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de Mateo Silleras B, Barrera Ortega S, Carreño Enciso L, de la Cruz Marcos S, Redondo del Río P. Prevalence of Malnutrition in a Group of Institutionalized Psychogeriatric Patients Using Different Diagnostic Criteria. Nutrients 2024; 16:1116. [PMID: 38674807 PMCID: PMC11053945 DOI: 10.3390/nu16081116] [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: 03/12/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition (MN) is a highly prevalent condition in the elderly. It is associated with functional impairment, disability, frailty, and sarcopenia. The aim was to analyze the capacity of GLIM and ESPEN criteria to diagnose MN in a sample of institutionalized psychogeriatric patients. Clinical and anthropometric data were collected in a cross-sectional study. Patients' frailty, dependence, functional capacity, MNA, hand-grip strength (HS), and sarcopenia were evaluated. Body composition (BC) was estimated by conventional bioimpedance analysis. MN diagnosis was established using the ESPEN and the GLIM criteria based on fat-free mass index (GLIM-FFMI), appendicular skeletal muscle mass index (GLIM-ASMMI), skeletal muscle mass index (GLIM-SMMI), and HS (mGLIM). Ninety-two patients (57.6% men; mean age: 79.4 years) were studied. Depending on the diagnosis criteria, MN prevalence was between 25% (ESPEN) and 41.3% (GLIM-SMMI). Agreement between ESPEN and all GLIM criteria was poor, but it was excellent between all GLIM criteria (kappa > 0.8). Phenotypic criteria carried more weight in the diagnosis of MN than etiological ones. Depending on the parameter used, the prevalence of reduced muscle mass was notably different. Differences in BMI, BC, inflammation, and albumin are detected by the GLIM-FFMI criteria in the MN and non-MN subjects. Also, this criterion is the only one that identified differences in phase angle (PhA) between these groups. In the elderly, PhA can be very useful to monitor nutritional status.
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Affiliation(s)
- Beatriz de Mateo Silleras
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
| | - Sara Barrera Ortega
- Psycho-Geriatric Area, Assistance Center of San Juan de Dios, 34005 Palencia, Spain;
| | - Laura Carreño Enciso
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
| | - Sandra de la Cruz Marcos
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
| | - Paz Redondo del Río
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
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Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg 2021; 90:287-295. [PMID: 33502146 DOI: 10.1097/ta.0000000000003018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND While the short-term risks of emergency general surgery (EGS) admission among older adults have been studied, little is known about long-term functional outcomes in this population. Our objective was to evaluate the relationship between EGS admission and the probability of an older adult being alive and residing in their own home 5 years later. We also examined the extent to which specific EGS diagnoses, need for surgery, and frailty modified this relationship. METHODS We performed a population-based, retrospective cohort study of community-dwelling older adults (age, ≥65 years) admitted to hospital for one of eight EGS diagnoses (appendicitis, cholecystitis, diverticulitis, strangulated hernia, bowel obstruction, peptic ulcer disease, intestinal ischemia, or perforated viscus) between 2006 and 2018 in Ontario, Canada. Cases were matched to controls from the general population. Time spent alive and at home (measured as time to nursing home admission or death) was compared between cases and controls using Kaplan-Meier analysis and Cox models. RESULTS A total of 90,245 older adults admitted with an EGS diagnosis were matched with controls. In the 5 years following an EGS admission, cases experienced significantly fewer months alive and at home compared with controls (mean time, 43 vs. 50 months; p < 0.001). Except for patients operated on for appendicitis and cholecystitis, all remaining patient subgroups experienced reduced time alive and at home compared with controls (p < 0.001). Cases remained at elevated risk of nursing home admission or death compared with controls for the entirety of the 5-year follow-up (hazard ratio, 1.17-5.11). CONCLUSION Older adults who required hospitalization for an EGS diagnosis were at higher risk for death or admission to a nursing home for at least 5 years following admission compared with controls. However, most patients (57%) remained alive and living in their own home at the end of this 5-year period. LEVEL OF EVIDENCE Epidemiological, level III.
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Affiliation(s)
- Matthew P Guttman
- From the Institute of Health Policy, Management, and Evaluation (M.P.G., B.W.T., A.B.N., S.E.B., B.H.), Department of Surgery (M.P.G., A.B.N., B.H.), and Interdepartmental Division of Critical Care Medicine, Department of Medicine (B.W.T., B.H.), University of Toronto; Evaluative Clinical Sciences, Sunnybrook Research Institute (A.B.N., S.E.B., B.H.), Toronto, Ontario, Canada; American College of Surgeons, Trauma Quality Improvement Program (A.B.N.), Chicago, Illinois; and ICES Central, ICES (R.S., S.E.B., A.H.), Toronto, Ontario, Canada
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Araújo POD, Freitas MYGS, Carvalho ESDS, Peixoto TM, Servo MLS, Santana LDS, Silva JMDS, Moura JCV. Institutionalized elderly: vulnerabilities and strategies to cope with Covid-19 in Brazil. Invest Educ Enferm 2021; 39:e07. [PMID: 33687811 PMCID: PMC7987285 DOI: 10.17533/udea.iee.v39n1e07] [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] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
This article presents a systematized reflection and discussion around two guiding axes: the first discusses aging and vulnerabilities to biological, physical, cognitive, social and affective losses that require specific attention, as well as vulnerabilities to COVID-19 to which institutionalized elderly people are exposed; the second, we reflect on the adoption of restrictive and protective measures to prevent the spread of the virus, aiming to keep the elder health and mitigate the effects of the pandemic. The conclusion is that the pandemic has increased the many vulnerabilities to which institutionalized older people were already exposed, adding vulnerability to a new disease, such as COVID-19, due to its high lethality and comorbidity, aggravated by precariousness of long-term Brazilian institutions due to the negligence of public authorities, civil society, the management of the institution and the families of the patients. The post-pandemic scenario will require collective efforts to protect and ensure the survival of the elderly living in those residences.
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Araújo MPD, Nunes VMDA, Costa LDA, de Souza TA, Torres GDV, Nobre TTX. Health conditions of potential risk for severe Covid-19 in institutionalized elderly people. PLoS One 2021; 16:e0245432. [PMID: 33444352 PMCID: PMC7808625 DOI: 10.1371/journal.pone.0245432] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/03/2021] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to identify the health conditions considered potential risk factors for severe Covid-19 and analyze its association with the BMI of elderly people living in Long-Term Care Facilities (LTCF). This is a descriptive and cross-sectional study, with a quantitative approach, carried out in eight LTCF in the Metropolitan Region of Natal, Rio Grande do Norte, with a population of 267 elderly people, between the months of February and December 2018. The Elderly Health Handbook was used to collect data on sociodemographic, health and risk factors. The Pearson’s Chi-square test and odds ratio were used for the analysis. A higher frequency of low weight was observed in elderly people with cognitive impairment (24.6%), and overweight in those hypertensive (23.3%) and diabetics (12.9%). BMI was associated with the age group of 80 years or over, hypertension and diabetes (p = 0.013; p < 0.001; p = 0.001). Hypertensive elderly people were more likely to have low weight when compared to non-hypertensive individuals (RC = 3.6; 95% CI 1.5–8.6). The institutionalized elderly individuals present health conditions that may contribute to the occurrence of adverse outcomes in case of infection by Covid-19. The importance of protective measures for this population must be reinforced, in view of the devastating action of this disease in these institutions.
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Affiliation(s)
| | | | | | - Talita Araujo de Souza
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | | | - Thaiza Teixeira Xavier Nobre
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
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González-Fraile E, Ballesteros J, Rueda JR, Santos-Zorrozúa B, Solà I, McCleery J. Remotely delivered information, training and support for informal caregivers of people with dementia. Cochrane Database Syst Rev 2021; 1:CD006440. [PMID: 33417236 PMCID: PMC8094510 DOI: 10.1002/14651858.cd006440.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many people with dementia are cared for at home by unpaid informal caregivers, usually family members. Caregivers may experience a range of physical, emotional, financial and social harms, which are often described collectively as caregiver burden. The degree of burden experienced is associated with characteristics of the caregiver, such as gender, and characteristics of the person with dementia, such as dementia stage, and the presence of behavioural problems or neuropsychiatric disturbances. It is a strong predictor of admission to residential care for people with dementia. Psychoeducational interventions might prevent or reduce caregiver burden. Overall, they are intended to improve caregivers' knowledge about the disease and its care; to increase caregivers' sense of competence and their ability to cope with difficult situations; to relieve feelings of isolation and allow caregivers to attend to their own emotional and physical needs. These interventions are heterogeneous, varying in their theoretical framework, components, and delivery formats. Interventions that are delivered remotely, using printed materials, telephone or video technologies, may be particularly suitable for caregivers who have difficulty accessing face-to-face services because of their own health problems, poor access to transport, or absence of substitute care. During the COVID-19 pandemic, containment measures in many countries required people to be isolated in their homes, including people with dementia and their family carers. In such circumstances, there is no alternative to remote delivery of interventions. OBJECTIVES To assess the efficacy and acceptability of remotely delivered interventions aiming to reduce burden and improve mood and quality of life of informal caregivers of people with dementia. SEARCH METHODS We searched the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE, Embase and four other databases, as well as two international trials registries, on 10 April 2020. We also examined the bibliographies of relevant review papers and published trials. SELECTION CRITERIA We included only randomised controlled trials that assessed the remote delivery of structured interventions for informal caregivers who were providing care for people with dementia living at home. Caregivers had to be unpaid adults (relatives or members of the person's community). The interventions could be delivered using printed materials, the telephone, the Internet or a mixture of these, but could not involve any face-to-face contact with professionals. We categorised intervention components as information, training or support. Information interventions included two key elements: (i) they provided standardised information, and (ii) the caregiver played a passive role. Support interventions promoted interaction with other people (professionals or peers). Training interventions trained caregivers in practical skills to manage care. We excluded interventions that were primarily individual psychotherapy. Our primary outcomes were caregiver burden, mood, health-related quality of life and dropout for any reason. Secondary outcomes were caregiver knowledge and skills, use of health and social care resources, admission of the person with dementia to institutional care, and quality of life of the person with dementia. DATA COLLECTION AND ANALYSIS Study selection, data extraction and assessment of the risk of bias in included studies were done independently by two review authors. We used the Template for Intervention Description and Replication (TIDieR) to describe the interventions. We conducted meta-analyses using a random-effects model to derive estimates of effect size. We used GRADE methods to describe our degree of certainty about effect estimates. MAIN RESULTS We included 26 studies in this review (2367 participants). We compared (1) interventions involving training, support or both, with or without information (experimental interventions) with usual treatment, waiting list or attention control (12 studies, 944 participants); and (2) the same experimental interventions with provision of information alone (14 studies, 1423 participants). We downgraded evidence for study limitations and, for some outcomes, for inconsistency between studies. There was a frequent risk of bias from self-rating of subjective outcomes by participants who were not blind to the intervention. Randomisation methods were not always well-reported and there was potential for attrition bias in some studies. Therefore, all evidence was of moderate or low certainty. In the comparison of experimental interventions with usual treatment, waiting list or attention control, we found that the experimental interventions probably have little or no effect on caregiver burden (nine studies, 597 participants; standardised mean difference (SMD) -0.06, 95% confidence interval (CI) -0.35 to 0.23); depressive symptoms (eight studies, 638 participants; SMD -0.05, 95% CI -0.22 to 0.12); or health-related quality of life (two studies, 311 participants; SMD 0.10, 95% CI -0.13 to 0.32). The experimental interventions probably result in little or no difference in dropout for any reason (eight studies, 661 participants; risk ratio (RR) 1.15, 95% CI 0.87 to 1.53). In the comparison of experimental interventions with a control condition of information alone, we found that experimental interventions may result in a slight reduction in caregiver burden (nine studies, 650 participants; SMD -0.24, 95% CI -0.51 to 0.04); probably result in a slight improvement in depressive symptoms (11 studies, 1100 participants; SMD -0.25, 95% CI -0.43 to -0.06); may result in little or no difference in caregiver health-related quality of life (two studies, 257 participants; SMD -0.03, 95% CI -0.28 to 0.21); and probably result in an increase in dropouts for any reason (12 studies, 1266 participants; RR 1.51, 95% CI 1.04 to 2.20). AUTHORS' CONCLUSIONS Remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone, but not when compared with usual treatment, waiting list or attention control. They seem to make little or no difference to health-related quality of life. Caregivers receiving training or support were more likely than those receiving information alone to drop out of the studies, which might limit applicability. The efficacy of these interventions may depend on the nature and availability of usual services in the study settings.
