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Fränzel K, Koschate J, Freiberger E, Shigematsu R, Zieschang T, Tietgen S. Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study. BMC Geriatr 2024; 24:326. [PMID: 38600478 PMCID: PMC11005258 DOI: 10.1186/s12877-024-04932-3] [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: 10/16/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT). METHODS Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system. RESULTS Both the SPPB total score improved significantly (p = < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p = < 0.001), walk ratio (p = 0.011), step length (p = < 0.001), stride length (p = < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible. CONCLUSIONS SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care. TRIAL REGISTRATION DRKS00026191.
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Affiliation(s)
- Katja Fränzel
- Department of Geriatrics, Carl von Ossietzky Universität Oldenburg Faculty VI Medicine and Health Sciences, Department of Health Services Research, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany.
| | - Jessica Koschate
- Department of Geriatrics, Carl von Ossietzky Universität Oldenburg Faculty VI Medicine and Health Sciences, Department of Health Services Research, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Ageing Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nuremberg, Germany
| | - Ryosuke Shigematsu
- School of Health and Sport Science, Chukyo University, 101 Tokodachi, Toyota, Aichi, 470-0393, Japan
| | - Tania Zieschang
- Department of Geriatrics, Carl von Ossietzky Universität Oldenburg Faculty VI Medicine and Health Sciences, Department of Health Services Research, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany
| | - Svenja Tietgen
- Department of Geriatrics, Carl von Ossietzky Universität Oldenburg Faculty VI Medicine and Health Sciences, Department of Health Services Research, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany
- Department of Geriatrics, General Hospital Bremerhaven Reinkenheide gGmbH, Postbrookstraße 103, 27574, Bremerhaven, Germany
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Stuckenschneider T, Schmidt L, Speckmann EM, Koschate J, Zieschang T. Recruiting patients for falls prevention in the emergency department - worth the challenge. BMC Geriatr 2023; 23:880. [PMID: 38129767 PMCID: PMC10740331 DOI: 10.1186/s12877-023-04607-5] [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: 10/24/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited. OBJECTIVE Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study. METHODS The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics. RESULTS Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed. CONCLUSION ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory. TRIAL REGISTRATION DRKS00025949.
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Affiliation(s)
- Tim Stuckenschneider
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany.
| | - Laura Schmidt
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Elisa-Marie Speckmann
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Jessica Koschate
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Tania Zieschang
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
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Koschate J, Stuckenschneider T, Zieschang T. [Reactive dynamic balance in the geriatric setting : Possibilities for evaluation and quantification in functionally heterogeneous persons]. Z Gerontol Geriatr 2023; 56:458-463. [PMID: 37656226 DOI: 10.1007/s00391-023-02227-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Most falls in older persons occur during walking and are often due to maladaptation in response to gait perturbations. Therefore, the assessment of reactive dynamic balance is highly relevant for determining the individual risk of falling and could enable an early initiation of interventions. OBJECTIVE The methods available for perturbation of gait and for evaluating the corresponding reaction patterns are critically discussed in order to approach the assessment of reactive dynamic balance. MATERIAL AND METHODS A diagnostic protocol for perturbation of gait on a treadmill was developed based on the literature. The application of the protocol to map reactive dynamic balance as comprehensively as possible is presented. RESULTS After the initial determination of the individually preferred gait speed over ~ 6 min, the participant's gait is disrupted with 9 different types of perturbations over a time period of ~ 4:30 min. The evaluation options include spatiotemporal parameters and their variability, the margin of stability and the Lyapunov exponent. CONCLUSION Dynamic reactive balance is a promising and specific parameter for quantifying the risk of falling in older persons. The comprehensive evaluation of the documented parameters is currently insufficient because there are no established methods or references. The development of a unified method for the sensitive determination of reactive dynamic balance is essential for its use in assessment of the risk of falling in the clinical context and for measuring the success of training.
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Affiliation(s)
- J Koschate
- Fakultät VI - Medizin und Gesundheitswissenschaften, Abteilung Geriatrie, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - T Stuckenschneider
- Fakultät VI - Medizin und Gesundheitswissenschaften, Abteilung Geriatrie, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
| | - T Zieschang
- Fakultät VI - Medizin und Gesundheitswissenschaften, Abteilung Geriatrie, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
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Lohmöller M, Zieschang T, Koschate J. Leisure time physical activity and exercise performance in active older people in rural areas-Comparison of the first and second COVID-19 related lockdown in Germany. PLoS One 2023; 18:e0291560. [PMID: 37708185 PMCID: PMC10501614 DOI: 10.1371/journal.pone.0291560] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
The closure of all sports facilities during the two lockdowns in Germany favoured a reduction of leisure time physical activity during the COVID-19 pandemic. The aim of this study was to compare leisure time physical activity during the 1st and 2nd lockdown and to examine exercise performance before and after resumption of exercise. Leisure time physical activity was measured by the Longitudinal Urban Cohort Ageing Study (LUCAS) functional ability index and energy expenditure in the Minnesota Leisure Time Physical Activity Questionnaire. Participants' exercise performance was extracted from a chip-controlled fitness circuit. Differences were tested for statistical significance using Friedman tests. 35 participants above 60 years were included from the Oldenburg area (20 women, 15 men, mean age and standard deviation 71±6 years). The decline in energy expenditure was higher during the 2nd lockdown (1st lockdown: Median -55.7 kcal.day-1, Q0.25-121.3 kcal.day-1, Q0.75 132.9 kcal.day-1; 2nd lockdown: Median -119.7 kcal.day-1, Q0.25-255.6 kcal.day-1, Q0.75-65.1 kcal.day-1; Friedman test: p<0.001, n = 35, W = 0.262). The time spent in the fitness circuit decreased from lockdown to lockdown as well as the number of participants exercising there. Intense activities were performed during the two lockdowns by only 7 and 3 participants, respectively, and were not resumed by two-thirds of the participants after the 2nd lockdown. During the 1st lockdown, exercise performance on resistance exercise devices increased in most of them, while it decreased by 1 to 7% during the 2nd lockdown. The lockdowns limited leisure time physical activity in older adults. This was more pronounced during the lockdown in winter 2020/2021, when participants engaged less in outdoor activities. Therefore, measures should be taken to maintain physical activity and muscle strength, especially during winter months, with a home-based training, if visiting gyms is not possible.
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Affiliation(s)
- Maris Lohmöller
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Tania Zieschang
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jessica Koschate
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Hellmers S, Krey E, Gashi A, Koschate J, Schmidt L, Stuckenschneider T, Hein A, Zieschang T. Comparison of machine learning approaches for near-fall-detection with motion sensors. Front Digit Health 2023; 5:1223845. [PMID: 37564882 PMCID: PMC10410450 DOI: 10.3389/fdgth.2023.1223845] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Falls are one of the most common causes of emergency hospital visits in older people. Early recognition of an increased fall risk, which can be indicated by the occurrence of near-falls, is important to initiate interventions. Methods In a study with 87 subjects we simulated near-fall events on a perturbation treadmill and recorded them with inertial measurement units (IMU) at seven different positions. We investigated different machine learning models for the near-fall detection including support vector machines, AdaBoost, convolutional neural networks, and bidirectional long short-term memory networks. Additionally, we analyzed the influence of the sensor position on the classification results. Results The best results showed a DeepConvLSTM with an F1 score of 0.954 (precision 0.969, recall 0.942) at the sensor position "left wrist." Discussion Since these results were obtained in the laboratory, the next step is to evaluate the suitability of the classifiers in the field.
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Affiliation(s)
- Sandra Hellmers
- Assistance Systems and Medical Device Technology, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Elias Krey
- Assistance Systems and Medical Device Technology, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Arber Gashi
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Jessica Koschate
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Laura Schmidt
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Tim Stuckenschneider
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Andreas Hein
- Assistance Systems and Medical Device Technology, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Tania Zieschang
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
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Weimann A, Ahlert M, Seehofer D, Zieschang T, Schweda M. Old Age and Frailty in Deceased Organ Transplantation and Allocation-A Plea for Geriatric Assessment and Prehabilitation. Transpl Int 2023; 36:11296. [PMID: 37476294 PMCID: PMC10354295 DOI: 10.3389/ti.2023.11296] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
Due to demographic ageing and medical progress, the number and proportion of older organ donors and recipients is increasing. At the same time, the medical and ethical significance of ageing and old age for organ transplantation needs clarification. Advanced age is associated with the frailty syndrome that has a negative impact on the success of organ transplantation. However, there is emerging evidence that frailty can be modified by suitable prehabilitation measures. Against this backdrop, we argue that decision making about access to the transplant waiting list and the allocation of donor organs should integrate geriatric expertise in order to assess and manage frailty and impairments in functional capacity. Prehabilitation should be implemented as a new strategy for pre-operative conditioning of older risk patients' functional capacity. From an ethical point of view, advanced chronological age per se should not preclude the indication for organ transplantation and the allocation of donor organs.
