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Benzinger P, Jamour M, Grund S, Bauer JM. [Legally improved access to geriatric rehabilitation - prerequisites and weaknesses]. Dtsch Med Wochenschr 2024. [PMID: 38499040 DOI: 10.1055/a-2115-0439] [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] [Indexed: 03/20/2024]
Abstract
Geriatric rehabilitation is a cornerstone of the German healthcare system to maintain the functional capacity of older patients and prevent the need for long-term care. Until recently, access to geriatric rehabilitation was largely limited to post-acute care. With the introduction of new legislation, patients aged 70 and over can be referred to geriatric rehabilitation by practitioners. However, in order to prescribe geriatric rehabilitation, physicians must document relevant diagnoses supported by the results of a series of functional or cognitive assessments. Alongside this information, the SINGER profile has been introduced. It is mandatory, although there is currently no manual to guide assessment with this tool. Diagnoses and test results must be consistent in documenting the need for geriatric rehabilitation. However, individual assessment of resources and motivation are prerequisites that need to be assessed by prescribing practitioners prior to prescription, considering the structure of the available formats. First analyses document improvement in access to geriatric rehabilitation but point to limited availability.
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Affiliation(s)
- Petra Benzinger
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Heidelberg
- Institut für Gesundheit und Generationen, Fakultät für Gesundheit und Soziales, Hochschule für angewandte Wissenschaften Kempten, Kempten
| | - Michael Jamour
- Allgemeine Innere Medizin und Geriatrie, Alb-Donau Klinikum, Ehingen
| | - Stefan Grund
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Heidelberg
| | - Jürgen M Bauer
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Heidelberg
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Wirth R, Verdon J, Frohnhofen H, Djukic M, Meisel M, Musolf M, Zinke A, Heppner HJ, Jamour M, Denkinger M, Trampisch US. Characterization of patients admitted to specialized geriatric acute care hospital units with the German version of the Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening-instrument: a cross-sectional study. BMC Geriatr 2023; 23:613. [PMID: 37775729 PMCID: PMC10542688 DOI: 10.1186/s12877-023-04338-7] [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: 03/08/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening tool records major geriatric problems, originally applied in the emergency department. Particularly, the distinction of compensated and uncompensated problems is an interesting and new approach. Therefore, we translated the SEISAR in German language and used it to characterize patients in specialized geriatric hospital wards in Germany and to gather initial experience regarding its usability and practicability. METHODS The tool was translated by three independent specialists in geriatric medicine and backtranslated for quality-assurance by a non-medical English native speaker. In a second step, 8 acute care geriatric hospital departments used the translated version to characterize all consecutive patients admitted over a period of one month between December 2019 and May 2020 at time of admission. RESULTS Most of the 756 patients (78%) lived in an own apartment or house prior to hospital admission. Participants had on average 4 compensated and 6 uncompensated problems, a Barthel-Index of 40 pts. on admission with a median increase of 15 points during hospital stay, and a median length of stay of 16 days in the geriatric hospital department. CONCLUSION SEISAR is an interesting standardized brief comprehensive geriatric assessment tool for the identification of compensated and uncompensated health problems in older persons. The data of this study highlights the number, variability, and complexity of geriatric problems in patients treated in specialized acute care geriatric hospital wards in Germany. TRIAL REGISTRATION German Clinical trial register (DRKS-ID: DRKS00031354 on 27.02.2023).
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Affiliation(s)
- Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - J Verdon
- McGill University Health Center, Royal Victoria Hospital, Montreal, QC, Canada
| | - H Frohnhofen
- Department of Orthopedics and Traumasurgery, Heinrich Heine University, Düsseldorf, Germany
- Department of Health, University Witten-Herdecke, Witten, Germany
| | - M Djukic
- Department of Geriatric Medicine, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
| | - M Meisel
- MEDICLIN Heart-Center, Coswig, Germany
| | - M Musolf
- Department of Geriatric Medicine, Ev. Amalie Sieveking-Krankenhaus, Hamburg, Germany
| | - A Zinke
- Department of Geriatric Medicine, St. Marien- und St. Annastiftskrankenhaus, Ludwigshafen, Germany
| | - H J Heppner
- Department of Geriatric Medicine, Klinikum Bayreuth, Bayreuth, Germany
| | - M Jamour
- Department of Internal and Geriatric Medicine, Alb-Donau-Klinikum, Ehingen, Germany
| | - M Denkinger
- Geriatric Centre Ulm, Agaplesion Bethesda Clinic, Ulm University, Ulm, Germany
| | - U S Trampisch
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany.