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Affiliation(s)
| | - Javier Ballesteros
- Department of Neuroscience, University of the Basque Country, CIBER Salud Mental (CIBERSAM), Leioa, Spain
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Borja Santos-Zorrozúa
- Scientific coordination Unit, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Bowen ME, Gaynor B, Phillips LJ, Orsega-Smith E, Lavery A, Mitchell AB, Basehore HK. Factors Associated With Health Service Use Among Older Adults in a Mobile Veterans Program. J Gerontol Nurs 2020; 46:15-22. [PMID: 32324891 DOI: 10.3928/00989134-20200313-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/03/2019] [Indexed: 11/20/2022]
Abstract
The current retrospective, longitudinal study applied Andersen's Behavioral Model of Health Services Use to examine how demographic characteristics (age), available resources (e.g., a caregiver, the Mobile Veterans Program [MVP]) and health needs (e.g., cognitive and physical functioning, depressive symptoms) affect hospitalization and institutionalization outcomes among older adults using the MVP. Fifty-four Veterans (age 55 to 95) participating in the MVP for up to 2 years were examined using hierarchical linear modeling (HLM) and growth curve model. In the final HLM model, each 1-point increase in depressive symptoms was associated with 76% (p ≤ 0.05) greater risk of institutionalization and 40% (p ≤ 0.01) greater risk of hospitalization. Each 1-point increase in cognitive functioning was associated with 24% (p ≤ 0.05) lower risk of institutionalization. The relationship between caregiver burden and hospitalization was attenuated by frequency of MVP visits. Services focused on reducing depressive symptoms may influence health service use and reduce caregiver burden in this population. [Journal of Gerontological Nursing, 46(5), 15-22.].
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Desmond C, Watt K, Saha A, Huang J, Lu C. Prevalence and number of children living in institutional care: global, regional, and country estimates. Lancet Child Adolesc Health 2020; 4:370-377. [PMID: 32151317 DOI: 10.1016/s2352-4642(20)30022-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Children living in institutionalised settings are at risk of negative health and developmental outcomes, as well as physical and emotional abuse, yet information on their numbers is scarce. Therefore, the aim of our study was to estimate global-level, regional-level, and country-level numbers and percentages of children living in institutional care. METHODS In this estimation study, we did a systematic review of peer-reviewed publications and a comprehensive review of surveys and unpublished literature to construct a dataset on children living in institutional care from 136 countries between 2001 and 2018. We applied a wide range of methods to estimate the number and percentages of children living in institutional care in 191 countries in 2015, the year the Sustainable Development Goals were adopted. We generated 98 sets of estimates for each dataset, with possible combinations of imputation methods for countries with different available data points. Of these 98 sets, we report here five types of global-level estimates: estimates with the highest values, those with the lowest values, those with median values, those with uncertainty levels, and those derived from methods with the smallest root-mean-square errors (RMSE). FINDINGS Global estimates of children living in institutions in 2015 was highly sensitive to the methods and data used, ranging from 3·18 million to 9·42 million children, with a median estimate of 5·37 million. When selecting the method with the lowest RMSE, the global estimate was 4·21 million, whereas with negative binomial regression with bootstrapping, the global estimate was 7·52 (95% CI 7·48-7·56) million. We also observed large variations in country-level estimates. Compared with other regions, estimates in south Asia, sub-Saharan Africa, and Latin America had larger variations in values when switching between estimation methods. High-income countries had the highest average prevalence of institutionalisation, whereas low-income countries had the lowest average prevalence. Estimates from the full data with the smallest RMSE method showed that south Asia had the largest estimated number of children living in institutions (1·13 million), followed by Europe and central Asia (1·01 million), east Asia and Pacific (0·78 million), sub-Saharan Africa (0·65 million), Middle East and North Africa (0·30 million), Latin America and the Caribbean (0·23 million), and North America (0·09 million). North America consistently had the lowest estimates among all regions. INTERPRETATION Worldwide, institutional care places millions of children at elevated risk of negative health and developmental outcomes, highlighting the need for deinstitutionalisation. However, there is considerable uncertainty regarding the number of children living in institutions. To improve estimates of the size of this population, we need to standardise the definition of institutional care and improve data collection, particularly in countries with large child populations. FUNDING Lumos Foundation.
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Affiliation(s)
- Chris Desmond
- Centre for Liberation Studies, Durban, KwaZulu-Natal, South Africa; Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Kathryn Watt
- Centre for Liberation Studies, Durban, KwaZulu-Natal, South Africa
| | - Anamika Saha
- Harvard School of Public Health, Boston, MA, USA
| | - Jialin Huang
- National School of Development, Peking University, Beijing, China
| | - Chunling Lu
- Division of Global Health Equity, Brigham and Women's Hospital, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Shepherd-Banigan M, Smith VA, Lindquist JH, Cary MP, Miller KEM, Chapman JG, Van Houtven CH. Identifying treatment effects of an informal caregiver education intervention to increase days in the community and decrease caregiver distress: a machine-learning secondary analysis of subgroup effects in the HI-FIVES randomized clinical trial. Trials 2020; 21:189. [PMID: 32059687 PMCID: PMC7023677 DOI: 10.1186/s13063-020-4113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Informal caregivers report substantial burden and depressive symptoms which predict higher rates of patient institutionalization. While caregiver education interventions may reduce caregiver distress and decrease the use of long-term institutional care, evidence is mixed. Inconsistent findings across studies may be the result of reporting average treatment effects which do not account for how effects differ by participant characteristics. We apply a machine-learning approach to randomized clinical trial (RCT) data of the Helping Invested Family Members Improve Veteran's Experiences Study (HI-FIVES) intervention to explore how intervention effects vary by caregiver and patient characteristics. METHODS We used model-based recursive partitioning models. Caregivers of community-residing older adult US veterans with functional or cognitive impairment at a single VA Medical Center site were randomized to receive HI-FIVES (n = 118) vs. usual care (n = 123). The outcomes included cumulative days not in the community and caregiver depressive symptoms assessed at 12 months post intervention. Potential moderating characteristics were: veteran age, caregiver age, caregiver ethnicity and race, relationship satisfaction, caregiver burden, perceived financial strain, caregiver depressive symptoms, and patient risk score. RESULTS The effect of HI-FIVES on days not at home was moderated by caregiver burden (p < 0.001); treatment effects were higher for caregivers with a Zarit Burden Scale score ≤ 28. Caregivers with lower baseline Center for Epidemiologic Studies Depression Scale (CESD-10) scores (≤ 8) had slightly lower CESD-10 scores at follow-up (p < 0.001). CONCLUSIONS Family caregiver education interventions may be less beneficial for highly burdened and distressed caregivers; these caregivers may require a more tailored approach that involves assessing caregiver needs and developing personalized approaches. TRIAL REGISTRATION ClinicalTrials.gov, ID:NCT01777490. Registered on 28 January 2013.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham VA HSR&D ADAPT, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Department of Population Health Sciences, Duke School of Medicine, 215 Morris Street, Durham, NC, 27701, USA.
| | - Valerie A Smith
- Durham VA HSR&D ADAPT, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 300 Morris Street, Durham, NC, 27701, USA
| | - Jennifer H Lindquist
- Durham VA HSR&D ADAPT, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Michael Paul Cary
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, USA
| | - Katherine E M Miller
- Durham VA HSR&D ADAPT, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Health Policy and Management, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - Jennifer G Chapman
- Durham VA HSR&D ADAPT, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Courtney H Van Houtven
- Durham VA HSR&D ADAPT, Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 300 Morris Street, Durham, NC, 27701, USA
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Oh A, Patel K, Boscardin WJ, Max W, Stephens C, Ritchie CS, Smith AK. Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study. J Am Geriatr Soc 2019; 67:2622-2627. [PMID: 31593295 PMCID: PMC7276300 DOI: 10.1111/jgs.16184] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/02/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify participants living at home and to estimate the risk of their transition into an institutional setting. DESIGN Prospective cohort study from the National Health and Aging Trends Study (NHATS), a nationally representative survey of US adults aged 65 and older. SETTING US national sample. PARTICIPANTS A total of 4712 NHATS participants were living at home in 2011. Residential transitions were described every year through 2017. MEASUREMENTS The primary outcome was transition time into an institutional setting. Primary predictors were social support factors (living spouse, lives with others, presence of social network, and participation in social activities). Covariates included age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment. A Fine and Gray hazards model estimated the risk of transition into an institutional setting, with death before institutionalization considered a competing risk. RESULTS In 2011, 4712 NHATS participants were living at home (78 ± 8 y; 57% female; 80% white; 10% probable dementia; 7% with three or more activities of daily living disabilities). By 2017, 58% remained at home, 17% had either transitioned to an institution or died in an institution, and 25% died before institutionalization. In multivariable analyses that adjusted for age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment, participants were more likely to move out of the home into an institution if they had no social network (0 vs three or more people; subhazard ratio [sHR] = 1.8; 95% confidence interval [CI] = 1.2-2.5; P = .003) or lived alone (sHR = 1.9; 95% CI = 1.6-2.2; P < .0001). Older adults who enjoyed going to the movies, dinner, or the casino and visiting family or friends had a lower probability of institutionalization compared with participants who did not enjoy these activities or did not visit family or friends (adjusted sHR = .7; 95% CI = .6-.9; adjusted sHR = .7; 95% CI = .6-.9, respectively). CONCLUSION Policy initiatives should target older adults with limited social support to reduce the risk of moving from home into an institution. J Am Geriatr Soc 67:2622-2627, 2019.