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Affiliation(s)
- Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
| | - Marlies Ahlert
- Department of Economics, Martin-Luther-University of Halle, Halle, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Tania Zieschang
- Division of Geriatric Medicine, Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Mark Schweda
- Division of Medical Ethics, Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
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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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Hackbarth M, Koschate J, Lau S, Zieschang T. Depth-Imaging for Gait Analysis on a Treadmill in Older Adults at Risk of Falling. IEEE J Transl Eng Health Med 2023; 11:479-486. [PMID: 37817821 PMCID: PMC10561749 DOI: 10.1109/jtehm.2023.3277890] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Accidental falls are a major health issue in older people. One significant and potentially modifiable risk factor is reduced gait stability. Clinicians do not have sophisticated kinematic options to measure this risk factor with simple and affordable systems. Depth-imaging with AI-pose estimation can be used for gait analysis in young healthy adults. However, is it applicable for measuring gait in older adults at a risk of falling? METHODS In this methodological comparison 59 older adults with and without a history of falls walked on a treadmill while their gait pattern was recorded with multiple inertial measurement units and with an Azure Kinect depth-camera. Spatiotemporal gait parameters of both systems were compared for convergent validity and with a Bland-Altman plot. RESULTS Correlation between systems for stride length (r=.992, [Formula: see text]) and stride time (r=0.914, [Formula: see text]) was high. Bland-Altman plots revealed a moderate agreement in stride length (-0.74 ± 3.68 cm; [-7.96 cm to 6.47 cm]) and stride time (-3.7±54 ms; [-109 ms to 102 ms]). CONCLUSION Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect cameras. Affordable and small depth-cameras agree with IMUs for gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact. Clinical Translation Statement- Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect. Affordable and small depth-cameras, developed for various purposes in research and industry, agree with IMUs in clinical gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy to assess function or monitor changes in gait is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact.
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Affiliation(s)
- Michel Hackbarth
- School of Medicine and Health ScienceDepartment for Health Services Research, Geriatrics DivisionCarl von Ossietzky University Oldenburg26129OldenburgGermany
| | - Jessica Koschate
- School of Medicine and Health ScienceDepartment for Health Services Research, Geriatrics DivisionCarl von Ossietzky University Oldenburg26129OldenburgGermany
| | - Sandra Lau
- School of Medicine and Health ScienceDepartment for Health Services Research, Geriatrics DivisionCarl von Ossietzky University Oldenburg26129OldenburgGermany
| | - Tania Zieschang
- School of Medicine and Health ScienceDepartment for Health Services Research, Geriatrics DivisionCarl von Ossietzky University Oldenburg26129OldenburgGermany
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Gehle T, Lau S, Hackbarth M, Zieschang T, Koschate J. Physical performance and compensation strategies of older adults to maintain physical fitness and well-being during the COVID-19 pandemic in Germany. BMC Geriatr 2023; 23:239. [PMID: 37081379 PMCID: PMC10117253 DOI: 10.1186/s12877-023-03952-9] [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: 01/15/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION During the first wave of the COVID-19 pandemic in March 2020, worldwide restrictions in social life, including the closure of sport facilities, led to a reduction of physical activity and subjective well-being. The aim of this study is to describe physical training habits, and subjective well-being in relation to objective training data from a chip-controlled fitness circuit in the rural area of Oldenburg, Germany. MATERIALS AND METHODS Overall, 35 older adults (20 women 71 ± 6 y/o and 15 men, 72 ± 7 y/o), regularly exercising in a chip-controlled fitness circuit before the lockdown in March 2020, were interviewed. The training data from February to August 2020 from six strength and two endurance exercise devices were extracted and compared to data before and up to three months after the lockdown. Additionally, participants' personal characteristics, physical activities and quality of life before, during, and after the first lockdown were assessed. RESULTS The leg score (pre, postJune, postJuly, postAugust: 1207 ± 469 kg, 1248 ± 477 kg, 1254 ± 516 kg, 1283 ± 493 kg; p = 0.137) and endurance scores (ergometer: 0.93 ± 0.35 min- 1 · watt- 1, 0.86 ± 0.31 min- 1 · watt- 1, 0.86 ± 0.31 min- 1 · watt- 1, 0.85 ± 0.28 min- 1 · watt- 1 ; p = 0.442) were not significantly different, in contrast to the rowing score (1426 ± 582 kg, 1558 ± 704 kg, 1630 ± 757 kg, 1680 ± 837 kg; p < 0.001). A significant increase of total energy expenditure (p = 0.026), mainly through gardening, walking, and bike riding was observed. The greatest personal limitation reported, was the loss of social contacts. CONCLUSION The presented data did not show a decrease in training performance, but a slight trend towards an increase. A compensatory increase in regular outdoor activities seems to have a protective effect against a loss of training performance and may have the potential to stabilize subjective well-being during lockdown periods.
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Affiliation(s)
- Torben Gehle
- School of Medicine and Health Sciences, Department for Health Services Research, Geriatric Medicine, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
| | - Sandra Lau
- School of Medicine and Health Sciences, Department for Health Services Research, Geriatric Medicine, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michel Hackbarth
- School of Medicine and Health Sciences, Department for Health Services Research, Geriatric Medicine, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Tania Zieschang
- School of Medicine and Health Sciences, Department for Health Services Research, Geriatric Medicine, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jessica Koschate
- School of Medicine and Health Sciences, Department for Health Services Research, Geriatric Medicine, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Fassmer AM, Allers K, Helbach J, Zuidema S, Freitag M, Zieschang T, Hoffmann F. Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability. J Am Med Dir Assoc 2023; 24:609-618.e6. [PMID: 36898411 DOI: 10.1016/j.jamda.2023.01.030] [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: 11/15/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To investigate proportions of hospitalized nursing home residents during periods of increased vulnerability, ie, the first 6 months after institutionalization and the last 6 months before death, and comparing the figures between Germany and the Netherlands. DESIGN Systematic review, registered in PROSPERO (CRD42022312506). SETTING AND PARTICIPANTS Newly admitted or deceased residents. METHODS We searched MEDLINE via PubMed, EMBASE, and CINAHL from inception through May 3, 2022. We included all observational studies that reported the proportions of all-cause hospitalizations among German or Dutch nursing home residents during these defined vulnerable periods. Study quality was assessed using the Joanna Briggs Institute's tool. We assessed study and resident characteristics and outcome information and descriptively reported them separately for both countries. RESULTS We screened 1856 records for eligibility and included 9 studies published in 14 articles (Germany: 8; Netherlands: 6). One study for each country investigated the first 6 months after institutionalization. A total of 10.2% of the Dutch and 42.0% of the German nursing home residents were hospitalized during this time. Overall, 7 studies reported on in-hospital deaths, with proportions ranging from 28.9% to 29.5% for Germany and from 1.0% to 16.3% for the Netherlands. Proportions for hospitalization in the last 30 days of life ranged from 8.0% to 15.7% (Netherlands: n = 2) and from 48.6% to 58.0% (Germany: n = 3). Only German studies assessed the differences by age and sex. Although hospitalizations were less common at older ages, they were more frequent in male residents. CONCLUSIONS AND IMPLICATIONS During the observed periods, the proportion of nursing homes residents being hospitalized differed greatly between Germany and the Netherlands. The higher figures for Germany can probably be explained by differences in the long-term care systems. There is a lack of research, especially for the first months after institutionalization, and future studies should examine the care processes of nursing home residents following acute events in more detail.
