. DESIGN Multicentre longitudinal cohort-study. SETTING 57 nursing homes (NH) in 7EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). PARTICIPANTS 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. MEASUREMENTS We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. RESULTS During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64-0.97) and obesity (HR 0.64; 95% C.I. 0.48-0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54-0.83), social activities (HR 0.63; 95% C.I. 0.51-0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55-0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63-0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03-1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27-2.42) were associated with higher mortality. CONCLUSIONS Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.
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Affiliation(s)
- Davide L Vetrano
- Department of Geriatrics, Catholic University of Rome, Italy; Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
| | | | | | - Agnieszka Sowa
- Department of Social Policy, Institute of Labour and Social Studies, Warsaw, Poland
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Science, South Bohemian University, Czech Republic
| | - Harriet Finne-Soveri
- Ageing and Services Unit, National Institutes of Health and Welfare (THL), Helsinki, Finland
| | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | | | | | - Walter Ricciardi
- Institute of Public Health, Catholic University of Rome, Italy; Italian National Institute of Health, Rome, Italy
| | | | - Graziano Onder
- Department of Geriatrics, Catholic University of Rome, Italy
| | - Andrea Poscia
- Institute of Public Health, Catholic University of Rome, Italy
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Liperoti R, Sganga F, Landi F, Topinkova E, Denkinger MD, van der Roest HG, Foebel AD, Finne-Soveri H, Bernabei R, Onder G. Antipsychotic Drug Interactions and Mortality Among Nursing Home Residents With Cognitive Impairment. J Clin Psychiatry 2017; 78:e76-e82. [PMID: 28129493 DOI: 10.4088/jcp.15m10303] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Among elderly individuals with dementia, the use of antipsychotics has been associated with serious adverse events including ischemic stroke and death. Multiple medications can interact with antipsychotics and increase the risk of such adverse events. The purpose of this retrospective, longitudinal cohort study was to estimate the prevalence of potential antipsychotic drug interactions and their effect on increasing the risk of death among cognitively impaired elderly individuals treated with antipsychotics. METHODS We conducted a retrospective longitudinal cohort study in 59 nursing homes of 7 European Union countries and Israel. The study was conducted during the years 2009 to 2011. Participants were cognitively impaired individuals aged 65 years or older residing in the participating nursing homes and being treated with antipsychotics (N = 604). Risk of death associated with potential antipsychotic drug interactions was the main outcome. The inter-Resident Assessment Instrument for Long Term Care Facilities (interRAI LTCF) was used to assess participants. Follow-up time was 12 months. RESULTS The prevalence of potential antipsychotic drug interactions was 46.0%. Antipsychotic drug interactions were associated with higher mortality (incidence rate of 0.26 per person-year in the antipsychotic drug-interaction group versus 0.17 per person year in the no antipsychotic drug-interaction group). After adjusting for potential confounders, risk of death was higher in the group of residents with potential antipsychotic drug interactions relative to those unexposed to such interactions (hazard ratio = 1.71; 95% CI, 1.15-2.54). CONCLUSIONS Part of the observed excess risk of death associated with the use of antipsychotic medications in elderly individuals with cognitive impairment may be attributable to antipsychotic drug interactions. Antipsychotics should be used with extreme caution especially among those individuals receiving concomitant cardiovascular or psychotropic medications.
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Affiliation(s)
- Rosa Liperoti
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy. .,Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Sganga
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Henriëtte G van der Roest
- EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Andrea D Foebel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Harriet Finne-Soveri
- Ageing and Services Unit, National Institutes of Health and Welfare (THL), Helsinki, Finland
| | - Roberto Bernabei
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Neuroscience and Orthopedics, Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Pilotto A, Gallina P, Panza F, Copetti M, Cella A, Cruz-Jentoft A, Daragjati J, Ferrucci L, Maggi S, Mattace-Raso F, Paccalin M, Polidori MC, Topinkova E, Trifirò G, Welmer AK, Strandberg T, Marchionni N. Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease. Am J Cardiol 2016; 118:1624-1630. [PMID: 27670793 DOI: 10.1016/j.amjcard.2016.08.042] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 01/14/2023]
Abstract
Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged ≥65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1, -2, and -3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and ≥85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins.