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Hobert MA, Jamour M. [Assessment of mobility-Geriatric assessment instruments for mobility impairments and perspectives of instrumentation]. Z Gerontol Geriatr 2022; 55:116-122. [PMID: 35181808 DOI: 10.1007/s00391-022-02040-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Mobility and its limitations play an important role in the quality of life of geriatric patients and influence activity and participation. The assessment of mobility is therefore of particular importance for treatment and treatment planning in geriatric patients. There is a variety of assessment tools that cannot be used in every patient group, e.g. due to floor effects. This article provides an overview of common assessment tools and facilitates the evaluation and use of these tools. Special consideration is given to performance-oriented aspects and current technical developments such as wearables.
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Affiliation(s)
- Markus A Hobert
- Klinik für Neurologie, UKSH Campus Kiel, Christian-Albrechts-University zu Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - Michael Jamour
- Allgemeine Innere Medizin und Geriatrie, Alb-Donau-Klinikum, Ehingen, Deutschland.,Geriatrische Rehabilitationsklinik Ehingen, Ehingen, Deutschland
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Gerhard T, Mayer K, Braisch U, Dallmeier D, Jamour M, Klaus J, Seufferlein T, Denkinger M. [Validation of the geriatrie-check for identification of geriatric patients in emergency departments]. Z Gerontol Geriatr 2020; 54:106-112. [PMID: 32112273 PMCID: PMC7946687 DOI: 10.1007/s00391-020-01699-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/14/2019] [Accepted: 01/16/2020] [Indexed: 11/12/2022]
Abstract
Hintergrund Der Geriatrie-Check wurde im Rahmen des Geriatriekonzept Baden-Württemberg zur Identifikation geriatrischer Patienten in der Notaufnahme entwickelt. Ziel Bestimmung der konvergenten und prädiktiven Validität des Geriatrie-Checks zu Identifikation und Verlaufsprädiktion geriatrischer Patienten in der Notaufnahme. Material und Methoden Prospektive Kohortenstudie zwischen November 2015 und April 2016 mit 146 Patienten, älter als 70 Jahre, der internistischen Notaufnahme der Uniklinik Ulm. Getrennte Erhebung durch Ärzte und Pflegende: Identification of Seniors at Risk (ISAR), Geriatrie-Check, weitere kognitive und funktionelle Assessments und als Endpunkte: Veränderung von Pflegestufe, Barthel-Index, Wohnform. Ergebnisse Der ISAR klassifizierte n =117 Patienten als geriatrisch, der Geriatrie-Check n =107. Die Übereinstimmung betrug 78,1 %. Mit dem ISAR als Goldstandard zeigte der Geriatrie-Check eine Sensitivität von 82,0 % und eine Spezifität von 62,1 %. Der positiv- bzw. negativ-prädiktive Wert lag bei 89,7 % bzw. 46,1 %. Mit dem ISAR als Goldstandard war die Einschätzung der Pflege präziser als die der Ärzte überlegen (Sensitivität 70,5 % vs. 58 %; Spezifität 88,9 % vs. 83,3 %). Die prädiktive Validität 5 Monate nach Aufnahme bezüglich oben genannter Endpunkte war am besten für die Einschätzung durch Pflege und Ärzte (insbesondere die Spezifität). Beide Tests waren sehr sensitiv, aber wenig spezifisch. Diskussion Der Geriatrie-Check ist dem ISAR vergleichbar. Die konvergente Validität unterscheidet sich nur wenig. Beide, ISAR und Geriatrie-Check, sind etwas sensitiver als Ärzte und Pflege. Bezüglich der prädiktiven Validität sind Ärzte und Pflege den Scores überlegen. Ein Algorithmus aus ISAR oder Geriatrie-Check mit nachfolgender Einschätzung durch Arzt oder Pflege könnte sich für eine bedarfsgerechte Ressourcenallokation am besten eignen.
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Affiliation(s)
- Tobias Gerhard
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Kristina Mayer
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Ulrike Braisch
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland.,Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland
| | - Dhayana Dallmeier
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Michael Jamour
- Geriatrische Rehabilitationsklinik Ehingen, Ehingen, Deutschland
| | - Jochen Klaus
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm, Deutschland
| | | | - Michael Denkinger
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland. .,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland.