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Affiliation(s)
- Alexander M Fassmer
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany.
| | - Katharina Allers
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Jasmin Helbach
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael Freitag
- Division of General Practice, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Tania Zieschang
- Division of Geriatrics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
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Zieschang T, Schütze S. [General aspects of dementia disorders]. Inn Med (Heidelb) 2023; 64:127-130. [PMID: 36692517 DOI: 10.1007/s00108-022-01462-1] [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] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/25/2023]
Abstract
The prevalence of dementia increases with age. In rare cases, people younger than 65 years old are also affected, with substantial consequences for the professional life. The symptoms depend on the form of dementia and can vary individually. Impairment of short-term memory is not always in the foreground and other neurocognitive domains, such as the disturbance of executive functions can have a significant impact on the ability to cope with everyday life. Pathophysiologically, neurodegenerative dementias with the major forms of Alzheimer's dementia, Lewy body dementia, and frontotemporal dementia are distinguished from vascular dementias. Mixed forms are common. There is no curative treatment, but progression can be slowed by nonpharmacological measures and, especially in Alzheimer's dementia, by pharmacological treatment. Appropriate measures can promote independence and autonomy for as long as possible; however, in the course of the disease restrictions in the extended activities of independent living will initially occur, such as banking transactions, use of means of transport and, in the further course, also in the basic activities of daily living. Legal capacity and the ability to consent to health interventions are restricted sooner or later; however, this must always be evaluated for the specific situation and is not generally the case with the diagnosis of dementia. Instruments such as living wills, identification of a health care proxy, and advanced care planning should be used at an early stage. To decrease family caregiver burden with the increased risk of developing depression, supportive, accompanying measures and education are of great importance.
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Affiliation(s)
- Tania Zieschang
- Abteilung für Geriatrie, Department für Versorgungsforschung, Fakultät VI Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland. .,Geriatrisches Zentrum Oldenburg (GZO), Universitätsklinik für Geriatrie, Klinikum Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland.
| | - Sandra Schütze
- Sektion Neurogeriatrie, Medizinisch-Geriatrische Klinik, AGAPLESION Frankfurter Diakonie Kliniken, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland.
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12
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Zieschang T, Otto-Sobotka F, Shakoor A, Lau S, Hackbarth M, Koschate J. The impact of pandemic-related social distancing regulations on exercise performance-Objective data and training recommendations to mitigate losses in physical fitness. Front Public Health 2023; 11:1099392. [PMID: 36926166 PMCID: PMC10011707 DOI: 10.3389/fpubh.2023.1099392] [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: 11/15/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction In the context of the COVID-19 pandemic in Germany, governmental restrictions led to the closure of sports facilities for several months. To date, only subjective and fitness-tracking related data on physical activity during the pandemic are available. Using data of a chip-controlled fitness circuit, training data as a measure of physical performance before and after the lockdown during the first wave of the COVID-19 pandemic will show the impact of the training interruption on exercise performance in middle-aged and older adults. The re-training data are analyzed, to extract practical recommendations. Methods Objective training data of 17,450 participants [11,097 middle-aged (45-64 yrs), 6,353 older (≥65 yrs)] were exported from chip-controlled milon® fitness circuit systems before and after the first COVID-19 related lockdown in Germany. The change in the product of training weight (sum of lifting and lowering the training weight) and repetitions on the leg extension resistance exercise device (leg score) between the last three training sessions before the lockdown and the first ten training sessions after individual training resumption as well as the last training session before the second lockdown in October 2020 was analyzed. Results Participants who trained with high intensity before the lockdown, experienced deleterious effects of the training interruption (middle-aged group: -218 kg, older group: ~-230.8 kg; p < 0.001 for change in leg score from to post-lockdown) with no age effect. Participants training with a leg score of more than 3,000 kg did not resume their leg score until the second lockdown. Conclusion The interruption of training in a fitness circuit with combined resistance and endurance training due to the lockdown affected mainly those participants who trained at high intensity. Apparently, high-intensity training could not be compensated by home-based training or outdoor activities. Concepts for high-intensity resistance training during closure of sports facilities are needed to be prepared for future periods of high incidence rates of infectious diseases, while especially vulnerable people feel uncomfortable to visit sports facilities. Trial registration Identifier, DRKS00022433.
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Affiliation(s)
- Tania Zieschang
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Fabian Otto-Sobotka
- Epidemiology and Biometry, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Abdul Shakoor
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sandra Lau
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michel Hackbarth
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jessica Koschate
- Geriatric Medicine, Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Stuckenschneider T, Koschate J, Dunker E, Reeck N, Hackbarth M, Hellmers S, Kwiecien R, Lau S, Levke Brütt A, Hein A, Zieschang T. Sentinel fall presenting to the emergency department (SeFallED) - protocol of a complex study including long-term observation of functional trajectories after a fall, exploration of specific fall risk factors, and patients' views on falls prevention. BMC Geriatr 2022; 22:594. [PMID: 35850739 PMCID: PMC9289928 DOI: 10.1186/s12877-022-03261-7] [Citation(s) in RCA: 3] [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: 04/11/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a leading cause for emergency department (ED) visits in older adults. As a fall is associated with a high risk of functional decline and further falls and many falls do not receive medical attention, the ED is ideal to initiate secondary prevention, an opportunity generally not taken. Data on trajectories to identify patients, who would profit the most form early intervention and to examine the impact of a fall event, are lacking. To tailor interventions to the individual's needs and preferences, and to address the whole scope of fall risks, we developed this longitudinal study using an extensive assessment battery including dynamic balance and aerobic fitness, but also sensor-based data. Additionally, participative research will contribute valuable qualitative data, and machine learning will be used to identify trips, slips, and falls in sensor data during daily life. METHODS This is a mixed-methods study consisting of four parts: (1) an observational prospective study, (2) a randomized controlled trial (RCT) to explore whether a diagnostic to measure reactive dynamic balance influences fall risk, (3) machine learning approaches and (4) a qualitative study to explore patients' and their caregivers' views. We will target a sample size of 450 adults of 60 years and older, who presented to the ED of the Klinikum Oldenburg after a fall and are not hospitalized. The participants will be followed up over 24 months (within four weeks after the ED, after 6, 12 and 24 months). We will assess functional abilities, fall risk factors, participation, quality of life, falls incidence, and physical activity using validated instruments, including sensor-data. Additionally, two thirds of the patients will undergo intensive testing in the gait laboratory and 72 participants will partake in focus group interviews. DISCUSSION The results of the SeFallED study will be used to identify risk factors with high predictive value for functional outcome after a sentinel fall. This will help to (1) establish a protocol adapted to the situation in the ED to identify patients at risk and (2) to initiate an appropriate care pathway, which will be developed based on the results of this study. TRIAL REGISTRATION DRKS (Deutsches Register für klinische Studien, DRKS00025949 ). Prospectively registered on 4th November, 2021.
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Affiliation(s)
- Tim Stuckenschneider
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Jessica Koschate
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Ellen Dunker
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Nadja Reeck
- Department of Health Services Research, Junior Research Group for Rehabilitation Sciences, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Michel Hackbarth
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Sandra Hellmers
- Department for Health Assistance Systems and Medical Device Technology, Services Research, School of Medicine and Health Sciences, Carl Von Ossietzky University, Oldenburg, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Münster, Germany
| | - Sandra Lau
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, Junior Research Group for Rehabilitation Sciences, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Andreas Hein
- Department for Health Assistance Systems and Medical Device Technology, Services Research, School of Medicine and Health Sciences, Carl Von Ossietzky University, Oldenburg, Germany
| | - Tania Zieschang
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Sciences, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany.