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Affiliation(s)
- Anna Oh
- Department of Social and Behavioral Sciences, UCSF
| | - Kanan Patel
- Department of Medicine, Division of Geriatrics, UCSF
| | | | - Wendy Max
- Department of Social and Behavioral Sciences, UCSF
- Institute of Aging, UCSF
| | | | | | - Alexander K. Smith
- Department of Medicine, Division of Geriatrics, UCSF
- San Francisco VA Medical Center, San Francisco, CA
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Pereira F, Roux P, Santiago-Delefosse M, von Gunten A, Wernli B, Martins MM, Verloo H. Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol. BMJ Open 2019; 9:e030030. [PMID: 31662367 PMCID: PMC6830655 DOI: 10.1136/bmjopen-2019-030030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Optimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes. METHODS AND ANALYSIS A mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles-made up of patient-related, medication-related and environment-related factors-of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky's quadruple aim. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers' and patients' associations.
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Affiliation(s)
- Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Pauline Roux
- Research Center for Psychology of Health, Aging and Sport Examination, University of Lausanne, Lausanne, Switzerland
| | - Marie Santiago-Delefosse
- Research Center for Psychology of Health, Aging and Sport Examination, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences, University of Lausanne, FORS, Lausanne, Switzerland
| | - Maria Manuela Martins
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Higher School of Nursing of Porto, Porto, Portugal
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Kar SK, Roy P, Singh J, Tripathi A, Dalal PK. Clinical profile and correlates of hospital stay in patients with severe mental illness. Asian J Psychiatr 2019; 45:41-43. [PMID: 31493623 DOI: 10.1016/j.ajp.2019.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Pritha Roy
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, U.P, India.
| | - Jai Singh
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Pronob Kumar Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
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Friedman C. The Relationship Between Disability Prejudice and Institutionalization of People With Intellectual and Developmental Disabilities. Intellect Dev Disabil 2019; 57:263-273. [PMID: 31373544 DOI: 10.1352/1934-9556-57.4.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There are decades of research indicating ableism is extremely prominent. The aim of this study was to examine the relationships between disability prejudice and institutionalization of people with intellectual and developmental disabilities (IDD). This study had two research questions: (1) How does disability prejudice impact the number of people with IDD who are institutionalized in a state? and (2) How does disability prejudice impact spending on institutions? To do so, we utilized secondary data about state utilization of institutions (fiscal year 2015), and disability prejudice data from 325,000 people. Findings revealed, states with higher disability prejudice institutionalize more people, even when controlling for size. Moreover, states with higher disability prejudice also spend more on institutional funding, regardless of size or wealth.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, CQL | The Council on Quality and Leadership, Towson, MD
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Lehmann J, Michalowsky B, Kaczynski A, Thyrian JR, Schenk NS, Esser A, Zwingmann I, Hoffmann W. The Impact of Hospitalization on Readmission, Institutionalization, and Mortality of People with Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2019; 64:735-749. [PMID: 29966191 DOI: 10.3233/jad-171128] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with dementia (PwD) are at a high risk of hospitalization. Hospitals are often not adequately equipped for PwD and discharges often come unexpected. Therefore, PwD are at a risk of adverse outcomes. However, information about those outcomes is rare but crucial for the development of preventive strategies. OBJECTIVES To conduct a quantitative systematic review and meta-analyses on the impact of a hospitalization on readmission, institutionalization, and mortality in PwD. To identify factors associated with these outcomes. METHODS PubMed, CENTRAL, and ScienceDirect were searched for studies including terms for dementia, hospital, readmission, institutionalization, and mortality. Relevant were assessed by a quality criteria sheet. Results were summarized in a table. Meta-analysis was conducted with Review Manager 5.3. RESULTS The search yielded 1,108 studies; 20 fulfilled the inclusion criteria and 10 studies were eligible for meta-analyses. The incidence and relative risk (RR) of mortality (RR 1.74 CI95 % 1.50, 2.05) and institutionalization (RR: 2.16 CI95 % 1.31, 3.56) of PwD was significantly higher when compared to people without dementia. Results according to readmission rate were inconsistent. Factors significantly associated with the examined adverse outcomes were severity of dementia, number of medications, and deficits in daily living activities. CONCLUSION Hospitalization of PwD lead to adverse outcomes. An improvement in the identification of and care for PwD in the acute setting as well as in after care in the community setting, especially in the interface between both settings, is required to prevent adverse outcomes in hospitalized PwD.
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Benzinger P, Riem S, Bauer J, Jaensch A, Becker C, Büchele G, Rapp K. Risk of institutionalization following fragility fractures in older people. Osteoporos Int 2019; 30:1363-1370. [PMID: 30877349 DOI: 10.1007/s00198-019-04922-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/27/2019] [Indexed: 12/15/2022]
Abstract
UNLABELLED Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home. INTRODUCTION Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture. METHODS Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied. RESULTS Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture. CONCLUSIONS The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.
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Affiliation(s)
- P Benzinger
- Center for Geriatric Medicine, Bethanien Krankenhaus Heidelberg, University of Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany.
- Faculty of Social and Health Studies, University of Applied Sciences Kempten, Bahnhofstraße 61, 87435, Kempten, Germany.
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany.
| | - S Riem
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
- Klinik für Unfallchirurgie, Kreiskrankenhaus Lörrach, Spitalstraße 25, 79539, Lörrach, Germany
| | - J Bauer
- Center for Geriatric Medicine, Bethanien Krankenhaus Heidelberg, University of Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany
| | - A Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
| | - G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| | - K Rapp
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
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Norte A, Alonso C, Martínez-Sanz JM, Gutierrez-Hervas A, Sospedra I. Nutritional Status and Cardiometabolic Risk Factors in Institutionalized Adults with Cerebral Palsy. ACTA ACUST UNITED AC 2019; 55:medicina55050157. [PMID: 31108986 PMCID: PMC6572289 DOI: 10.3390/medicina55050157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 01/10/2023]
Abstract
Background and Objectives: Cerebral palsy (CP) is a set of permanent disorders that limit physical activity and increase the risk of developing other diseases, such as metabolic syndrome (MS). Adequate nutrition can contribute to the prevention of associated symptoms. The main objective of this study is to evaluate the nutritional status and the prevalence of cardiometabolic risk factors in adults with CP and Gross Motor Function Classification System (GMFCS) levels between IV and V. Materials and Methods: A sample of 41 adults with CP and GMFCS levels from IV to V were studied. The variables used in the study were age, sex, weight, height, mean age, and GMFCS level range. To evaluate nutritional status, body mass index and the Mini Nutritional Assessment (MNA), a nutritional screening tool, were used. To assess cardiometabolic risk, data on obesity, central obesity, blood pressure, fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were collected. Results: More than 80% of the population studied was malnourished or at risk of malnutrition, according to the MNA tool classification ranges, and around 35% of the studied population was within the underweight range. Regarding cardiometabolic risk factors, only one adult with CP was diagnosed with MS. Conclusions: The studied population of adults with CP and GMFCS levels between IV and V is not a population at risk of MS; however, the high prevalence of malnutrition, as well as some of the most prevalent cardiovascular risk factors, should be taken into consideration.
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Affiliation(s)
- Aurora Norte
- Nursing Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
- Research Group on Food and Nutrition (ALINUT), University of Alicante, 03690 Alicante, Spain.
| | - Coral Alonso
- Nursing Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
| | - José Miguel Martínez-Sanz
- Nursing Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
- Research Group on Food and Nutrition (ALINUT), University of Alicante, 03690 Alicante, Spain.
| | - Ana Gutierrez-Hervas
- Nursing Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
| | - Isabel Sospedra
- Nursing Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
- Research Group on Food and Nutrition (ALINUT), University of Alicante, 03690 Alicante, Spain.
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Haerle DR. Unpacking Adultification: Institutional Experiences and Misconduct of Adult Court and Juvenile Court Youth Living Under the Same Roof. Int J Offender Ther Comp Criminol 2019; 63:663-693. [PMID: 30409073 DOI: 10.1177/0306624x18811083] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The present study explores the ability of juvenile waiver policy and the resulting adult court status to impact the experiences and behavior of male youth originating from differing jurisdictions but incarcerated together within state-level juvenile correctional facilities. Using official agency data and youth survey data, this research examines how "adult" status influences behavior for waived youth compared with their juvenile court counterparts. Structural equation modeling and multiple group analysis is used to determine the extent to which adult status moderates the measurement structure of models related to individual characteristics, institutional experiences, and institutional misconduct. Results reveal an improvement in model fit to occur when estimated across the two groups of juvenile court and adult court youth, beyond that which occurs when parameters are constrained to be equal for these two groups. This work reveals adult status to be powerful enough to moderate the effects of who a youth is and what that youth experiences, on how that youth behaves during a term of juvenile incarceration.