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Hobert M, Bernhard F, Sartor J, Bettecken K, Maetzler W, Jamour M. VALIDATION OF A SCREENING TOOL (GERIATRIC-CHECK) FOR GERIATRIC PATIENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1567] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M.A. Hobert
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany,
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany,
| | - F.P. Bernhard
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany,
| | - J. Sartor
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany,
| | - K. Bettecken
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany,
| | - W. Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany,
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany,
| | - M. Jamour
- Geriatric Rehabilitation Clinic of Ehingen (Krankenhaus GmbH Alb-Donau district), Ehingen, Germany
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Grund S, Denkinger M, Braisch U, Marburger C, Runge M, Jamour M. UTILITY OF THE SPPB FOR SHORT-TERM OUTCOME PREDICTION OF MULTIMORBID GERIATRIC REHABILITANTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3328] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S. Grund
- Diakonissenkrankenhaus Mannheim, Mannheim, Germany,
- Agaplesion Bethesda Klinik Ulm, Ulm, Germany
| | | | - U. Braisch
- Biometrie Universität Ulm, Ulm, Germany,
- Agaplesion Bethesda Klinik Ulm, Ulm, Germany
| | | | - M. Runge
- Privatpraxis, Esslingen am Neckar, Germany,
| | - M. Jamour
- Geriatrische Rehabilitationsklinik Ehingen, Ehingen, Germany,
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Jamour M, Marburger C, Runge M, Sieber CC, Tümena T, Swoboda W. [Effectiveness of geriatric rehabilitation in the oldest old: evaluation of South German observational data]. Z Gerontol Geriatr 2015; 47:389-96. [PMID: 25012107 DOI: 10.1007/s00391-014-0662-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Geriatric rehabilitation might be the only way for the very old to maintain their participation in social life, since in many cases self care, everyday skills and basic activities of daily living can only be recovered by an integrative treatment approach using a multiprofessional team setting. At the same time limited financial resources in health care have to be considered to make appropriate allocation decisions in geriatric rehabilitation. PURPOSE The goal of this work was to determine whether chronological age is a limiting factor for functional outcome in geriatric rehabilitation. MATERIALS AND METHODS Data from the state of Baden-Württemberg (KODAS data set) from the years 2005-2011 for nonagenarians and data for centenarians from the Geriatrics in Bavaria database (GiB-DAT) project from the years 2003-2011 were compared to the data of the younger seniors undergoing geriatric rehabilitation. For the KODAS data collection, 31 geriatric rehabilitation clinics in Baden-Württemberg were involved. The GiB-DAT project included 59 geriatric rehabilitation clinics in Bavaria. Both databases compare the results of the geriatric assessment at the beginning and at the end of geriatric rehabilitation. RESULTS The analyzed data are presented with regard to the functional outcome in the very elderly and are discussed with respect to policy implications.
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Affiliation(s)
- M Jamour
- Geriatrische Rehabilitationsklinik Ehingen, Alb-Donau-Klinikum, Spitalstr. 29, 89584, Ehingen, Deutschland,
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Benzinger P, Lindemann U, Becker C, Aminian K, Jamour M, Flick SE. Geriatric rehabilitation after hip fracture. Role of body-fixed sensor measurements of physical activity. Z Gerontol Geriatr 2014; 47:236-42. [PMID: 23780628 DOI: 10.1007/s00391-013-0477-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The demand for geriatric rehabilitation will drastically increase over the next years. It will be increasingly important to demonstrate the efficacy and effectiveness of geriatric rehabilitation. One component is the use of objective and valid assessment procedures. These should be understandable to patients, relevant for goal attainment, and able to document change. A number of currently used physical capacity measures have floor effects. The use of body-fixed sensor technology for monitoring physical activity is a possible supplement for the assessment during geriatric rehabilitation to overcome floor effects and directly monitor improvement of mobility as a component of geriatric rehabilitation in many patients. METHODS The observational study with a pre-post design examined 65 consecutive geriatric hip fracture inpatients. Measurements were performed on admission and 2 weeks later. The capacity measures included gait speed, chair rise time, a balance test, 2-Minute-Walk test and the Timed-Up-and-Go test. Physical activity was measured over 9 h using body-fixed sensor technology and expressed as cumulated walking and walking plus standing (time on feet). RESULTS Body-fixed sensors allowed direct measurement of physical activity in all patients available for testing. Cumulated walking and standing (time on feet) increased from a median 83.6 to 102.6 min. Cumulated walking increased from a median 7.0 to 16.3 min. The comparison with the physical capacity measures demonstrated a modest to fair correlation (rs = 0.455 and 0.653). This indicates that physical capacity measures are not the same construct as physical activity. CONCLUSION Body-fixed sensor-based assessment of physical activity was feasible even in geriatric patients with severe mobility problems and decreased the number of patients with missing data both on admission and 2 weeks later. Body-fixed sensor data documented change in activity level.