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Affiliation(s)
- Alberto Pilotto
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy; Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padua, Italy
| | | | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Cella
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy
| | | | - Julia Daragjati
- Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padua, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Section, Padua, Italy
| | | | | | - Maria Cristina Polidori
- Unit for Aging Clinical Research, Department of Medicine II, University of Cologne, Cologne, Germany
| | | | - Gianluca Trifirò
- Erasmus Medical Center, Rotterdam, The Netherlands; University of Messina, Messina, Italy
| | | | - Timo Strandberg
- Geriatric Clinic, Department of Medicine, University of Helsinki, Helsinki, Finland; Institute of Health Sciences/Geriatrics, University of Oulu, and Oulu University Hospital, Oulu, Finland
| | - Niccolò Marchionni
- Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy
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Cesari M, Abellan Van Kan G, Ariogul S, Baeyens JP, Bauer J, Cankurtaran M, Cederholm T, Cherubini A, Cruz-Jentoft AJ, Curgunlu A, Landi F, Sayer AA, Strandberg T, Topinkova E, Van Asselt D, Vellas B, Zekry D, Michel JP. The European Union Geriatric Medicine Society (EUGMS) Working Group on «Frailty in Older Persons». J Frailty Aging 2016; 2:118-20. [PMID: 27070810 DOI: 10.14283/jfa.2013.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The concept of frailty was introduced in literature to help atclinically depicting the transition of a robust older individualinto a different clinical phenotype of risk (1-5). Frailty isgenerally described as a multisystemic impairment responsiblefor a state of increased vulnerability to endogenous andexogenous stressors (6, 7). This syndrome may represent thefirst step towards the evident and clinically relevant functionaldisability (a cornerstone outcome for geriatric medicine)8, andhas shown to be predictive of major negative health-relatedevents, including
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Affiliation(s)
- M Cesari
- Matteo Cesari, MD, PhD, Institut du Vieillissement, Gérontopôle, INSERM UMR 1027, Université Toulouse III - Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse France, Phone: +33 (0)5 61145628, Fax: +33 (0)5 61145640,
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Vetrano DL, Lattanzio F, Martone AM, Landi F, Brandi V, Topinkova E, Onder G. Treating heart failure in older and oldest old patients. Curr Pharm Des 2015; 21:1659-64. [PMID: 25633115 DOI: 10.2174/1381612821666150130124021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/26/2015] [Indexed: 11/22/2022]
Abstract
Advanced age is a relevant risk factor for the heart failure (HF). The development of new pharmacological and non-pharmacological approaches has determined an improvement in survival of patients with HF, leading to the selection of an older and frailer population with HF. The clinical approach to such a complex population should require clear indications to assist physicians during their daily practice, but there is a huge lack of evidence regarding the treatment of HF in the oldest among the elderly patient population. In addition, the co-occurrence of specific conditions that are extremely prevalent in older individuals with HF, such as cognitive impairment, comorbidities, and polypharmacy, can further complicate the clinical man agement of this condition. Thus, a multidisciplinary approach with the goal of recognizing and treating conditions associated with HF may be necessary to improve the quality of care and to reduce expenditures. Several studies have assessed the effect of a comprehensive geriatric assessment and management on quality of care in HF patients, demonstrating a substantial improvement in patient outcomes and administration of the appropriate drug treatment.
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Affiliation(s)
| | | | | | | | | | | | - Graziano Onder
- Centro Medicina dell'Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Roma, Italy.
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Yamada Y, Denkinger MD, Onder G, van der Roest HG, Finne-Soveri H, Bernabei R, Topinkova E. Joint Associations of Dual Sensory Impairment and No-Activity Involvement With 1-Year Mortality in Nursing Homes: Results From the SHELTER Study. J Gerontol A Biol Sci Med Sci 2015; 71:643-8. [PMID: 26582074 DOI: 10.1093/gerona/glv191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 10/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Concurrent vision and hearing impairment, known as dual sensory impairment (DSI), is associated with increased mortality. We aimed to examine individual and joint associations of DSI and involvement in activities with mortality in a large European nursing home study. METHODS In total, 2,851 nursing home residents in 59 facilities in eight countries were followed for 1 year in the Services and Health for Elderly in Long TERm Care study. Vision and hearing impairment and average time of involvement in activities were assessed by trained research staff using the interRAI Long Term Care Facilities. Association between DSI and 1-year all-cause mortality was examined using Cox proportional hazards models adjusted for age, sex, facility, diagnoses of coronary heart disease and diabetes mellitus, self-rated health, end-stage disease, and functional and cognitive status. The modifying effect of involvement in activities on the association was investigated by the additive hazard model. RESULTS DSI, defined as moderate to severe impairment in both senses, was independently associated with a 35% increased risk of 1-year mortality compared with non-DSI. Residents with DSI who were involved in activities did not have higher mortality, while residents with DSI who were not involved in activities had 51% higher mortality than non-DSI residents who were involved in activities, equivalent to approximately 209 additional deaths per 1,000 person-years (p = .012) due to the interaction between DSI and no involvement in activities. CONCLUSIONS DSI is associated with increased mortality at nursing homes when combined with no involvement in activities.