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San-Juan-Rodriguez A, Zhang Y, He M, Hernandez I. Association of Antidementia Therapies With Time to Skilled Nursing Facility Admission and Cardiovascular Events Among Elderly Adults With Alzheimer Disease. JAMA Netw Open 2019; 2:e190213. [PMID: 30821828 PMCID: PMC6484658 DOI: 10.1001/jamanetworkopen.2019.0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE To date, no study has compared time to skilled nursing facility (SNF) admission and cardiovascular events across medications available to treat Alzheimer disease. OBJECTIVE To compare time to SNF admission and cardiovascular events between acetylcholinesterase inhibitor (AChEI) monotherapy, memantine hydrochloride monotherapy, and combination therapy with an AChEI and memantine in treating elderly adults with Alzheimer disease. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study uses January 1, 2006, to December 31, 2014, claims data from a 5% random sample of Medicare beneficiaries who had received a new diagnosis of Alzheimer disease between January 1, 2007, and December 31, 2013, and who initiated AChEI monotherapy, memantine monotherapy, or combination therapy with an AChEI and memantine (N = 73 475). Patients were followed up until discontinuation of treatment, switch of treatment, death, or the end of the study period. Statistical analysis was conducted from February 15, 2018, to June 15, 2018. EXPOSURES Acetylcholinesterase inhibitor monotherapy (n = 44 424), memantine monotherapy (n = 11 809), and combination therapy with an AChEI and memantine (n = 17 242). MAIN OUTCOMES AND MEASURES Primary outcomes were time to SNF admission and the composite of the following cardiovascular events: acute myocardial infarction, bradycardia, syncope, atrioventricular block, QT interval prolongation, and ventricular tachycardia. Cox proportional hazards regression models were constructed to compare outcomes between each pair of treatment groups, controlling for a comprehensive list of patient characteristics. RESULTS The study population included 73 475 participants (53 068 women and 20 407 men; mean [SD] age, 81.8 [8.3] years); 25.5% of the participants initiating AChEI monotherapy, 25.6% of participants initiating memantine monotherapy, and 29.7% of participants initiating combination therapy with an AChEI and memantine were admitted to an SNF. Similarly, 22.2% of the participants initiating AChEI monotherapy, 20.0% of those initiating memantine monotherapy, and 24.5% of those initiating combination therapy experienced at least 1 cardiovascular event. No difference in time to SNF admission was found across the 3 treatment groups. The risk of the composite measure of any cardiovascular event did not differ between the combination therapy and AChEI monotherapy groups (adjusted hazard ratio [aHR], 0.99; 95% CI, 0.96-1.03); however, it was higher for both AChEI monotherapy (aHR, 1.07; 95% CI, 1.02-1.12) and combination therapy (aHR, 1.07; 95% CI, 1.01-1.12), relative to memantine monotherapy. This result was mainly driven by the lower risk of bradycardia and syncope observed for the memantine monotherapy group relative to both AChEI monotherapy (bradycardia: aHR, 0.88; 95% CI, 0.82-0.95; and syncope: aHR, 0.92; 95% CI, 0.86-0.97) and combination therapy (bradycardia: aHR, 0.89; 95% CI, 0.82-0.97; and syncope: aHR, 0.87; 95% CI, 0.83-0.94). CONCLUSIONS AND RELEVANCE Time to SNF admission did not differ across treatment groups, but memantine monotherapy was associated with a lower risk of cardiovascular events compared with both AChEI monotherapy and combination therapy with an AChEI and memantine.
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Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuting Zhang
- Melbourne Institute, Faculty of Business and Economics, University of Melbourne, Melbourne, Victoria, Australia
| | - Meiqi He
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Cobos-Cali M, Ladera V, Perea MV, García R. Language disorders in victims of domestic violence in children's homes. Child Abuse Negl 2018; 86:384-392. [PMID: 28283312 DOI: 10.1016/j.chiabu.2017.02.028] [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] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Abstract
UNLABELLED Studies that deal with child maltreatment have become relevant during these past years. One important aspect to consider is the impact of maltreatment on the cognitive functioning and more precisely on language. Our objective is to analyze the different components in the comprehension and production of language in children victims of domestic abuse in Childreńs Homes. PARTICIPANTS The sample consists of 104 participants divided in two groups. A group of children who have just been institutionalized due to domestic abuse (VG) (Age: 8 years 2 months with a standard deviation of 1, 5 years) without previous treatment; a group of comparison (CG) made up by children who have not been victim of domestic violence (Age: 8 years 6 months with a standard deviation of 2 years and a month), with similar characteristics of gender, age and schooling. MATERIAL The Child Neuropsychological Assessment by Matute, Rosselli, Ardila and Ostrosky (2007) was applied. This test includes metalinguistic, oral and written comprehension and expression skills. RESULTS The VG group showed low scores in all components of the analyzed language with exception to the discourse, syllable and non-word dictation compared to the CG children. CONCLUSIONS The alterations of the language observed in these children semantic suggest a lack of consolidation of phonological coding and a low use of code. From our findings an early language evaluation in these children can be of especial interest to apply timely intervention programs with the aim of diminishing the impact caused by domestic violence on school failure which is a frequent trait in these children.
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Affiliation(s)
| | - Valentina Ladera
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Salamanca, Spain.
| | - María Victoria Perea
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Salamanca, Spain.
| | - Ricardo García
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Salamanca, Spain.
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Sales MC, Oliveira LP, Liberalino LCP, Cunha ATO, Sousa SES, Lemos TMAM, Lima SCVC, Lima KC, Sena-Evangelista KCM, Pedrosa LFC. Frequency of metabolic syndrome and associated factors in institutionalized elderly individuals. Clin Interv Aging 2018; 13:2453-2464. [PMID: 30555225 PMCID: PMC6280900 DOI: 10.2147/cia.s177731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Population aging generally accompanies an increase in chronic noncommunicable diseases, such as metabolic syndrome (MS). Nursing homes have provided a solution for the decreased ability of elderly individuals for self-care and familial difficulties in meeting the health care needs of elderly individuals. PURPOSE The aim of the present study was to determine the frequency of MS and its associated factors in elderly individuals living in nursing homes. PATIENTS AND METHODS This cross-sectional study was conducted with 202 institutionalized elderly individuals. MS was diagnosed according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Sociodemographic, clinical, and lifestyle factors were assessed to verify their association with MS by logistic regression. RESULTS The MS frequency was 29.2%. The most frequent MS components were low high-density lipoprotein cholesterol level (63.9%) and abdominal obesity (42.7%). Factors associated with MS were female sex (prevalence ratio [PR]=2.16; 95% CI, 1.04-4.49), age-adjusted institutionalization time >50% (PR=2.38, 95% CI, 1.46-3.88), and high concentrations of interleukin-6 (PR=2.01; 95% CI, 1.21-3.32) and tumor necrosis factor-α (PR=1.70; 95% CI, 1.05-2.77). Moreover, it was verified that the likelihood of having MS was 1.85-fold higher (95% CI, 1.11-3.10) in the group with a diet characterized by very high energy, very low fat, and high dietary fiber. CONCLUSION The occurrence of MS in institutionalized elderly individuals was higher in females, and individuals with longer age-adjusted institutionalization time, higher concentrations of immunologic biomarkers, and a dietary intake consisting of higher energy and fiber and lower total fat. The results of the study are useful for guiding health care programs aimed at institutionalized elderly individuals.
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Affiliation(s)
- Marcia Cristina Sales
- Postgraduate Program of Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Larissa Praça Oliveira
- School of Nutrition, Potiguar University (Laureate International Universities), Natal, Rio Grande do Norte, Brazil
| | | | - Aline Tuane Oliveira Cunha
- School of Nutrition, Potiguar University (Laureate International Universities), Natal, Rio Grande do Norte, Brazil
| | - Sara Estefani Soares Sousa
- Postgraduate Program of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Telma Maria Araujo Moura Lemos
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Kenio Costa Lima
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Bush SH, Lawlor PG, Ryan K, Centeno C, Lucchesi M, Kanji S, Siddiqi N, Morandi A, Davis DHJ, Laurent M, Schofield N, Barallat E, Ripamonti CI. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv143-iv165. [PMID: 29992308 DOI: 10.1093/annonc/mdy147] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- S H Bush
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa
- Ottawa Hospital Research Institute, Ottawa
- Bruyère Research Institute, Ottawa
- Bruyère Continuing Care, Ottawa, Canada
| | - P G Lawlor
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa
- Ottawa Hospital Research Institute, Ottawa
- Bruyère Research Institute, Ottawa
- Bruyère Continuing Care, Ottawa, Canada
| | - K Ryan
- Department of Palliative Medicine, Mater Misericordiae University Hospital, Dublin
- St Francis Hospice, Dublin
- School of Medicine, University College, Dublin, Ireland
| | - C Centeno
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona
- Palliative Medicine Group, Oncology Area, Navarra Institute for Health Research IdiSNA, Pamplona
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
| | - M Lucchesi
- Division of Thoracic Oncology, Cardio-Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - S Kanji
- Ottawa Hospital Research Institute, Ottawa
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Canada
| | - N Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - A Morandi
- Department of Rehabilitation, Aged Care Unit, Ancelle Hospital, Cremona, Italy
| | - D H J Davis
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - M Laurent
- Internal Medicine and Geriatric Department, APHP, Henri-Mondor Hospital, Créteil
- University Paris Est (UPE), UPEC A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA 7376, Créteil, France
| | | | - E Barallat
- Faculty of Nursing, Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - C I Ripamonti
- Department of Onco-Haematology Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
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Martschuk N, Goodman-Delahunty J, Powell MB, Westera NJ. Similarities in modi operandi of institutional and non-institutional child sexual offending: Systematic case comparisons. Child Abuse Negl 2018; 84:229-240. [PMID: 30121015 DOI: 10.1016/j.chiabu.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 07/26/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
Little is known about the extent to whichinstitutional child sex offending differs from non-institutional offending. Strategies to secure the compliance of child victims were systematically compared to compare the modi operandi (prior to, during and following abuse), and the type of power (intimate, aggressive, coercive) applied by child sexual offenders in institutional versus non-institutional settings. A sample of 59 of the most recent child sexual abuse cases referred for prosecution in three Australian states was manually reviewed and coded. Of these, six were cases of institutional abuse, one of which involved crossover offending. Based on complainant age and gender and patterns in offending behaviors, institutional cases were matched with cases of non-institutional abuse. Complainants of both genders ranged in age from 5 to 16 years at abuse onset. Offenders were male family members or friends, priests, an employer and one female school teacher. Results demonstrated commonalities in the modi operandi and grooming methods applied in institutional and non-institutional contexts. Implications for abuse prevention are summarized.