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14
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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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15
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Diekmann R, Hellmers S, Lau S, Heinks A, Elgert L, Bauer JM, Zieschang T, Hein A. Are vertical jumps able to predict 24-month follow-up functional geriatric assessment in a healthy community-dwelling older cohort? Aging Clin Exp Res 2022; 34:2769-2778. [PMID: 36053442 PMCID: PMC9675680 DOI: 10.1007/s40520-022-02230-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/11/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND When older adults fall below the thresholds of functional geriatric assessment (FGA), they may already be at risk of mobility impairment. A reduction in (jumping) power could be an indication of functional decline, one of the main risk factors for falls. OBJECTIVE This paper explores whether six-month delta (∆) values of muscle power can predict 24-month follow-up FGA in older adults. METHODS This observational study of independent, healthy, high-performing community-dwelling adults aged 70 + years involved FGA (mobility, balance, and endurance tests) at baseline (t0), after 6 months (t1), and after 24 months (t2); maximum jumping power (max JP) was determined at t0 and t1. A predictive linear model was developed in which the percentage change of Δmax JP0,1 was transferred to all FGA (t0) values. The results were compared with measured FGA values at t2 via sensitivity and specificity in terms of the clinically meaningful change (CMC) or the minimal detectable change (MDC). RESULTS In 176 individuals (60% female, mean age 75.3 years) the mean percentage (SD) between predicted and measured FGA ranged between 0.4 (51.3) and 18.11 (51.9). Sensitivity to identify the CMC or MDC of predicted FGA tests at t2 ranged between 17.6% (Timed up and go) and 75.0% (5-times-chair-rise) in a test-to-test comparison and increased to 97.6% considering clinically conspicuousness on global FGA. CONCLUSION The potential of jumping power to predict single tests of FGA was low regarding sensitivity and specificity of CMC (or MDC). 6 months Δmax JP seem to be suitable for predicting physical function, if the measured and predicted tests were not compared at the test level, but globally, in the target group in the long term.
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Affiliation(s)
- Rebecca Diekmann
- Assistance Systems and Medical Device Technology, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr. 140, 26129, Oldenburg, Germany.
| | - Sandra Hellmers
- Assistance Systems and Medical Device Technology, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr. 140, 26129, Oldenburg, Germany
| | - Sandra Lau
- Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - Andrea Heinks
- Assistance Systems and Medical Device Technology, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr. 140, 26129, Oldenburg, Germany
- Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - Lena Elgert
- Assistance Systems and Medical Device Technology, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr. 140, 26129, Oldenburg, Germany
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig, Hannover Medical School (MHH), Hannover, Germany
| | - Juergen M Bauer
- Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - Tania Zieschang
- Geriatric Medicine, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Andreas Hein
- Assistance Systems and Medical Device Technology, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr. 140, 26129, Oldenburg, Germany
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16
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Lau S, von Aschwege FM, Zieschang T, Bauer J, Hein A, Diekmann R. Activity Space and Functional Outcomes in Frail Older Persons Using GPS analysis. Innov Aging 2021. [PMCID: PMC8680707 DOI: 10.1093/geroni/igab046.1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
With increasing age, walking becomes a main functional ability to participate in activities of daily living and supports independence and mobility. Frailty in older, multimorbid patients has a negative impact on physical activity and may reduce the personal activity space (AS). In this pilot study, GPS data were used to identify walking tracks to define individual AS and to compare functional performance in frail older persons. GPS data of 20 community-dwelling adults (84.5(±5.2)years, 85% women, mean frailty phenotype 1.9 (70% ≥2)points) were analyzed using a customized software to assess individual AS over a ten-months period. A geriatric home assessment including Short Physical Performance Battery (SPPB), gait speed (GS) and Timed-up-and-Go (TUG) was conducted monthly. GPS analysis revealed three different walking types presenting AS similarities: Type A walkers prefer smaller short walks nearby the home while Type B can be characterized by taking larger regular walks. Type C presents the widest AS using different transportation modes, but only a moderate number of walks. Mean group difference in functional performance of Type A walkers showed significantly reduced GS (0.45(±0.1)m/s), TUG (23.4s(±4.9)) and SPPB scores (3.8(±0.8) points; p<0.05) compared to Type C (0.82(±0.1)m/s (GS); 13.2(±1.4)s (TUG); 7.0(±1.3) points (SPPB)). Functional performance of Type B walkers (0.63(±0.2)m/s (GS); 17.1(±4.4)s (TUG); 6.5(±2.4)points (SPPB)) revealed significantly higher SPPB scores compared to Type A (p<0.05). Walks and individual AS can be mapped via GPS under everyday conditions. High heterogeneity within frail older people was observed. Persons with lower functional performance showed a reduced AS and physical activity.
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Affiliation(s)
- Sandra Lau
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | | | - Tania Zieschang
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Juergen Bauer
- Heidelberg University, Heidelberg, Baden-Wurttemberg, Germany
| | - Andreas Hein
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Rebecca Diekmann
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
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17
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Koschate J, Hackbarth M, Lau S, Zieschang T. Changes in Physical Fitness of Older People During the COVID-19 Pandemic in Germany: Objective Training Data. Innov Aging 2021. [PMCID: PMC8680353 DOI: 10.1093/geroni/igab046.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to analyze objective training data on changes in leg muscle training before and after the COVID-19 lockdown during spring 2020 in Germany. Overall, the training data of 4435 individuals in the age group (AG) 45-64 years (55±5 years, 66% ♀) and of 2853 in the AG 65-95 years (72±6 years, 54% ♀) were exported from chip-controlled exercise circuits. Training weight and number of repetitions performed on the leg extensor were used to calculate a leg score (LS), considering the last three training sessions before the lockdown (baseline) and the first ten individual sessions as well as the averaged sessions for August, September and October after individual training resumption. Based on the baseline LS, three training intensity groups (TG_low, medium, high) were defined, and analyzed for differences (ANOVA). The LS in TG_low remained stable after the lockdown, but increased compared to baseline in both AGs after the first ten sessions (p<0.05). In TG_medium, LS was reduced at the first post training session (p<0.05) and returned to baseline levels at training session eight in the younger and session two in the older adults. In both AGs, LS was reduced in the TG_high (p<0.001), and did not reach baseline levels by October. Hence, the LS of TG_high was identified as being particularly affected by the training interruption, irrespective of age. More individually tailored training recommendations should be made for these individuals to be able to regain their initial training levels and avoid long-term adverse health effects.
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Affiliation(s)
- Jessica Koschate
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Michel Hackbarth
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Sandra Lau
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Tania Zieschang
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
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Hackbarth M, Koschate J, Lau S, Zieschang T. Finding Static Stability Limits: Comparison of Reactive Balance in Older People With and Without a History of Falls. Innov Aging 2021. [PMCID: PMC8679744 DOI: 10.1093/geroni/igab046.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Reactive balance is a highly relevant fall risk factor, but is rarely considered in clinical practice. Especially medio-lateral perturbations lead to a pronounced instability of the gait pattern. However, there is no consensus on a method for the assessment of individually challenging perturbation intensities to apply during walking. The aim of this study is to determine and compare the static stability-limits in older adults with and without a history of falls. Twelve older adults with (OAF; 75.6 ±3.66,9♀) and 19 older adults without a history of falls (OA; 77.5 ±4.99,12♀) were subjected to progressive-intensifying perturbations while standing on a perturbation treadmill. In addition, functional performance (Mini-BESTest), fear of falling (FES-I), and physical activity (kcal) were assessed Deflection of the treadmill-platform was randomized by timing and direction and was increased until the subject had to compensate with a step (stability-limit). The maximum deflection distance for each direction, as well as the FES-I score, mini-BESTest score, and activity level were evaluated for group differences using the t-test and Mann-Whitney-U test (α≤5%). There were no significant group differences in the mini-BESTest and between the maximum tolerated deflection distances. The OAF-subjects showed an increased FES-I score (median for OA=18.0 and OAF=22.0, p=0.032) and higher activity levels (median for OA=1974 kcal and OAF=3365 kcal, p=0.011). Despite an increased fear of falling, the older adults with a fall history showed a similar stability-limit, but higher activity levels. In future experiments these static stability limits should be tested during walking and evaluated via motion analysis.