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Affiliation(s)
- P Benzinger
- Geriatric Rehabilitation , Robert Bosch Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany,
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Benzinger P, Zijlstra GAR, Lindemann U, Nicolai S, Hoffrichter R, Jamour M, Becker C, Pfeiffer K. Erratum to: Depressive symptoms and fear of falling in previously community-dwelling older persons recovering from proximal femoral fracture. Aging Clin Exp Res 2013. [DOI: 10.1007/bf03325360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lindemann U, Jamour M, Nicolai SE, Benzinger P, Klenk J, Aminian K, Becker C. Physical activity of moderately impaired elderly stroke patients during rehabilitation. Physiol Meas 2012; 33:1923-30. [PMID: 23111341 DOI: 10.1088/0967-3334/33/11/1923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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
In older adults, physical activity (PA) is promoted for public health preventive effort. It is also a major target in the rehabilitation process. Existing assessment tools in the clinical routine do not include any aspects of PA or participation and are often prone to floor or ceiling effects. The aim of this study was to document the process of rehabilitation by activity monitoring without floor or ceiling effects. Ninety-two stroke patients of a geriatric rehabilitation unit (mean age 82 years, ±6.21 years, 61% women) were included in an observational study to assess physical capacity (balance, chair rise, gait speed) and PA at admission and two weeks thereafter. PA was measured through an ambulatory activity monitor based on accelerometers and gyroscopes and showed no floor or ceiling effects. Floor effects were however documented for measures of physical capacity (admission 5-11%; follow-up 2-9%) and ceiling effects were registered for the balance test (admission 17.4%; follow-up 22.8%). Improvements were documented for measures of physical capacity as well as for PA (all p < 0.001). We conclude that the assessment of PA by activity monitoring is a valuable measure to document objectively the process of rehabilitation without floor or ceiling effects.
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Affiliation(s)
- U Lindemann
- Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.
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Lukas A, Kilian R, Hay B, Muche R, von Arnim CAF, Otto M, Riepe M, Jamour M, Denkinger MD, Nikolaus T. [Maintenance of health and relief for caregivers of elderly with dementia by using "initial case management": experiences from the Lighthouse Project on Dementia, Ulm, ULTDEM-study]. Z Gerontol Geriatr 2012; 45:298-309. [PMID: 22538793 DOI: 10.1007/s00391-012-0337-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND When facing the well-known demographic development with an increasing number of people suffering from dementia, there is a need of programmes to support nursing relatives and care at home. Many support services have been established in the past few years but they are rarely used by the relatives and the patients. The purpose of the Lighthouse Project Ulm (ULTDEM Study) was to prove the effectiveness of a single advisory approach in order to provide support services after care level classification and to relieve the burden placed on relatives caring for family members suffering from dementia ("initial case management"). METHODS The ULTDEM Study is a prospective, open, randomized, controlled, interventional study with different parallel outcome measures (burden of caring, quality of life and mood). After the randomization, the interventional group was given comprehensive, individual advice about available treatment possibilities for dementia patients. Control group participants received standard treatment. Inclusion criteria were application of a care level (0 or 1) as well as dementia diagnosis. All participants (patients/relatives) underwent an initial and a 6 month comprehensive assessment. RESULTS Our results show that a single advisory approach does not lead to a significant difference in outcome measures in interventional and control groups. Those tendencies described have to be interpreted as clinically not relevant. Although utilization of support services increases, it remains similar in both study groups. A confirmatory interpretation has not been possible due to a lack of adjustment to the findings regarding multiple testing and an insufficient degree of recruitment. Possible causes will be discussed such as premature intervention during the course of the disease, a lack of intervention blinding, recruitment bias and lack of an influence on adherence with regard to the use of support services. IMPLICATIONS The study demonstrates that there is a substantial information deficit for persons affected by dementia and their relatives. Innovative ways still have to be developed to ensure that this information actually reaches the target audience.
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Affiliation(s)
- A Lukas
- AGAPLESION Bethesda Klinik Ulm, Akademisches Krankenhaus der Universität Ulm, Zollernring 26-28, 89073 Ulm.