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Affiliation(s)
- Natalie Martschuk
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Manly, Australia.
| | - Jane Goodman-Delahunty
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Manly, Australia
| | - Martine B Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | - Nina J Westera
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
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Kioh SH, Rashid A. The prevalence and the risk of falls among institutionalised elderly in Penang, Malaysia. Med J Malaysia 2018; 73:212-219. [PMID: 30121683] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Over the years, falls has been increasingly the most common public health issue worldwide that affects all age groups. However, the risk is nine times higher in older persons especially among those residing in nursing homes. The objective of this study is to determine the prevalence and the risk of falls and their associated factors among elderly living in nursing homes in Penang, Malaysia. METHODOLOGY Data were obtained from a cross-sectional survey in ten different nursing homes in the state of Penang, Malaysia. Participants were selected through convenience sampling were interviewed face-to-face using a questionnaire. Information concerning demographic characteristics, fall risk and depression status were collected. RESULTS Of the 357-elderly aged 60 years and above interviewed in the nursing homes, 32.8% (n=354) reported having one or more falls in the past 12 months whereas 13.3% were at moderate/high risk of fall. Depression (Adjusted Odds Ratio (aOR)=1.71, 95%CI: 1.00 to 2.91) and respiratory illnesses (aOR=3.38, 95%CI: 1.11 to 10.30) were shown to be associated with prevalence of falls. Depression (aOR=2.12, 95%CI: 1.06 to 4.23) and history of fall more than once in the past 12 months (aOR=3.90, 95%CI: 1.72 to 8.8) were found to be associated with moderate/high risk of falls. CONCLUSION This study showed that the prevalence of fall was higher among depressed elderly and those with respiratory illness. Elderly with higher history of falls were also at higher risk of falls. These findings suggest the importance of screening the elderly for the risk factors of falls as a preventive measure.
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Affiliation(s)
- S H Kioh
- Penang Medical College, Faculty of Medicine, Department of Public Health, Penang, Malaysia.
| | - A Rashid
- Penang Medical College, Faculty of Medicine, Department of Public Health, Penang, Malaysia
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Runte R. Predictors of institutionalization in people with dementia: a survey linked with administrative data. Aging Clin Exp Res 2018; 30:35-43. [PMID: 28251570 DOI: 10.1007/s40520-017-0737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND For people with dementia, moving into a nursing home is usually considered at some point in time. Currently available information on predictors of institutionalization is often based on small sample sizes, not taking competing risks into account, and with inconclusive results for sex. AIMS We aimed to carry out an analysis stratified by sex and using a competing risk approach. METHODS We carried out an analysis of a survey linked with administrative data including 652 people with dementia, aged 60 years and older. The follow-up was up to 4.5 years. We used the cumulative incidence function for examining time until institutionalization and survival time and the sub-distribution hazard model for estimating hazard ratios. RESULTS The participants were on average 81 years old, about 51% were female. At the end of the follow-up, 282 people had been institutionalized and 273 had died. The regression models show that the risk of institutionalization is higher in women than in men and when cared for by a care service in comparison to an informal caregiver. Inhibiting factors are Care Level (II, III) and positive evaluation of caregiving by caregivers. Stratified analysis by sex revealed that the risk of institutionalization in men is influenced by their relationship to their caregiver, in women by duration of care at baseline. DISCUSSION Sex seems to play a role in predicting institutionalization. CONCLUSION Future research should focus on stratified analysis by sex. Knowing the predictors of institutionalization for men and women could influence long-term care management remarkably.
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Affiliation(s)
- Rebecca Runte
- University of Bremen, SOCIUM, Mary-Somerville Street 5, 28359, Bremen, Germany.
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24
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Brummel NE, Boehm LM, Girard TD, Pandharipande PP, Jackson JC, Hughes CG, Patel MB, Han JH, Vasilevskis EE, Thompson JL, Chandrasekhar R, Bernard GR, Dittus RS, Ely EW. Subsyndromal Delirium and Institutionalization Among Patients With Critical Illness. Am J Crit Care 2017; 26:447-455. [PMID: 29092867 PMCID: PMC5831547 DOI: 10.4037/ajcc2017263] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 12/31/2022]
Abstract
BACKGROUND The prognostic importance of subsyndromal delirium is unknown. OBJECTIVE To test whether duration of subsyndromal delirium is independently associated with institutionalization. METHODS The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used twice daily to assess for subsyndromal delirium in patients with respiratory failure or shock. Delirium was considered present if the assessment was positive. Subsyndromal delirium was considered present if the assessment was negative but the patient exhibited any CAM-ICU features. Multivariable regression was used to determine the association between duration of subsyndromal delirium and institutionalization, adjusting for age, education, baseline cognition and disability, comorbidities, severity of illness, delirium, coma, sepsis, and doses of sedatives and opiates. RESULTS Subsyndromal delirium, lasting a median of 3 days, developed in 702 of 821 patients (86%). After adjusting for covariates, duration of subsyndromal delirium was an independent predictor of increased odds of institutionalization (P = .007). This association was greatest in patients with less delirium (P for interaction = .01). Specifically, of patients who were never delirious, those with 5 days of subsyndromal delirium (upper interquartile range [IQR]) were 4.2 times more likely to be institutionalized than those with 1.5 days of subsyndromal delirium (lower IQR). CONCLUSIONS Subsyndromal delirium occurred in most critically ill patients, and its duration was an independent predictor of institutionalization. Routine monitoring of all delirium symptoms may enable detection of full and subsyndromal forms of delirium.
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Affiliation(s)
- Nathan E Brummel
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center.
| | - Leanne M Boehm
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Timothy D Girard
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Pratik P Pandharipande
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - James C Jackson
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Christopher G Hughes
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Mayur B Patel
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Jin H Han
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Eduard E Vasilevskis
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Jennifer L Thompson
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Rameela Chandrasekhar
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Gordon R Bernard
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - Robert S Dittus
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
| | - E Wesley Ely
- Nathan E. Brummel is an assistant professor and E. Wesley Ely is a professor, Department of Medicine, Center for Quality Aging and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. Dr Ely is also the associate director for research for the Geriatric Research, Education, and Clinical Center Service (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee. Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, GRECC, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center. Timothy D. Girard is an associate professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Pratik P. Pandharipande is a professor and Christopher G. Hughes is an associate professor, Department of Anesthesiology, Vanderbilt University Medical Center. James C. Jackson is a research associate professor, Department of Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, and Mayur B. Patel is an assistant professor, Department of Surgery, Vanderbilt University Medical Center. Jin H. Han is an associate professor, Department of Emergency Medicine and Center for Quality Aging, Vanderbilt University Medical Center. Eduard E. Vasilevskis is a staff physician, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and an assistant professor, Department of Medicine and Center for Health Services Research, Vanderbilt University Medical Center. Jennifer L. Thompson is a biostatistician and Rameela Chandrasekhar is an assistant professor, Department of Biostatistics, Vanderbilt University School of Medicine. Gordon R. Bernard is associate vice-chancellor for research and a professor, Department of Medicine, Vanderbilt University Medical Center. Robert S. Dittus is director, GRECC, Department of Veterans Affairs Medical Center, VA Tennessee Valley Healthcare System, and a professor, Department of Medicine, Vanderbilt University Medical Center
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Abstract
Aim To establish the effectiveness of a restorative home support service on institutional-free survival in frail older people referred for needs assessment. Method A randomised controlled trial of Community Flexible Integrated Responsive Support Team versus usual care in 113 older people at risk of institutionalisation in New Zealand. Primary outcome was death or permanent institutional care evaluated in a Cox proportional hazards model adjusted for baseline prognostic variables. A variety of secondary outcomes including the health of informal caregivers were also evaluated. Results The primary outcome was lower, but not statistically significant, in the intervention group (adjusted hazard ratio 0.69, 95% confidence interval 0.4 to 1.16). Informal caregivers of interventional participants had significantly better physical and mental component scores on the 36-item Short-Form questionnaire. Conclusion Restorative home support may reduce the risk of death and institutionalisation in frail older people without affecting the health of informal caregivers.
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Affiliation(s)
- Matthew Parsons
- Gerontology, School of Nursing, University of Auckland, New Zealand
| | - Hugh Senior
- Massey University - Albany Campus, New Zealand
| | - Ngaire Kerse
- Primary care, University of Auckland, New Zealand
| | | | | | - Craig Anderson
- Neurological and Mental Health Division, George Institute for International Health, University of Sydney, Australia
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Petrowski N, Cappa C, Gross P. Estimating the number of children in formal alternative care: Challenges and results. Child Abuse Negl 2017; 70:388-398. [PMID: 28578826 DOI: 10.1016/j.chiabu.2016.11.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/01/2016] [Accepted: 11/23/2016] [Indexed: 06/07/2023]
Abstract
Given the relatively large body of literature documenting the adverse impacts of institutionalization on children's developmental outcomes and well-being, it is essential that countries work towards reducing the number of children in alternative care (particularly institutional care), and, when possible, reunite children with their families. In order to do so, reliable estimates of the numbers of children living in such settings are essential. However, many countries still lack functional administrative systems for enumerating children living outside of family care. The purpose of this paper is to provide a snapshot of the availability and coverage of data on children living in residential and foster care from some 142 countries covering more than 80 per cent of the world's children. Utilizing these country-level figures, it is estimated that approximately 2.7 million children between the ages of 0 and 17 years could be living in institutional care worldwide. Where possible, the article also presents regional estimates of the number of children living in residential and foster care. This work represents an important step to systematically identify and compile sources of data on children in alternative care and provides updated global and regional estimates on the magnitude of the issue. Its findings contribute to raising awareness of the urgent need to strengthen the capacity of countries to improve national systems for counting, monitoring and reporting on these vulnerable children.
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Affiliation(s)
- Nicole Petrowski
- Consultant (N. Petrowski) and Statistics Specialist (C. Cappa), Data and Analytics Section, Division of Data, Research and Policy, United Nations Children's Fund (UNICEF), 3 UN Plaza, New York, NY, 10017, USA.
| | - Claudia Cappa
- Consultant (N. Petrowski) and Statistics Specialist (C. Cappa), Data and Analytics Section, Division of Data, Research and Policy, United Nations Children's Fund (UNICEF), 3 UN Plaza, New York, NY, 10017, USA.
| | - Peter Gross
- Former Child Protection Specialist, Child Protection Section, Programme Division, United Nations Children's Fund (UNICEF), 3 UN Plaza, New York, NY, 10017, USA.