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Affiliation(s)
- Michel Hackbarth
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Jessica Koschate
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Sandra Lau
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Tania Zieschang
- Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
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Happe L, Lau S, Koschate J, Diekmann R, Hein A, Zieschang T. [Feasibility and acceptance of video-based physiotherapy : New medical care provision for older people during the COVID-19 pandemic]. Z Gerontol Geriatr 2021; 54:346-352. [PMID: 33938980 PMCID: PMC8090529 DOI: 10.1007/s00391-021-01899-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund und Ziel Einschränkungen des öffentlichen Lebens durch die COVID-19-Pandemie dienen insbesondere dazu, Risikogruppen vor einer Ansteckung zu schützen. Darunter fallen auch ältere, multimorbide Patienten, für die körperliche Inaktivität und Auslassen von Maßnahmen wie Physiotherapie jedoch negative Folgen haben können. Die vorliegende Studie untersucht die Machbarkeit und die subjektive Bewertung videobasierter Physiotherapie (VT). Methoden Von April bis Juni 2020 nahmen 4 Einrichtungen mit 9 Patienten (6 Frauen, 64 bis 82 Jahre) an der Studie teil, die mit Tablets ausgestattet wurden. Durch semistrukturierte Telefoninterviews wurden körperliche Aktivität, funktionelle Kompetenz und Partizipation vor und während den Einschränkungen bei 8 Patienten erfasst. Patienten und Therapeuten wurden zu ihren subjektiven Erfahrungen mit der VT befragt. Ergebnisse Es fanden insgesamt 92 VT-Einheiten statt. Die Umsetzung der Übungen wurde als gut bis sehr gut bewertet. Insgesamt zeigte sich eine hohe Akzeptanz der VT. Vier von 8 Patienten beschrieben eine subjektive Reduzierung ihrer körperlichen Aktivitäten aufgrund der Einschränkungen. Diese Veränderungen wurden über die verwendeten Fragebogen zur Partizipation und zur körperlichen Aktivität nicht abgebildet. Diskussion Bei älteren Patienten ist VT mit geringer technischer Unterstützung machbar. Sowohl in Pandemiesituationen als auch in anderen Kontexten stellt sich VT als eine realisierbare Ergänzung oder Alternative zur normalen Physiotherapie dar. Weitere Studien zur Identifikation von geeigneten Patientengruppen, Effektivität der VT und Weiterentwicklung inhaltlicher Aspekte sind dringend notwendig. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-021-01899-3) enthalten.
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Affiliation(s)
- Lisa Happe
- Abteilung für Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - Sandra Lau
- Abteilung für Geriatrie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - Jessica Koschate
- Abteilung für Geriatrie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
| | - Rebecca Diekmann
- Abteilung für Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
| | - Andreas Hein
- Abteilung für Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
| | - Tania Zieschang
- Abteilung für Geriatrie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
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Emmerich K, Müller-Simianer E, Penner H, Zieschang T. Dysphagietherapie in der Geriatrie: Abwägungen zwischen Lebensqualität und Risiko – eine qualitative Studie. Ethik Med 2020. [DOI: 10.1007/s00481-020-00597-9] [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: 11/29/2022]
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Koschate J, Lau S, Zieschang T, Hoffmann U. 28 Cardiorespiratory Regulation and Aerobic Fitness in Older People – A New Approach for Falls Interventions? Age Ageing 2019. [DOI: 10.1093/ageing/afz164.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Guidelines for physical activity give recommendations for moderate to vigorous aerobic training 2-3 times per week. Aerobic exercise, like walking, shows mixed effects in regard to falls prevention. However, after high intensity exercise postural stability is decreased and better aerobic fitness might be relevant to minimize this fall risk in older individuals. So far, the association of aerobic fitness and falls has not been examined in older people. Feasible methodology is lacking. Aerobic fitness can be assessed measuring cardiorespiratory (heart rate [HR] and oxygen uptake [V’O2]) regulation in response to changing submaximal work rate (WR) intensities. For cycle ergometry (cycling) cardiorespiratory regulation correlated with aerobic fitness. Since treadmill walking (TMW) is closer to daily life activities, TMW is tested for feasibility in older people and compared to data during cycling.
Methods
17 participants (65±6 years, 23.9±3.8 kg∙m-2) were tested for V’O2 and HR regulation during cycling (30W, 80W) and TMW (1.9 km·h-1, 5 km·h-1). Inclination during TMW was matched to WR during cycling. Additionally, WR was further increased until the first ventilatory threshold (VT1) was reached. Kinetics were assessed applying cross-correlation functions (CCF). Higher maxima in CCF (CCFmax () in a.u.) imply faster system responses. T-tests were applied to calculate differences between the exercise modes. Correlations were computed using Pearson tests.
Results
Significant differences for CCFmax (V’O2) were identified between cycling and TMW (0.51±0.10 vs. 0.45±0.08; p=0.032), but not for CCFmax (HR) (cycling: 0.62±0.13; TMW: 0.60±0.10; p=0.623). CCFmax (HR) during TMW correlated with V’O2 at VT1 during TMW (r=0.538, p=0.013).
Discussion
TMW is feasible to adequately determine cardiorespiratory regulation and correlated with aerobic fitness in older people and has a better applicability. Hence, cardiorespiratory regulation might be an important factor to assess in the context of falls.
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Affiliation(s)
- Jessica Koschate
- Health Services Research - Geriatric Medicine, University of Oldenburg, Germany
| | - Sandra Lau
- Health Services Research - Geriatric Medicine, University of Oldenburg, Germany
| | - Tania Zieschang
- Health Services Research - Geriatric Medicine, University of Oldenburg, Germany
| | - Uwe Hoffmann
- Exercise Physiology, German Sport University, Germany
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von Arnim CAF, Bartsch T, Jacobs AH, Holbrook J, Bergmann P, Zieschang T, Polidori MC, Dodel R. Diagnosis and treatment of cognitive impairment. Z Gerontol Geriatr 2019; 52:309-315. [PMID: 31161337 DOI: 10.1007/s00391-019-01560-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/12/2019] [Accepted: 05/07/2019] [Indexed: 01/14/2023]
Abstract
As a result of the aging population dementia is a growing challenge, especially in healthcare. Nevertheless, cognitive disorders are often not systematically evaluated, especially during hospital stays for other reasons; however, cognitive impairment is associated with a number of geriatric syndromes, including falls, delirium, dysphagia and lack of adherence to treatment plans. This article considers the current state of diagnosis and treatment of dementia. Non-pharmacological therapeutic approaches as well as current and future pharmacological treatment options are discussed. The drugs of choice for the symptomatic treatment of cognitive deficits in Alzheimer's disease and Parkinson-associated dementia are cholinesterase inhibitors and memantine; there is no specific pharmacological treatment for other types of dementia. Prevention and treatment of cardiovascular risk factors can potentially retard the progression of possibly all forms of dementia.
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Affiliation(s)
- Christine A F von Arnim
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | | | | | - Jill Holbrook
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | | | - Tania Zieschang
- University Clinic of Geriatric Medicine, Oldenburg University, Oldenburg, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Dpt. II Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Richard Dodel
- Geriatric Medicine, University Duisburg-Essen, Essen, Germany
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Zieschang T, Bauer J, Kopf D, Rösler A. [Special care units for patients with cognitive impairment : Results of a nationwide survey in geriatric hospitals in Germany]. Z Gerontol Geriatr 2018; 52:598-606. [PMID: 30178120 DOI: 10.1007/s00391-018-1439-z] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/18/2018] [Accepted: 08/07/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND A large number of older acutely ill patients with cognitive impairment are treated in geriatric care units. Since 1990 some geriatric departments in Germany have established special care units (SCU) for this patient population. In 2010 the first inventory of SCUs in Germany was carried out, which was not based on a nationwide systematic survey. OBJECTIVE Nationwide systematic survey of SCUs for patients with cognitive impairment in geriatric institutions in Germany. METHODS An online questionnaire (SurveyMonkey®, San Mateo, CA, USA) was sent to all heads of geriatric departments that provide advanced education in geriatric medicine of at least 12 months as registered by the German Society for Geriatric Medicine (DGG). RESULTS The questionnaire was sent to 495 geriatric institutions of which 161 answered (response rate 32.5%). Additionally, 13 institutions answered through a weblink sent in a newsletter by the DGG. In 2017 a total of 42 SCUs existed with a mean size of 13.5 ± 4.7 beds. A further 15 hospitals plan to install an SCU in the near future, 5 probably in 2018. In four geriatric departments an existing SCU was closed down. All SCUs implemented special architectural, structural and personnel measures as recommended by the position paper of the DGG. The few conducted evaluations indicated beneficial results for mobility and disruptive behavior. CONCLUSION In recent years the number of SCUs has increased considerably. A methodologically sound evaluation with respect to patient-related outcomes including follow-up and cost-effectiveness is lacking and should be carried out in the near future.