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Affiliation(s)
- Yukari Yamada
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic. Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Japan.
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Graziano Onder
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Henriëtte G van der Roest
- EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands. Elderly Care Research Unit at LUCAS and Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | - Roberto Bernabei
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Foebel AD, van Hout HP, van der Roest HG, Topinkova E, Garms-Homolova V, Frijters D, Finne-Soveri H, Jónsson PV, Hirdes JP, Bernabei R, Onder G. Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs). BMC Geriatr 2015; 15:148. [PMID: 26572734 PMCID: PMC4647796 DOI: 10.1186/s12877-015-0146-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/10/2015] [Indexed: 11/21/2022] Open
Abstract
Background Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI’s second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Methods Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. Results A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. Conclusions The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.
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Affiliation(s)
- Andrea D Foebel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. .,Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Rome, Italy.
| | - Hein P van Hout
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Vjenka Garms-Homolova
- HTW Berlin, University of Applied Sciences in Technology and Economics, Berlin, Germany.
| | - Dinnus Frijters
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | | | - Pálmi V Jónsson
- Department of Geriatrics, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | - Roberto Bernabei
- Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Rome, Italy.
| | - Graziano Onder
- Department of Geriatrics, Neuroscience and Orthopedics, Catholic University, Rome, Italy.
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Poscia A, Collamati A, Collamati V, Moscato U, Topinkova E, Landi F, Bernabei R, Onder G. Two is better than one: vaccination impact on survival of older adult living in nursing home. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv167.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Collamati A, Landi F, Poscia A, Topinkova E, Bernabei R, Onder G. O-048: Vaccination and survival in a population of older adult living in nursing home. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Yamada Y, Denkinger MD, Onder G, Henrard JC, van der Roest HG, Finne-Soveri H, Richter T, Vlachova M, Bernabei R, Topinkova E. Dual Sensory Impairment and Cognitive Decline: The Results From the Shelter Study. J Gerontol A Biol Sci Med Sci 2015; 71:117-23. [PMID: 25869524 DOI: 10.1093/gerona/glv036] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To examine whether nursing home residents with concurrent vision and hearing impairment, dual sensory impairment (DSI), have a greater cognitive decline over time than do those without sensory impairment and whether social engagement modifies this association. METHODS Based on the Services and Health for Elderly in Long TERm Care study, 1,989 nursing home residents who were assessed using the interRAI LTCF at 6-month intervals over 1 year were included. Multivariate linear regression models with time-variant exposure variables of sensory impairment and social engagement using generalized estimating equations were performed to predict cognitive function measured by the Cognitive Performance Scale (range 0-6). RESULTS Residents with DSI had a greater cognitive decline [changes in Cognitive Performance Scale over 1 year = 1.12 (95% confidence interval = 0.81:1.42)] compared to those with either vision or hearing impairment [0.67 (0.53:0.64)] and those without sensory impairment [0.56 (0.48:0.64)]. A lower level of social engagement was also associated with a greater cognitive decline. The combined exposure variable of sensory impairment and social engagement revealed the greatest cognitive decline for socially disengaged residents with DSI [1.87 (1.24:2.51)] and the potential effect modification of social engagement on the association between DSI and cognitive decline; DSI was not associated with a greater cognitive decline among socially engaged residents, while it was associated among socially disengaged residents DISCUSSION Cognitive function declines faster in nursing home residents with DSI only when residents were not socially engaged. Therefore, residents with DSI might cognitively benefit from interventions to improve involvement in social life at nursing homes.
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Affiliation(s)
- Yukari Yamada
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic. Department of Nursing, Faculty of Health Sciences, Palacky Univestiy, Olomouc, Czech Republic.