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Brar A, Mallappallil M, Stefanov DG, Kau D, Salifu MO. Dialysis in the Elderly and Impact of Institutionalization in the United States Renal Data System. Am J Nephrol 2017; 46:114-119. [PMID: 28704826 DOI: 10.1159/000463393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/01/2016] [Accepted: 02/09/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND We hypothesized that in the very elderly dialysis patients in the United States, institutionalization in nursing homes would increase mortality in addition to age alone. METHODS Incident dialysis patients from 2001 to 2008 above the age of 70 were included. Patients above 70 were categorized into 4 groups according to age as 70-75, 76-80, 81-85, and >85 years and further divided into institutionalized and noninstitutionalized. Kaplan-Meier survival curves were plotted to assess patient survival. RESULTS A total of 349,440 patients were identified above the age of 70 at the time of initiation of dialysis. For institutionalized patients, the mean survival was significantly lower, 1.71 ± 0.03 years for those in the age range 70-75, 1.44 ± 0.02 years for those in the age range 76-80, 1.25 ± 0.02 years for those in the age range 81-85, and 1.04 ± 0.02 for those in the >85 years age group (p = 0.0001). The hazard ratio for mortality in institutionalized elderly patients on dialysis was 1.80 ([95% CI 1.77-1.83]; p = 0.0001). After adjustment for other variables (multivariate Cox regression), to be institutionalized was still an independent risk factor for mortality (adjusted hazard ratio = 1.57 [95% CI 1.54-1.60]; p = 0.0001). CONCLUSION There was increased mortality in institutionalized elderly patients as compared to noninstutionalized elderly patients in the same age group. In accordance with the increased frailty and decreased benefits of therapies in the very elderly, especially in those with additional co-morbidities besides age, palliative and end-of-life care should be considered.
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Affiliation(s)
- Amarpali Brar
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Jerez-Roig J, de Brito Macedo Ferreira LM, Torres de Araújo JR, Costa Lima K. Functional decline in nursing home residents: A prognostic study. PLoS One 2017; 12:e0177353. [PMID: 28493946 PMCID: PMC5426763 DOI: 10.1371/journal.pone.0177353] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 11/29/2016] [Accepted: 04/26/2017] [Indexed: 12/16/2022] Open
Abstract
Aim To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults. Methods A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013–2015), conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil). Functional capacity was assessed by the items ‘eating’, ‘personal hygiene’, ‘dressing’, ‘bathing’, ‘transferring’, ‘toileting’ and ‘walking’, through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Cox's regression were applied as statistical methods. Results The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8–82.7%), 65.1% (CI 95%: 58.9–70.5%), 53.5% (CI 95%: 47.2–59.5%) and 44.0% (CI 95%: 37.7–50.2%) at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001), continence decline (HR = 1.85; p = 0.002) and incidence of hospitalizations (HR = 1.62; p = 0.020), adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight. Conclusions The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.
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Affiliation(s)
- Javier Jerez-Roig
- Postgraduate Program in Collective Health, Odontology Department, Federal University of Rio Grande do Norte (UFRN), Avenida Salgado Filho 1787, Lagoa Nova, Natal-RN, Brazil
- Can Misses Hospital, Ibiza, Spain
- * E-mail:
| | - Lidiane Maria de Brito Macedo Ferreira
- Postgraduate Program in Collective Health, Odontology Department, Federal University of Rio Grande do Norte (UFRN), Avenida Salgado Filho 1787, Lagoa Nova, Natal-RN, Brazil
| | - José Rodolfo Torres de Araújo
- Postgraduate Program in Health Sciences, Center of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Av. Gustavo Cordeiro de Farias, s/n, Petrópolis, Natal RN, Natal-RN, Brazil
| | - Kenio Costa Lima
- Postgraduate Program in Collective Health, Odontology Department, Federal University of Rio Grande do Norte (UFRN), Avenida Salgado Filho 1787, Lagoa Nova, Natal-RN, Brazil
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29
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Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, Rajan S, Lippert F, Folke F, Gislason G, Køber L, Fonager K, Jensen SE, Gerds TA, Torp-Pedersen C, Rasmussen BS. Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. N Engl J Med 2017; 376:1737-1747. [PMID: 28467879 DOI: 10.1056/nejmoa1601891] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P=0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation. (Funded by TrygFonden and the Danish Heart Foundation.).
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Affiliation(s)
- Kristian Kragholm
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Mads Wissenberg
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Rikke N Mortensen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Steen M Hansen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Carolina Malta Hansen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Kristinn Thorsteinsson
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Shahzleen Rajan
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Freddy Lippert
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Fredrik Folke
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Gunnar Gislason
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Lars Køber
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Kirsten Fonager
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Svend E Jensen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Thomas A Gerds
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Christian Torp-Pedersen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
| | - Bodil S Rasmussen
- From the Departments of Anesthesiology and Intensive Care Medicine (K.K., B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg University, Aalborg, the Clinical Institute of Medicine, Aarhus University, Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen University Hospital, Emergency Medical Services Copenhagen and University of Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute of Public Health, University of Southern Denmark (G.G.), and the Department of Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark; and Duke Clinical Research Institute, Durham, NC (C.M.H.)
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Sonuga-Barke EJS, Kennedy M, Kumsta R, Knights N, Golm D, Rutter M, Maughan B, Schlotz W, Kreppner J. Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study. Lancet 2017; 389:1539-1548. [PMID: 28237264 DOI: 10.1016/s0140-6736(17)30045-4] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Time-limited, early-life exposures to institutional deprivation are associated with disorders in childhood, but it is unknown whether effects persist into adulthood. We used data from the English and Romanian Adoptees study to assess whether deprivation-associated adverse neurodevelopmental and mental health outcomes persist into young adulthood. METHODS The English and Romanian Adoptees study is a longitudinal, natural experiment investigation into the long-term outcomes of individuals who spent from soon after birth to up to 43 months in severe deprivation in Romanian institutions before being adopted into the UK. We used developmentally appropriate standard questionnaires, interviews completed by parents and adoptees, and direct measures of IQ to measure symptoms of autism spectrum disorder, inattention and overactivity, disinhibited social engagement, conduct or emotional problems, and cognitive impairment (IQ score <80) during childhood (ages 6, 11, and 15 years) and in young adulthood (22-25 years). For analysis, Romanian adoptees were split into those who spent less than 6 months in an institution and those who spent more than 6 months in an institution. We used a comparison group of UK adoptees who did not experience deprivation. We used mixed-effects regression models for ordered-categorical outcome variables to compare symptom levels and trends between groups. FINDINGS Romanian adoptees who experienced less than 6 months in an institution (n=67 at ages 6 years; n=50 at young adulthood) and UK controls (n=52 at age 6 years; n=39 at young adulthood) had similarly low levels of symptoms across most ages and outcomes. By contrast, Romanian adoptees exposed to more than 6 months in an institution (n=98 at ages 6 years; n=72 at young adulthood) had persistently higher rates than UK controls of symptoms of autism spectrum disorder, disinhibited social engagement, and inattention and overactivity through to young adulthood (pooled p<0·0001 for all). Cognitive impairment in the group who spent more than 6 months in an institution remitted from markedly higher rates at ages 6 years (p=0·0001) and 11 years (p=0·0016) compared with UK controls, to normal rates at young adulthood (p=0·76). By contrast, self-rated emotional symptoms showed a late-onset pattern with minimal differences versus UK controls at ages 11 years (p=0·0449) and 15 years (p=0·17), and then marked increases by young adulthood (p=0·0005), with similar effects seen for parent ratings. The high deprivation group also had a higher proportion of people with low educational achievement (p=0·0195), unemployment (p=0·0124), and mental health service use (p=0·0120, p=0·0032, and p=0·0003 for use when aged <11 years, 11-14 years, and 15-23 years, respectively) than the UK control group. A fifth (n=15) of individuals who spent more than 6 months in an institution were problem-free at all assessments. INTERPRETATION Notwithstanding the resilience shown by some adoptees and the adult remission of cognitive impairment, extended early deprivation was associated with long-term deleterious effects on wellbeing that seem insusceptible to years of nurturance and support in adoptive families. FUNDING Economic and Social Research Council, Medical Research Council, Department of Health, Jacobs Foundation, Nuffield Foundation.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Mark Kennedy
- Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | | | - Dennis Golm
- Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Michael Rutter
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Barbara Maughan
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Wolff Schlotz
- Max Planck Institute for Empirical Aesthetics, Frankfurt, Germany
| | - Jana Kreppner
- Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK
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Trétarre B, Bourgarel S, Stoebner-Delbarre A, Jacot W, Bessaoud F, Satge D. Breast cancer and screening in persons with an intellectual disability living in institutions in France. J Intellect Disabil Res 2017; 61:266-278. [PMID: 27624823 DOI: 10.1111/jir.12336] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/29/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND We aimed to describe, among a population of women with intellectual disabilities (ID) living in institutions in France, the characteristics in whom breast cancer (BC) was diagnosed and of those who participated in BC screening. METHODS Study was performed in 2009 among a random, representative sample of women with ID living in institutions in France. Participants answered a questionnaire either directly by themselves, or with the help of an intermediary. RESULTS In total, 978 women with ID aged over 18 years were included, and 14 were diagnosed with BC. The incidence observed in this sample of women with ID is similar to that of the general population (standardised incidence ratio, SIR 0.857, 95% confidence interval (CI) 0.42-1.53). Average age at diagnosis was 47.8 years, and the risk of developing BC before the age of 50 was 2.03% (0.4-3.66). This risk was not significantly different from that of the general population (2.4%, 1.0-3.78). Obesity was almost twice as frequent in women who had BC as compared to those without BC (43% vs. 22.5%, P = 0.0196). Among the 310 women aged >50 years and eligible for the national BC screening programme, 238 (77%) had already had at least one mammogram, and 199 had had it within the previous 2 years. Adherence to the screening programme was 64.2% (199/310) in the participating institutions. This rate was slightly higher than the national average of 62% for the same period. CONCLUSIONS The results of this study show that BC is equally as frequent among women with ID living in institutions as in the general population, and occurs at around the same age. Obesity was significantly more frequent among women in whom BC was diagnosed in our study. Participation in BC screening is slightly higher among women with ID living in institutions than among the general population.