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Affiliation(s)
- Tania Zieschang
- Geriatrisches Zentrum der Universität Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacherstraße 149, 69126, Heidelberg, Deutschland.
| | - Jürgen Bauer
- Geriatrisches Zentrum der Universität Heidelberg, AGAPLESION Bethanien Krankenhaus Heidelberg, Rohrbacherstraße 149, 69126, Heidelberg, Deutschland
| | - Daniel Kopf
- Kath. Marienkrankenhaus gGmbH, Alfredstraße 9, 22087, Hamburg, Deutschland
| | - Alexander Rösler
- Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Deutschland
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Roeben B, Zieschang T, Maetzler W. [Therapy of Dementia: State of the Art]. Dtsch Med Wochenschr 2018; 143:741-747. [PMID: 29727890 DOI: 10.1055/s-0043-113619] [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: 10/17/2022]
Abstract
Due to the aging population, dementias represent a growing challenge for the health systems and for the society. This overview summarizes the current state of already practice-relevant therapies and management of dementias. Non-pharmacological approaches have a greater impact than pharmacological treatment. Increasing evidence underlines that consistent management of cardiovascular risk factors has beneficial effects on the progression of at least some, possibly almost all types of dementias. The main pharmacological agents for symptomatic treatment of cognitive deficits in Alzheimer's and Parkinson's disease-associated dementias are cholinesterase inhibitors and memantine. In most other dementias, no specific pharmacological treatment is currently available. There is an urgent need for further research on the effective management of dementias.
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Zieschang T, Wolf M, Vellappallil T, Uhlmann L, Oster P, Kopf D. The Association of Hyponatremia, Risk of Confusional State, and Mortality. Dtsch Arztebl Int 2018; 113:855-862. [PMID: 28098064 DOI: 10.3238/arztebl.2016.0855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 03/17/2016] [Accepted: 08/11/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hyponatremia and delirium are frequent problems in older hospitalized patients. Although confusional states are considered to be a possible complication of hyponatremia, there has been no systematic study to date of the precise prevalence of delirium among patients with hyponatremia and its effect on long-term outcomes. METHODS In a 13-month period in 2009/2010, all patients with a serum sodium level less than or equal to 130 mmol/L (the hyponatremia group) in a cohort of hospitalized older patients were studied and compared to a normonatremic control group of patients who were matched for age, sex, and diagnosis group. The prevalence of delirium was determined by two-stage examination. Inhospital mortality, mortality six months after initial examination, and functional status were prospectively analyzed. RESULTS 179 patients were identified whose serum sodium level was less than or equal to 130 mmol/L (7.9% of all treated patients), of whom 141 were included in the hyponatremia group. The mean age of the participants was 83 (range, 63-102), and 84% were women. Patients with hyponatremia suffered more often from delirium (22.7% versus 8.5%; p = 0.002) and had a higher inhospital mortality (10.6% versus 2.1%; p = 0.005). The mortality six months after initial examination was 31.9% versus 22.7% (p = 0.080). 59.7% of patients in the hyponatremia group and 49% in the control group (p = 0.146) needed a higher level of chronic care after discharge than they had needed before the hospitalization. CONCLUSION Hyponatremia in hospitalized older patients is associated with a higher likelihood of delirium and an elevated in-hospital mortality.
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Affiliation(s)
- Tania Zieschang
- Geriatric Centre at the University of Heidelberg, Agaplesion Bethanien Hospital Heidelberg; SLK-Kliniken Heilbronn GmbH; Department of Anesthesiology and Intensive Care, Evangelische Diakonissenanstalt Karlsruhe-Rüppurr; Institute for Medical Biometry and Informatics (IMBI), University of Heidelberg; Geriatric Hospital, Katholisches Marienkrankenhaus Hamburg, gGmbH
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Zieschang T. In Reply. Dtsch Arztebl Int 2017; 114:289-290. [PMID: 28502317 PMCID: PMC5437265 DOI: 10.3238/arztebl.2017.0289b] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Tania Zieschang
- *Geriatrisches Zentrum an der Universität Heidelberg Agaplesion Bethanien Krankenhaus Heidelberg
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Affiliation(s)
- Tania Zieschang
- Agaplesion Bethanien Krankenhaus, Rohrbacher Str. 149, 69126, Heidelberg, Deutschland.
| | - Jürgen M Bauer
- Lehrstuhl für Geriatrie, Ruprecht-Karls-Universität, Heidelberg, Deutschland.
- Agaplesion Bethanien Krankenhaus, Rohrbacher Str. 149, 69126, Heidelberg, Deutschland.
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Hummel J, Weisbrod C, Boesch L, Himpler K, Hauer K, Hautzinger M, Gaebel A, Zieschang T, Fickelscherer A, Diener S, Dutzi I, Krumm B, Oster P, Kopf D. AIDE-Acute Illness and Depression in Elderly Patients. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial. J Am Med Dir Assoc 2016; 18:341-349. [PMID: 27956074 DOI: 10.1016/j.jamda.2016.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression. OBJECTIVES To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness. DESIGN Randomized controlled trial with waiting list control group. SETTING Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients' homes. PARTICIPANTS A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness. INTERVENTION Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group. MEASUREMENTS HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician. RESULTS The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures. CONCLUSIONS CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients. CLINICAL TRIAL REGISTRATION www.germanctr.de German Trial Register DRKS 00004728.
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Affiliation(s)
- Jana Hummel
- Geriatric and Gerontopsychotherapeutic Practice, Mannheim, Germany.
| | | | | | | | - Klaus Hauer
- Geriatric Center Bethanien, Heidelberg, Germany
| | | | | | | | | | | | - Ilona Dutzi
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Bertram Krumm
- Central Institute of Mental Health, Mannheim, Germany
| | - Peter Oster
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Daniel Kopf
- Department of Geriatrics, Marien Hospital, Hamburg, Germany
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Büter K, Motzek T, Dietz B, Hofrichter L, Junge M, Kopf D, von Lützau-Hohlbein H, Traxler S, Zieschang T, Marquardt G. [Dementia-friendly hospital wards : Expert recommendations for planning and design]. Z Gerontol Geriatr 2016; 50:67-72. [PMID: 27325444 DOI: 10.1007/s00391-016-1079-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/16/2016] [Revised: 04/13/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. MATERIAL AND METHODS An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. RESULTS The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.
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Affiliation(s)
- K Büter
- Fakultät Architektur, Professur für Sozial- und Gesundheitsbauten, TU Dresden, 01062, Dresden, Deutschland
| | - T Motzek
- Fakultät Architektur, Professur für Sozial- und Gesundheitsbauten, TU Dresden, 01062, Dresden, Deutschland
| | - B Dietz
- Fakultät für Architektur, Krankenhausbau und Bauten des Gesundheitswesens, TU München, München, Deutschland.,Fakultät für Medizin, TU München, München, Deutschland.,Bayerisches Institut für alters- und demenzsensible Architektur, München, Deutschland
| | - L Hofrichter
- Fachbereich Life Science Engineering LSE, THM Technische Hochschule Mittelhessen, Gießen, Deutschland
| | - M Junge
- Diakonissenkrankenhaus Dresden, Dresden, Deutschland
| | - D Kopf
- Katholisches Marienkrankenhaus Hamburg, Hamburg, Deutschland
| | - H von Lützau-Hohlbein
- Selbsthilfe Demenz/Alzheimer Europe, Deutsche Alzheimer Gesellschaft e. V., Berlin, Deutschland
| | - S Traxler
- wörner traxler richter planungsgesellschaft mbh, Dresden, Deutschland
| | - T Zieschang
- Agaplesion Bethanien Krankenhaus Heidelberg, Heidelberg, Deutschland
| | - G Marquardt
- Fakultät Architektur, Professur für Sozial- und Gesundheitsbauten, TU Dresden, 01062, Dresden, Deutschland.