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Jamour M, Becker C, Bachmann S, de Bruin ED, Grüneberg C, Heckmann J, Marburger C, Nicolai SE, Schwenk M, Lindemann U. [Recommendation of an assessment protocol to describe geriatric inpatient rehabilitation of lower limb mobility based on ICF: an interdisciplinary consensus process]. Z Gerontol Geriatr 2012; 44:429-36. [PMID: 22159835 DOI: 10.1007/s00391-011-0267-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Because of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.
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Affiliation(s)
- M Jamour
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstr 110, 70376 Stuttgart.
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Denkinger MD, Lindemann U, Nicolai S, Igl W, Jamour M, Nikolaus T. Assessing Physical Activity in Inpatient Rehabilitation: Validity, Practicality, and Sensitivity to Change in the Physical Activity in Inpatient Rehabilitation Assessment. Arch Phys Med Rehabil 2011; 92:2012-7. [DOI: 10.1016/j.apmr.2011.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 06/24/2011] [Indexed: 11/25/2022]
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Benzinger P, Zijlstra GAR, Lindemann U, Nicolai S, Hoffrichter R, Jamour M, Becker C, Pfeiffer K. Depressive symptoms and fear of falling in previously community-dwelling older persons recovering from proximal femoral fracture. Aging Clin Exp Res 2011; 23:450-6. [PMID: 22526077 DOI: 10.1007/bf03325241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Depression and fear of falling are common problems following proximal femoral fracture. The role of fear of falling in depressive symptoms after such a fracture has not yet been investigated. The aim of this study was to establish possible changes during recovery in fear of falling and depressive symptoms following rehabilitation in this population and to explore their association. METHODS Observational study with pre-post design at a single geriatric rehabilitation hospital in Germany. Data were collected during in-hospital rehabilitation and four months later at participants' home. The data of 51 participants living in the community at the time of fracture could be analysed. MAIN MEASURES Fear of falling, depressive symptoms, cognition, pain, ADL functioning, and physical performance. RESULTS Although physical and ADL performance improved between admission to rehabilitation and follow-up four months later, the prevalence of depressive symptoms increased, and levels of fear of falling remained at the same level. There was a significant correlation between fear of falling and depressive symptoms at follow-up, but the two were not significantly correlated at baseline. Fear of falling and depressive symptoms were not significantly associated in a path analysis model. CONCLUSIONS Fear of falling and depressive symptoms are highly prevalent after proximal femoral fracture. Yet there seems to be no simple association between either psychological parameter in older persons recovering from fall-related fractures. Further research is warranted, in order to develop interventions targeting these psychological outcomes.
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Denkinger MD, Igl W, Jamour M, Bader A, Bailer S, Lukas A, Nikolaus T. Does functional change predict the course of improvement in geriatric inpatient rehabilitation? Clin Rehabil 2010; 24:463-70. [PMID: 20354056 DOI: 10.1177/0269215509353269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The evaluation of rehabilitation success as measured by different tools is becoming increasingly important in terms of time and money allocation. We wanted to know whether functional change in the first week predicts subsequent improvement in a geriatric inpatient rehabilitation clinic. DESIGN Observational longitudinal study. SETTING Geriatric inpatient rehabilitation clinic in Germany. SUBJECTS One hundred and sixty-one inpatients (117 women) with a median age of 82 years, capable of walking at baseline. MAIN MEASURES Weekly assessments of physical function were performed from admission until three weeks later. We used a self-rated tool (the function component of the Short Form - Late Life Function and Disability Index), a proxy-rated tool (the Barthel Index) and a performance-based tool (gait speed). We set up linear regression models to estimate the predictive capacity of change in physical function within the first week on change in physical function within the following two weeks. RESULTS Positive correlations were found between functional change within the first week and total change within three weeks. However, correlations of the same periods of change with subsequent change were negative. Correlations were highly significant for both analysis with P-values <0.0001 when the same measures for prediction and outcome were used. Correlations were inconsistent when prediction and outcome were different. CONCLUSIONS Improvement within the first week of inpatient rehabilitation is negatively correlated with subsequent functional change.