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Affiliation(s)
- B Trétarre
- Registre des tumeurs de l'Hérault, 298 rue des Apothicaires, Montpellier Cedex 5, France
| | - S Bourgarel
- Centre régional d'études, d'actions et d'information sur le handicap (CREAI) PACA et Corse, Marseille, France
| | - A Stoebner-Delbarre
- Institut regional du Cancer de Montpellier, Department of Supportive Care, Montpellier, Languedoc-Roussillon, France
| | - W Jacot
- Institut regional du Cancer de Montpellier, Department of Medical Oncology, Montpellier, Languedoc-Roussillon, France
| | - F Bessaoud
- Registre des tumeurs de l'Hérault, 298 rue des Apothicaires, Montpellier Cedex 5, France
| | - D Satge
- Oncodefi, Montpellier, France, and Institut Universitaire de Recherche Clinique de Montpellier (IURC), Montpellier, France
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Blasi F, Akova M, Bonanni P, Dartois N, Sauty E, Webber C, Torres A. Community-acquired pneumonia in adults: Highlighting missed opportunities for vaccination. Eur J Intern Med 2017; 37:13-18. [PMID: 27756499 DOI: 10.1016/j.ejim.2016.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022]
Abstract
Pneumococcal pneumonia remains a clear unmet medical need for adults worldwide. Despite advances in vaccine technology, vaccination coverage remains low, putting many people at risk of significant morbidity and mortality. The herd effect seen with paediatric vaccination is not enough to protect all older and vulnerable people in the community, and more needs to be done to increase the uptake of pneumococcal vaccination in adults. Several key groups are at increased risk of contracting pneumococcal pneumonia, and eligible patients are being missed in clinical practice. At present, community-acquired pneumonia costs over €10 billion annually in Europe alone. Pneumococcal conjugate vaccination could translate into preventing 200,000 cases of community-acquired pneumonia every year in Europe alone. This group calls on governments and decision makers to implement consistent age-based vaccination strategies, and for healthcare professionals in daily clinical practice to identify eligible patients who would benefit from vaccination strategies.
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Affiliation(s)
- Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Murat Akova
- Infectious Diseases Department, Hacettepe University School of Medicine, Ankara, Turkey
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Italy
| | | | | | - Chris Webber
- Pfizer Vaccine Clinical Research, Maidenhead, UK
| | - Antoni Torres
- Pulmonology Department, Hospital Clinic, University of Barcelona, IDIBAPS. CIBERES, Barcelona, Spain
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Petrovic BB, Peric TO, Markovic DLJ, Bajkin BB, Petrovic D, Blagojevic DB, Vujkov S. Unmet oral health needs among persons with intellectual disability. Res Dev Disabil 2016; 59:370-377. [PMID: 27697655 DOI: 10.1016/j.ridd.2016.09.020] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 09/04/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease.
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Affiliation(s)
- Bojan B Petrovic
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
| | - Tamara O Peric
- Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia
| | - Dejan L J Markovic
- Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia
| | - Branislav B Bajkin
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Djorde Petrovic
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Duska B Blagojevic
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Sanja Vujkov
- Dentistry Clinic of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Willink A, Davis K, Schoen C. Risks for Nursing Home Placement and Medicaid Entry Among Older Medicare Beneficiaries with Physical or Cognitive Impairment. Issue Brief (Commonw Fund) 2016; 37:1-14. [PMID: 27827434] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Issue: More than half of individuals who age into Medicare will experience physical and/or cognitive impairment (PCI) at some point that hinders independent living and requires long-term services and supports. As a result of Medicare’s limits on covered services, Medicare beneficiaries with PCI experience financial burdens and reduced ability to live independently. Goal: Describe the characteristics and health spending of Medicare beneficiaries with PCI and estimate the likelihood of Medicaid entry and long-term nursing home placement. Methods: The Health and Retirement Study 1998–2012 is used to estimate long-term nursing home placement, as well as Medicaid entry. The Medicare Current Beneficiary Survey 2012 provides information on health care spending and utilization. Key findings and conclusions: Almost two-thirds of community-dwelling Medicare beneficiaries with PCI have three or more chronic conditions. More than one-third of those with PCI have incomes less than 200 percent of the federal poverty level but are not covered by Medicaid; almost half spend 10 percent or more of their incomes out-of-pocket on health care. Nineteen percent of individuals with PCI and high out-of-pocket costs entered Medicaid over 14 years, compared to 10 percent without PCI and low out-of-pocket costs.
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Affiliation(s)
- Amber Willink
- Department of Health Policy and Management and Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomber School of Public Health, USA
| | - Karen Davis
- Department of Health Policy and Management and Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomber School of Public Health, USA
| | - Cathy Schoen
- The Commonwealth Fund Council of Economic Advisors
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Abstract
Delirium is a frequent syndrome among patients who are elderly. People who are older with cognitive impairment who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. This study goal was to describe the effect of severity of prior cognitive impairment on delirium prevalence and symptom presentation among patients who were older and were newly admitted to an acute care hospital. A total of 104 were included in this descriptive study and screened for delirium. The results showed that the prevalence of delirium increased according to the severity of the patients’ prior cognitive impairment. Except for disorganized thinking, all symptoms of delirium were similar among patients with mild, moderate, and severe prior cognitive impairment. The study concluded that training nurses to recognize subtle changes in mental status among those patients who were older with prior cognitive impairment may prevent the underdetection of delirium.
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Affiliation(s)
- Philippe Voyer
- Laval University, St. Sacrement Hospital Centre, Québec, Canada.
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Abstract
This prospective study examines the relationship between caregiver psychological adjustment and institutionalization of persons with Alzheimer’s disease (AD). Method: A 3-year longitudinal study was conducted with a clinic-based cohort of 396 persons with AD and their respective family caregivers. Caregiver adjustment was sequentially measured in 3-month intervals using standard scales of appraisal (perceived burden and satisfaction) and emotion (depressive symptoms and positive affect). Results: In multivariable proportional hazards regression models predicting time to institutionalization controlling for AD severity, hazard ratios were significant for appraisal measures of caregiver adjustment, perceived burden (1.053; 95% confidence interval [CI], 1.014, 1.093), and satisfaction (.929; 95% CI, .883, .977). In contrast, levels of caregivers’ positive and negative emotion did not reliably predict institutionalization. Discussion: The findings highlight the importance of caregiver appraisals in decisions to institutionalize persons with a dementia syndrome, but the limited impact of caregiver emotion was unexpected and requires further study.
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Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Mösch E, Wagner M, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Longitudinal Predictors of Institutionalization in Old Age. PLoS One 2016. [PMID: 26658776 DOI: 10.1371/journal.pone.014420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE To investigate time-dependent predictors of institutionalization in old age using a longitudinal approach. METHODS In a representative survey of the German general population aged 75 years and older predictors of institutionalization were observed every 1.5 years over six waves. Conditional fixed-effects logistic regressions (with 201 individuals and 960 observations) were performed to estimate the effects of marital status, depression, dementia, and physical impairments (mobility, hearing and visual impairments) on the risk of admission to old-age home or nursing home. By exploiting the longitudinal data structure using panel econometric models, we were able to control for unobserved heterogeneity such as genetic predisposition and personality traits. RESULTS The probability of institutionalization increased significantly with occurrence of widowhood, depression, dementia, as well as walking and hearing impairments. In particular, the occurrence of widowhood (OR = 78.3), dementia (OR = 154.1) and substantial mobility impairment (OR = 36.7) were strongly associated with institutionalization. CONCLUSION Findings underline the strong influence of loss of spouse as well as dementia on institutionalization. This is relevant as the number of old people (a) living alone and (b) suffering from dementia is expected to increase rapidly in the next decades. Consequently, it is supposed that the demand for institutionalization among the elderly will increase considerably. Practitioners as well as policy makers should be aware of these upcoming challenges.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Lange
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Posselt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Susanne Steinmann
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chow WS, Priebe S. How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990. BMJ Open 2016; 6:e010188. [PMID: 27130161 PMCID: PMC4854016 DOI: 10.1136/bmjopen-2015-010188] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/22/2015] [Accepted: 01/25/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES It has been suggested that since 1990, de-institutionalisation of mental healthcare in Western Europe has been reversed into re-institutionalisation with more forensic beds, places in protected housing services and people with mental disorders in prisons. This study aimed to identify changes in the numbers of places in built institutions providing mental healthcare in Western Europe from 1990 to 2012, and to explore the association between changes in psychiatric bed numbers and changes in other institutions. SETTINGS AND DATA Data were identified from 11 countries on psychiatric hospital beds, forensic beds, protected housing places and prison populations. Fixed effects regression models tested the associations between psychiatric hospital beds with other institutions. RESULTS The number of psychiatric hospital beds decreased, while forensic beds, places in protected housing and prison populations increased. Overall, the number of reduced beds exceeded additional places in other institutions. There was no evidence for an association of changes in bed numbers with changes in forensic beds and protected housing places. Panel data regression analysis showed that changes in psychiatric bed numbers were negatively associated with rising prison populations, but the significant association disappeared once adjusted for gross domestic product as a potential covariate. CONCLUSIONS Institutional mental healthcare has substantially changed across Western Europe since 1990. There are ongoing overall trends of a decrease in the number of psychiatric hospital beds and an increase in the number of places in other institutions, including prisons. The exact association between these trends and their drivers remains unclear. More reliable data, information on the characteristics of patients in different institutions, long-term pathway analyses and effectiveness studies are required to arrive at evidence-based policies for the provision of institutional mental healthcare.
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Affiliation(s)
- Winnie S Chow
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
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Blackburn J, Locher JL, Morrisey MA, Becker DJ, Kilgore ML. The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture. Osteoporos Int 2016; 27:953-961. [PMID: 26400010 DOI: 10.1007/s00198-015-3327-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
SUMMARY This study measures the effect of spending policies for long-term care services on the risk of becoming a long-stay nursing home resident after a hip fracture. Relative spending on community-based services may reduce the risk of long-term nursing home residence. Policies favoring alternative sources of care may provide opportunities for older adults to remain community-bound. INTRODUCTION This study aims to understand how long-term care policies affect outcomes by investigating the effect of state-level spending for home- and community-based services (HCBSs) on the likelihood of an individual's nursing home placement following hip fracture. METHODS This study uses data from the 5% sample of Medicare beneficiaries from 2005 to 2010 to identify incident hip fractures among dual-eligibility, community-dwelling adults aged at least 65 years. A multilevel generalized estimating equation (GEE) model estimated the association between an individual's risk of nursing home residence within 1 year and the percent of states' Medicaid long-term support service (LTSS) budget allocated to HCBS. Other covariates included expenditures for Title III services and individual demographic and health status characteristics. RESULTS States vary considerably in HCBS spending, ranging from 17.7 to 83.8% of the Medicaid LTSS budget in 2009. Hip fractures were observed from claims among 7778 beneficiaries; 34% were admitted to a nursing home and 25% died within 1 year. HCBS spending was associated with a decreased risk of nursing home residence by 0.17 percentage points (p 0.056). CONCLUSIONS Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.