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Zieschang T, Schwenk M, Oster P, Hauer K. Intensive, progressive motor training in people with mild to moderate dementia. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.06.014] [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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Schwenk M, Hauer K, Zieschang T, Englert S, Mohler J, Najafi B. Sensor-derived physical activity parameters can predict future falls in people with dementia. Gerontology 2014; 60:483-92. [PMID: 25171300 DOI: 10.1159/000363136] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a need for simple clinical tools that can objectively assess the fall risk in people with dementia. Wearable sensors seem to have the potential for fall prediction; however, there has been limited work performed in this important area. OBJECTIVE To explore the validity of sensor-derived physical activity (PA) parameters for predicting future falls in people with dementia. To compare sensor-based fall risk assessment with conventional fall risk measures. METHODS This was a cohort study of people with confirmed dementia discharged from a geriatric rehabilitation ward. PA was quantified using 24-hour motion-sensor monitoring at the beginning of the study. PA parameters (percentage of walking, standing, sitting, and lying; duration of single walking, standing, and sitting bouts) were extracted using specific algorithms. Conventional assessment included performance-based tests (Timed Up and Go Test, Performance-Oriented Mobility Assessment, 5-chair stand) and questionnaires (cognition, ADL status, fear of falling, depression, previous faller). Outcome measures were fallers (at least one fall in the 3-month follow-up period) versus non-fallers. RESULTS 77 people were included in the study (age 81.8 ± 6.3; community-dwelling 88%, institutionalized 12%). Surprisingly, fallers and non-fallers did not differ on any conventional assessment (p = 0.069-0.991), except for 'previous faller' (p = 0.006). Interestingly, several PA parameters discriminated between the groups. The 'walking bout average duration', 'longest walking bout duration' and 'walking bout duration variability' were lower in fallers, compared to non-fallers (p = 0.008-0.027). The 'standing bout average duration' was higher in fallers (p = 0.050). Two variables, 'walking bout average duration' [odds ratio (OR) 0.79, p = 0.012] and 'previous faller' (OR 4.44, p = 0.007) were identified as independent predictors for falls. The OR for a 'walking bout average duration' <15 s for predicting fallers was 6.30 (p = 0.020). Combining 'walking bout average duration' and 'previous faller' improved fall prediction (OR 7.71, p < 0.001, sensitivity/specificity 72%/76%). DISCUSSION RESULTS demonstrate that sensor-derived PA parameters are independent predictors of the fall risk and may have higher diagnostic accuracy in persons with dementia compared to conventional fall risk measures. Our findings highlight the potential of telemonitoring technology for estimating the fall risk. RESULTS should be confirmed in a larger study and by measuring PA over a longer period of time.
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Affiliation(s)
- Michael Schwenk
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, Tucson, Ariz., USA
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Schwenk M, Zieschang T, Englert S, Grewal G, Najafi B, Hauer K. Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomised controlled trial. BMC Geriatr 2014; 14:73. [PMID: 24924703 PMCID: PMC4062767 DOI: 10.1186/1471-2318-14-73] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 02/12/2014] [Accepted: 06/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventing and rehabilitating gait disorders in people with dementia during early disease stage is of high importance for staying independent and ambulating safely. However, the evidence gathered in randomized controlled trials (RCTs) on the effectiveness of exercise training for improving spatio-temporal gait parameters in people with dementia is scarce. The aim of the present study was to determine whether a specific, standardized training regimen can improve gait characteristics in people with dementia. METHODS Sixty-one individuals (mean age: 81.9 years) with confirmed mild to moderate stage dementia took part in a 3-month double-blinded outpatient RCT. Subjects in the intervention group (IG) received supervised, progressive resistance and functional group training for 3 months (2 times per week for two hours) specifically developed for people with dementia. Subjects in the control group (CG) conducted a low-intensity motor placebo activity program. Gait characteristics were measured before and after the intervention period using a computerized gait analysis system (GAITRite®). RESULTS Adherence to the intervention was excellent, averaging 91.9% in the IG and 94.4% in the CG. The exercise training significantly improved gait speed (P < 0.001), cadence (P = 0.002), stride length (P = 0.008), stride time (P = 0.001), and double support (P = 0.001) in the IG compared to the CG. Effect sizes were large for all gait parameters that improved significantly (Cohen's d: 0.80-1.27). No improvements were found for step width (P = 0.999), step time variability (P = 0.425) and Walk-Ratio (P = 0.554). Interestingly, low baseline motor status, but not cognitive status, predicted positive training response (relative change in gait speed from baseline). CONCLUSION The intensive, dementia-adjusted training was feasible and improved clinically meaningful gait variables in people with dementia. The exercise program may represent a model for preventing and rehabilitating gait deficits in the target group. Further research is required for improving specific gait characteristics such as gait variability in people with dementia. TRIAL REGISTRATION ISRCTN49243245.
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Affiliation(s)
- Michael Schwenk
- Department of Geriatric Research, Bethanien-Hospital/ Geriatric Center at the University of Heidelberg, Heidelberg, Germany
- Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), College of Medicine, University of Arizona, 1656 E Mabel Street, Tucson, Arizona 85724, USA
- Arizona Center on Aging, University of Arizona, Tucson, USA
| | - Tania Zieschang
- Department of Geriatric Research, Bethanien-Hospital/ Geriatric Center at the University of Heidelberg, Heidelberg, Germany
| | - Stefan Englert
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Gurtej Grewal
- Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), College of Medicine, University of Arizona, 1656 E Mabel Street, Tucson, Arizona 85724, USA
| | - Bijan Najafi
- Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), College of Medicine, University of Arizona, 1656 E Mabel Street, Tucson, Arizona 85724, USA
- Arizona Center on Aging, University of Arizona, Tucson, USA
| | - Klaus Hauer
- Department of Geriatric Research, Bethanien-Hospital/ Geriatric Center at the University of Heidelberg, Heidelberg, Germany
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Zieschang T, Schwenk M, Becker C, Oster P, Hauer K. Motor training and falls in older people with dementia. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.220] [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: 10/26/2022]
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Zieschang T, Schwenk M, Oster P, Hauer K. Long-term effect of a standardized motor training on cognition in patients with dementia: Results of a RCT. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.704] [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: 11/26/2022]
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Affiliation(s)
- Tania Zieschang
- Agaplesion Bethanien Hospital, Center for Geriatric Medicine at the University of Heidelberg, Heidelberg, Germany
| | - Michael Schwenk
- Interdisciplinary Consortium on Advanced Motion Performance, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA
- Arizona Center on Aging, University of Arizona, Tucson, AZ, USA
| | - Peter Oster
- Agaplesion Bethanien Hospital, Center for Geriatric Medicine at the University of Heidelberg, Heidelberg, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital, Center for Geriatric Medicine at the University of Heidelberg, Heidelberg, Germany
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Affiliation(s)
- T Zieschang
- AGAPLESION Bethanien Krankenhaus, Geriatrisches Zentrum an der Universität Heidelberg, Rohrbacher Strasse 149, Heidelberg.
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Zieschang T, Oster P, Pfisterer M, Schneider N. Palliativversorgung von Menschen mit Demenz. Z Gerontol Geriatr 2012; 45:50-4. [DOI: 10.1007/s00391-011-0270-6] [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] [Received: 09/20/2011] [Accepted: 10/18/2011] [Indexed: 10/14/2022]
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Hummel J, Weisbrod C, Bösch L, Himpler K, Böhm G, Diener S, Gaebel A, Dipper L, Zieschang T, Oster P, Kopf D. [Acute illness and depression in the elderly and the influence of cognitive impairment : AIDE-cog trial]. Z Gerontol Geriatr 2012; 45:34-9. [PMID: 22278004 DOI: 10.1007/s00391-011-0271-5] [Citation(s) in RCA: 3] [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] [Received: 09/14/2011] [Accepted: 11/04/2011] [Indexed: 10/14/2022]
Abstract
Geriatric patients with acute somatic illness have a high comorbidity of depression and dementia. The following differential diagnoses have to be discerned: pseudodementia in acute depressive states, depression as a risk factor for dementia, and a depressive episode in the early stage of dementia. For both the symptoms and the trigger factors of these differential diagnoses the overlap and the particularities were qualitatively examined in the AIDE-cog (Acute Illness and Depression in Elderly cognition) trial. A second prospective randomized controlled part of the AIDE-cog trial quantitatively evaluated the influence of cognitive impairment in geriatric patients with an acute somatic illness and comorbid depression on the therapeutic effect of cognitive behavioral therapy. A preliminary analysis shows that already in early dementia the therapeutic effects are inferior. Other psychotherapeutic methods that address the remaining cognitive and emotional functions in dementia must be evaluated.
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Affiliation(s)
- J Hummel
- AGAPLESION Bethanien-Krankenhaus, Geriatrisches Zentrum am Klinikum der Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland.