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Denkinger MD, Igl W, Lukas A, Bader A, Bailer S, Franke S, Denkinger CM, Nikolaus T, Jamour M. Relationship Between Fear of Falling and Outcomes of an Inpatient Geriatric Rehabilitation Population-Fear of the Fear of Falling. J Am Geriatr Soc 2010; 58:664-73. [DOI: 10.1111/j.1532-5415.2010.02759.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Denkinger MD, Igl W, Coll-Planas L, Bleicher J, Nikolaus T, Jamour M. Evaluation of the Short Form of the Late-Life Function and Disability Instrument in Geriatric InpatientsâValidity, Responsiveness, and Sensitivity to Change. J Am Geriatr Soc 2009; 57:309-14. [DOI: 10.1111/j.1532-5415.2008.02095.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Denkinger MD, Igl W, Coll-Planas L, Nikolaus T, Bailer S, Bader A, Jamour M. Practicality, validity and sensitivity to change of fear of falling self-report in hospitalised elderly--a comparison of four instruments. Age Ageing 2009; 38:108-12. [PMID: 19001557 DOI: 10.1093/ageing/afn233] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Denkinger MD, Coll-Planas L, Jamour M, Nikolaus T. The assessment of physical activity in inpatient rehabilitation-an important aspect of the identification of frailty in hospitalized older people. J Am Geriatr Soc 2007; 55:967-8; author reply 968-9. [PMID: 17537110 DOI: 10.1111/j.1532-5415.2007.01192.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The racemic selective serotonin reuptake inhibitor citalopram (CIT) is increasingly used for depressive disorders. As both enantiomers of CIT differ in pharmacologic activity and demethylated metabolites might contribute to the antidepressent action of CIT, a stereoselective assay for all active compounds is needed, but will require that pharmacokinetic/pharmacodynamic relationships be investigated. A stereoselective high-performance liquid chromatography (HPLC)-assay (Chirobiotic V column) with UV-detection (lambda = 240 nm) for R- and S-CIT as well as both enantiomers of desmethyl(DM)-CIT and didesmethyl(DDM)-CIT was developed. The calibration range was linear from 5 to 200 ng/mL and the lower limit of detection averaged 2 ng/mL. Based on three quality controls (10, 75, and 150 ng/mL) the intraday and interday coefficients of variation ranged from 1.3% to 9.0% for CIT and from 2.2% to 10.3% for DM-CIT and DDM-CIT. The assay was used to analyze the trough steady state plasma levels of all 6 agents in 16 elderly patients treated daily with 20 to 40 mg CIT. For the dose of 20 mg (n = 14) mean values +/- SD of R- (and S-CIT) averaged 36.2+/-15.0 (27.4+/-13.1) ng/mL, respectively (mean R/S-ratio: 1.4+/-0.4), for R- (and S-DM-CIT) 7.2+/-3.1 (7.7+/-3.8) ng/mL, respectively (R/S-ratio: 1.0+/-0.3) whereas DDM-CIT was only detectable as R-enantiomer in 8 cases (13.2+/-12.1 ng/mL; range: 2.2-36.2 ng/mL). Significant (p < 0.01) linear correlations could be found between both enantiomers of CIT and DM-CIT as well as between parent drug and primary metabolite for the R-enantiomers. Apparently R/S- and metabolic ratios increased with dose; this might indicate that stereoselective disposition of CIT and DM-CIT is concentration-dependent. The present assay allows a rapid, sensitive, and reliable stereoselective determination of CIT and its (active) metabolites which can be applied for assessing pharmacokinetic parameters and evaluating putative relationships to clinical (side) effects.
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Affiliation(s)
- Z Zheng
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
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Abstract
BACKGROUND In Germany the implementation of specialized wards for the care of stroke patients is proposed. However, which type of organized inpatient stroke unit care is most effective and which group of patients will benefit most remains unclear. METHODS Based on the analyses of the Stroke Unit Trialists' Collaboration this paper reports results of randomized and quasi-randomized trials that compared organized inpatient (stroke unit) care with contemporary conventional care. The primary analyses examined death, dependency and institutionalization. Secondary outcome measures included patient quality of life, patient and carer satisfaction and length of stay in hospital and/or institution. RESULTS The analysis of twenty trails with 3864 patients showed a reduction in the rate of deaths in the stroke unit group as compared with the control group (OR 0.83, 95% CI 0.71-0.97). The odds of death or institutionalized care were lower (OR 0.76, 95% CI 0.65-0.90) as were death or dependency (OR 0.75, 95% CI 0.65-0.87). The results were independent of patient age, sex, stroke severity, and type of stroke unit organization. CONCLUSION Organized care in stroke units resulted in benefits for stroke patients with regard to survival, independence, and probability of living at home. However, these results refer exclusively to Anglo-American and Scandinavian trials. German stroke unit services are organized in a different way. No data about the effectiveness of the German model is yet available.
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Affiliation(s)
- T Nikolaus
- Bethesda Geriatrische Klinik/Universität Ulm.
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