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Graziano Onder
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Jean-Claude Henrard
- Research Unit Health-Environment-Ageing, Versailles- Saint-Quentin en Yvelines University, Paris, France
| | - Henriëtte G van der Roest
- EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands. Elderly Care Research Unit at LUCAS and Center for Sociological Research, KU Leuven, Leuven, Belgium
| | | | - Tomas Richter
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martina Vlachova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roberto Bernabei
- Center on Aging, Catholic University of Sacred Heart, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Pilotto A, Sancarlo D, Polidori M, Cruz-Jentoft A, Mattace-Raso F, Paccalin M, Topinkova E, Welmer AK, Maggi S. The MPI_AGE European Project: Using Multidimensional Prognostic Indices (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons. Background, aim and design. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Colloca G, Bernabei R, Topinkova E, Onder G. Inappropriate drug use in advanced dementia. JAMA Intern Med 2015; 175:315. [PMID: 25642674 DOI: 10.1001/jamainternmed.2014.7026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Giuseppe Colloca
- Department of Geriatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Eva Topinkova
- Department of Geriatrics, Charles University, Prague, Czech Republic
| | - Graziano Onder
- Department of Geriatrics, Catholic University of Sacred Heart, Rome, Italy
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Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen MLG, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014. [PMID: 25071125 DOI: 10.200/jco.2013.54.8347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. METHODS SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. RESULTS GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. CONCLUSION There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
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Gindin J, Shochat T, Chetrit A, Epstein S, Ben Israel Y, Levi S, Onder G, Carpenter I, Finne-Soveri H, van Hout H, Henrard JC, Nikolaus T, Topinkova E, Fialová D, Bernabei R. Insomnia in Long-Term Care Facilities: A Comparison of Seven European Countries and Israel: The Services and Health for Elderly in Long TERm care Study. J Am Geriatr Soc 2014; 62:2033-9. [DOI: 10.1111/jgs.13099] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jacob Gindin
- Center for Standards in Health and Disability; University of Haifa; Mt. Carmel Haifa Israel
| | - Tamar Shochat
- Center for Standards in Health and Disability; University of Haifa; Mt. Carmel Haifa Israel
| | - Angela Chetrit
- Center for Standards in Health and Disability; University of Haifa; Mt. Carmel Haifa Israel
| | - Shulamit Epstein
- Center for Standards in Health and Disability; University of Haifa; Mt. Carmel Haifa Israel
| | | | - Sarah Levi
- Geriatrics Division; Ministry of Health; Jerusalem Israel
| | - Graziano Onder
- Centro Medicina dell'Invecchiamento; Università Cattolica Sacro Cuore; Rome Italy
| | - Ian Carpenter
- Centre for Health Services Studies; University of Kent; Canterbury UK
| | | | - Hein van Hout
- Department of General Practice and Elderly Care Medicine; VU University/EMGO; Amsterdam The Netherlands
| | - Jean-Claude Henrard
- Research Unit; Health Environment and Ageing Sainte Périne Hospital and Medical Faculty Paris-Ile-de-France-Ouest; Paris France
| | | | - Eva Topinkova
- Department of Geriatrics; 1st Medical Faculty; Charles University and Institute of Postgraduate Medical Education; Prague Czech Republic
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy; Faculty of Pharmacy, Hradec Králové; Charles University; Prague Czech Republic
- Institute for Postgraduate Education in Healthcare; Prague Czech Republic
| | - Roberto Bernabei
- Centro Medicina dell'Invecchiamento; Università Cattolica Sacro Cuore; Rome Italy
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Yamada Y, Vlachova M, Richter T, Finne-Soveri H, Gindin J, van der Roest H, Denkinger MD, Bernabei R, Onder G, Topinkova E. Prevalence and Correlates of Hearing and Visual Impairments in European Nursing Homes: Results From the SHELTER Study. J Am Med Dir Assoc 2014; 15:738-43. [DOI: 10.1016/j.jamda.2014.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 11/25/2022]
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Pilotto A, Pellegrini F, Maggi S, Cruz-Jentoft A, Paccalin M, Polidori M, Topinkova E, Trifirò G, Welmer A, Marcato F, Strandberg T. P095: Statin treatment reduces all-cause mortality in older patients with cardio- or cerebro-vascular disease regardless of their mortality risk. Results of the EU-funded MPI_AGE Project. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Finne-Soveri U, Noro A, Topinkova E, Fialovsa D, Foebel A, Onder G, Gindin J, Bernabei R, Mäkelä M. P033: Use of anti-dementia drugs in nursing homes. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014; 32:2595-603. [PMID: 25071125 PMCID: PMC4876338 DOI: 10.1200/jco.2013.54.8347] [Citation(s) in RCA: 1153] [Impact Index Per Article: 115.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. METHODS SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. RESULTS GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. CONCLUSION There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
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Affiliation(s)
- Hans Wildiers
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Pieter Heeren
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Martine Puts
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Eva Topinkova
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Maryska L.G. Janssen-Heijnen
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Martine Extermann
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Claire Falandry
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Andrew Artz
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Etienne Brain
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Giuseppe Colloca
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Johan Flamaing
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Theodora Karnakis
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Cindy Kenis
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Riccardo A. Audisio
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Supriya Mohile
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Lazzaro Repetto
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Barbara Van Leeuwen
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Koen Milisen
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Arti Hurria
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
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