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Hauer K, Schwenk M, Zieschang T, Essig M, Becker C, Oster P. Physical training improves motor performance in people with dementia: a randomized controlled trial. J Am Geriatr Soc 2011; 60:8-15. [PMID: 22211512 DOI: 10.1111/j.1532-5415.2011.03778.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether a specific, standardized training regimen can improve muscle strength and physical functioning in people with dementia. DESIGN Double-blinded, randomized, controlled trial with 3-month intervention and 3-month follow-up period in 2006 to 2009. SETTING Outpatient geriatric rehabilitation. PARTICIPANTS Individuals with confirmed mild to moderate dementia, no severe somatic or psychological disease, and ability to walk 10 m. Most participants were still living independently with or without supportive care. INTERVENTION Supervised, progressive resistance and functional group training for 3 months specifically developed for people with dementia (intervention, n = 62) compared with a low-intensity motor placebo activity (control, n = 60). MEASUREMENTS Primary outcome measures were one-repetition maximum in a leg press device for maximal strength and duration of the five-chair-stand test for functional performance. Secondary outcome measures were assessed for a number of established parameters for maximal strength, physical function, and physical activity. RESULTS Training significantly improved both primary outcomes (percentage change from baseline: maximal strength, intervention group (IG): +51.5 ± 41.5 kg vs control group (CG): -1.0 ± 28.9 kg, P < .001; functional performance, IG: -25.9 ± 15.1 seconds vs CG: +11.3 ± 60.4 seconds, P < .001). Secondary analysis confirmed effects for all strength and functional parameters. Training gains were partly sustained during follow-up. Low baseline performance on motor tasks but not cognitive impairment predicted positive training response. Physical activity increased significantly during the intervention (P < .001). CONCLUSION The intensive, dementia-adjusted training was feasible and substantially improved motor performance in frail, older people with dementia and may represent a model for structured rehabilitation or outpatient training.
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Affiliation(s)
- Klaus Hauer
- Department of Geriatric Research, Bethanien-Hospital and Geriatric Centre, University of Heidelberg, Rohrbacherstraße 149, 69126 Heidelberg, Germany. khauer@bethanien-heidelberg
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Abstract
BACKGROUND Deficits in attention-related cognitive performance measured as dual-task performance represent early markers of dementia and are associated with motor deficits and increased risk of falling. The purpose of this study was to examine the effect of a specific dual-task training in patients with mild to moderate dementia. METHODS Sixty-one geriatric patients with confirmed dementia took part in a 12-week randomized, controlled trial. Subjects in the intervention group (IG) underwent dual-task-based exercise training. The control group (CG) performed unspecific low-intensity exercise. Motor performance (gait speed, cadence, stride length, stride time, single support) and cognitive performance (serial 2 forward calculation [S2], serial 3 backward calculation [S3]) were examined as single and dual tasks. Decrease in performance during dual tasks compared to single task expressed as motor, cognitive, and combined motor/cognitive dual-task cost (DTC) was calculated before and after intervention. Primary outcome was defined as DTC for gait speed under complex S3 conditions. RESULTS Specific training significantly improved dual-task performance under complex S3 conditions compared to the CG (reduction of DTC: gait speed 21.7% IG, 2.6% CG, p < 0.001; other gait variables: 8.7% to 41.1% IG, -0.9% to 8.1% CG, p <or= 0.001 to 0.056; combined motor/cognitive: 20.6% IG, 2.2% CG, p = 0.026). No significant effects were found under less challenging dual-task S2 conditions or for cognitive dual-task S3 performance. CONCLUSIONS The specific exercise program was effective to improve dual-task performance in patients with dementia. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that specific dual-task training improves dual-task performance during walking under complex S3 conditions in geriatric patients with mild to moderate dementia.
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Affiliation(s)
- Michael Schwenk
- Department of Geriatric Research, Bethanien-Krankenhaus/Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
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Bahrmann A, Abel A, Specht-Leible N, Abel A, Wörz E, Hölscher E, Zieschang T, Oster P, Zeyfang A. [Treatment quality in geriatric patients with diabetes mellitus in various home environments]. Z Gerontol Geriatr 2010; 43:386-92. [PMID: 20401505 DOI: 10.1007/s00391-010-0104-y] [Citation(s) in RCA: 14] [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] [Received: 11/10/2009] [Accepted: 02/08/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient). METHODS Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes. RESULTS Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control. CONCLUSION The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.
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Affiliation(s)
- A Bahrmann
- Bethanien-Krankenhaus, Geriatrisches Zentrum an der Ruprecht-Karls-Universität Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.
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Zieschang T, Dutzi I, Müller E, Hestermann U, Specht-Leible N, Grünendahl K, Braun A, Hüger D, Oster P. A special care unit for acutely ill patients with dementia and challenging behaviour as a model of geriatric care. Z Gerontol Geriatr 2008; 41:453-9. [PMID: 19190868 DOI: 10.1007/s00391-008-0023-3] [Citation(s) in RCA: 9] [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: 09/30/2008] [Accepted: 10/14/2008] [Indexed: 01/28/2023]
Abstract
This paper describes the development and management of a new model of care for hospitalized patients with challenging behaviour evoked by dementia and/or delirium. To ameliorate care for patients with dementia in a geriatric acute care hospital a segregated Special Care Unit for patients with challenging behaviour was created. Environmental features allow for safe and unrestricted ambulation within the unit and create a home-like atmosphere. Day-time activities structure the day and assure additional professional presence in the unit. An intensive training program for the staff was provided. The SCU has been well accepted by the staff and is considered to be an improvement in care. Psychological burden of the nurses did not increase over a time period of one year in caring for these difficult patients.
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Affiliation(s)
- Tania Zieschang
- Bethanien Krankenhaus, Geriatrisches Zentrum an der Universität Heidelberg, Rohrbacher Strasse 149, 69126, Heidelberg, Germany.
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Braun A, Sämann A, Kubiak T, Zieschang T, Kloos C, Müller UA, Oster P, Wolf G, Schiel R. Effects of metabolic control, patient education and initiation of insulin therapy on the quality of life of patients with type 2 diabetes mellitus. Patient Educ Couns 2008; 73:50-59. [PMID: 18583087 DOI: 10.1016/j.pec.2008.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 05/07/2008] [Accepted: 05/07/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of initiation of insulin therapy, metabolic control and structured patient education on the diabetes-related quality of life (QoL) in insulin-treated patients with type 2 diabetes mellitus. METHODS This prospective study was conducted with 71 consecutively recruited patients with insulin-treated diabetes at the University hospital. All patients participated an inpatient diabetes treatment and teaching program (DTTP) for conventional insulin therapy (mean age 68.9 years, HbA1c 10.1+/-1.4%, diabetes duration 11.2 years (range: 0-25.5 years), body-mass-index 28.7+/-5.7 kg/m(2). Diabetes-related quality of life was assessed before and 6 months after participation in the DTTP using the standardized questionnaire of Lohr analysing the subscales: social relations, physical complaints, worries about the future, dietary restrictions, fear of hypoglycaemia, and daily struggles. RESULTS Only patients switched on insulin therapy showed significant improvement in diabetes-related quality of life 6 months after participation in the DTTP (p=0.03), fewer physical complaints (p=0.03), fewer worries about the future (p=0.02), fewer daily struggles (p=0.01) and less fear of hypoglycaemia (p<0.001), while patients, who were already on insulin therapy showed no improvements in diabetes-related quality of life. Though, residual analysis reveals that effects on patients' QoL are mainly caused by improvements in metabolic control. CONCLUSIONS Improvements in metabolic control have a significant effect on different diabetes-related quality of life domains in patients with diabetes mellitus. PRACTICE IMPLICATIONS Appropriate interventions resulting in better metabolic control, such as starting on insulin therapy within a structured patient education program seem to be an effective approach to improve patients' diabetes-related quality of life.
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Affiliation(s)
- Anke Braun
- Bethanien Hospital, Department of Geriatrics at the University of Heidelberg, Heidelberg, Germany.
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Abel A, Braun A, Wittmann-Jennewein C, Zieschang T, Oster P. Behandlungsqualität von Pflegeheimpatienten mit Typ-2-Diabetes mellitus. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076498] [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: 10/21/2022]
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Abel A, Braun A, Wittmann-Jennewein C, Zieschang T, Oster P. Behandlungsqualität von geriatrischen Patienten mit Diabetes mellitus. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982214] [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: 10/21/2022]
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