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Affiliation(s)
- J Blackburn
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330K, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA.
| | - J L Locher
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, 933 19th Street South, CH19 218, Birmingham, AL, 35294-2041, USA
| | - M A Morrisey
- Department of Health Policy and Management, School of Public Health, 306 SPH Administration Building, Texas A&M University, College Station, TX, 77843-1266, USA
| | - D J Becker
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330K, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA
| | - M L Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330K, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA
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Friščić M, Šantek-Zlatar G, Žulec M. [PATIENTS WITH PRESSURE ULCERS IN THE UNIFIED EMERGENCY ADMISSION DEPARTMENT – OUR REALITY]. Acta Med Croatica 2016; 70 Suppl 1:93-96. [PMID: 29087678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Patients with pressure ulcers usually arrive to the Unified Emergency Admission Department (UEAD) due to other illnesses, from the family or social care institutions. After triage and treatment at UEAD, the patient is hospitalized or discharged from the hospital. The objective of this study was to examine the incidence, reasons for presenting to UEAD and further procedure that patients with pressure ulcers admitted to UEAD were subjected to. Data in the Hospital Information System on patients with pressure ulcers admitted to UEAD, Dr Tomislav Bardek General Hospital in Koprivnica in the period between January 1, 2016 and May 31, 2016 were retrospectively analyzed. The analysis included demographic data, location from which the patient arrived, triage category and further procedure the patient was subjected to. Data were analyzed by using the methods of descriptive statistics. A total of 18 patients with pressure ulcers were admitted to UEAD, 13 (72%) women and five (28%) men. Five (28%) patients were referred from social care institutions and 13 (72%) from the family. Triage category 2 included 7 (38.8%) patients, four (22%) patients were included in triage categories 3 and 4, while three (16%) patients were included in triage category 5. Ten (55.5%) patients were hospitalized, while eight (44.4%) patients were discharged from the hospital. Only one patient was admitted primarily due to pressure ulcer complications. Contrary to our assumptions, a lower number of patients were referred from social care institutions, i.e. more patients were referred from the family. These data resulted from a long lasting active training of nurses and implementation of the nurse’s discharge letter.
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Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Mösch E, Wagner M, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Longitudinal Predictors of Institutionalization in Old Age. PLoS One 2015; 10:e0144203. [PMID: 26658776 PMCID: PMC4685990 DOI: 10.1371/journal.pone.0144203] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [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: 08/11/2015] [Accepted: 11/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate time-dependent predictors of institutionalization in old age using a longitudinal approach. Methods In a representative survey of the German general population aged 75 years and older predictors of institutionalization were observed every 1.5 years over six waves. Conditional fixed-effects logistic regressions (with 201 individuals and 960 observations) were performed to estimate the effects of marital status, depression, dementia, and physical impairments (mobility, hearing and visual impairments) on the risk of admission to old-age home or nursing home. By exploiting the longitudinal data structure using panel econometric models, we were able to control for unobserved heterogeneity such as genetic predisposition and personality traits. Results The probability of institutionalization increased significantly with occurrence of widowhood, depression, dementia, as well as walking and hearing impairments. In particular, the occurrence of widowhood (OR = 78.3), dementia (OR = 154.1) and substantial mobility impairment (OR = 36.7) were strongly associated with institutionalization. Conclusion Findings underline the strong influence of loss of spouse as well as dementia on institutionalization. This is relevant as the number of old people (a) living alone and (b) suffering from dementia is expected to increase rapidly in the next decades. Consequently, it is supposed that the demand for institutionalization among the elderly will increase considerably. Practitioners as well as policy makers should be aware of these upcoming challenges.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Lange
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Posselt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Susanne Steinmann
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Laudisio A, Marinosci F, Fontana D, Gemma A, Zizzo A, Coppola A, Rodano L, Antonelli Incalzi R. The burden of comorbidity is associated with symptomatic polymicrobial urinary tract infection among institutionalized elderly. Aging Clin Exp Res 2015; 27:805-12. [PMID: 25916348 DOI: 10.1007/s40520-015-0364-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 02/05/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host. AIMS The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs. METHODS We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI. RESULTS P-UTIs were detected in 118/299 (39%) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95% CI 1.06-2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95% CI 1.13-3.11; P = .015). DISCUSSION The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases. CONCLUSIONS Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity.
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Affiliation(s)
- Alice Laudisio
- Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
| | - Felice Marinosci
- Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy
| | - Davide Fontana
- Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy
| | - Antonella Gemma
- UOS Accesso e Presa in Carico Assistenziale, Azienda Sanitaria Locale Roma E, Borgo S. Spirito, 3, Rome, Italy
| | - Alessandro Zizzo
- Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy
| | - Anna Coppola
- Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy
| | - Leonardo Rodano
- Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy
| | - Raffaele Antonelli Incalzi
- Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy
- Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy
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Huang SW, Chang KH, Escorpizo R, Hu CJ, Chi WC, Yen CF, Liao HF, Chiu WT, Liou TH. Using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for Predicting Institutionalization of Patients With Dementia in Taiwan. Medicine (Baltimore) 2015; 94:e2155. [PMID: 26632747 PMCID: PMC5059016 DOI: 10.1097/md.0000000000002155] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is an assessment tool and it has been applied for disability status assessment of Taiwanese dementia patients since July 2012. The aim of this study was to investigate the predicting accuracy of WHODAS 2.0 for institutionalization of dementia patients.Of these patients, 13,774 resided in a community and 4406 in a long-term care facility. Demographic data and WHODAS 2.0 standardized scores were analyzed using the Chi-square test and independent t test to compare patients with dementia in an institution with those in a community. The receiver operating characteristic (ROC) curve was applied to investigate accuracy in predicting institutionalization, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was used to analyze variables to determine risk factors for the institutionalization of patients with dementia.WHODAS 2.0 scores in all domains were higher in patients with dementia in a long-term care facility than in those in a community (P < 0.01). The ROC curve showed moderate accuracy for all domains of WHODAS 2.0 (area under curve 0.6~0.8). Binary logistic regression revealed that the male gender, severity of disease, and standardized WHODAS 2.0 scores surpassing the cutoff values were risk factors for the institutionalization of patients with dementia.Although the accuracy of WHODAS 2.0 in predicting institutionalization is not considerably high for patients with dementia, our study found that the WHODAS 2.0 scores, the male gender, education status, urbanization level, and severity of disease were risk factors for institutionalization in long-term care facilities.
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Affiliation(s)
- Shih-Wei Huang
- From the Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital (S-WH, W-CC, T-HL); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine (S-WH, T-HL); Graduate Institute of Injury Prevention and Control (K-HC, W-TC, T-HL); Department of Physical Medicine and Rehabilitation, Wan Fang Hospital (K-HC); Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA (RE); Swiss Paraplegic Research, Nottwil, Switzerland (RE); Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City (C-JH); Department of Public Health, Tzu Chi University, Hualien (C-FY); Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City (H-FL); School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan (H-FL)
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Langeland W, Hoogendoorn AW, Mager D, Smit JH, Draijer N. Childhood sexual abuse by representatives of the Roman Catholic Church: a prevalence estimate among the Dutch population. Child Abuse Negl 2015; 46:67-77. [PMID: 26003819 DOI: 10.1016/j.chiabu.2015.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 06/04/2023]
Abstract
Estimates of the extent of childhood sexual abuse (CSA) within in the Roman Catholic Church (RCC) in the general population are difficult to find. The independent Commission of Inquiry into sexual abuse of minors in the RCC in the Netherlands collected population-based data to estimate its prevalence. A large random online population sample was surveyed using a two-phase stratified sampling procedure. In Phase 1, 34,267 subjects aged 40 years and older were screened for childhood exposure to sexual abuse by non-family members, a history of institutionalization and a Roman Catholic upbringing. In Phase 2, a stratified subset of 2,462 subjects was assessed to obtain more detailed target information about sexual abuse reports within the RCC. We employed multiple imputation for the estimation of RCC CSA in the original Phase 1 sample. The prevalence of non-familial CSA in general (14.0%) was higher among women (17.2%) than among men (10.6%). The prevalence of CSA within the Dutch RCC (1.7%) was higher among men (2.7%) than among women (0.7%). As expected, older subjects reported more often CSA in the RCC than their younger counterparts. Respondents who stayed for some time in RCC run institutions for education or child protection had a higher risk to report sexual abuse. Although sexual abuse of minors by representatives of the RCC was a structural problem during a period that the Church was highly influential in the Netherlands, the estimated prevalence of the phenomenon is only a fraction of the prevalence rate of non-familial CSA.
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Affiliation(s)
- Willemien Langeland
- Vrije University Medical Center/GGZinGeest, Department of Psychiatry and EMGO Institute, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Vrije University Medical Center/GGZinGeest, Department of Psychiatry and EMGO Institute, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Daniel Mager
- TNS NIPO, Grote Bickersstraat 74, 1013 KS, Amsterdam, The Netherlands
| | - Jan H Smit
- Vrije University Medical Center/GGZinGeest, Department of Psychiatry and EMGO Institute, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Nel Draijer
- Vrije University Medical Center/GGZinGeest, Department of Psychiatry and EMGO Institute, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
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Pfrimer K, Marques Messias M, Ferriolli E, Vieira Salles MS, Roma Junior LC, Saran Netto A, Zanetti MA, Vannucchi H. [Assessment, evaluation and nutrition monitoring in older people living in a rest home]. Arch Latinoam Nutr 2015; 65:104-109. [PMID: 26817382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Institutionalized elderly have an increased risk of changes in nutritional status, therefore sensitive parameters are necessary for the identification of changes in nutritional status. The aim of this study was to evaluate parameters for analysis of the nutritional status of institutionalized elderly in a period of three months by means of biochemical and anthropometric measurements. Eighty one volunteers were selected, with 78 ± 10 years old and 53% female. Anthropometric data showed that the variables body mass index, weight, fat mass, and phase angle of the institutionalized elderly in three months decreased with significant difference between the assessments. Among all the biochemical and anthropometric measurements, body mass index, weight, fat mass, phase angle and blood fat were the indicators of nutritional assessment that identified early changes and nutritional risks of institutionalized elderly in three months. It is noteworthy that the early evaluation of nutritional indicators can prevent nutritional risk among elderly in living in rest homes.
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Mallett CA, Boitel C. From Juvenile Offender Institutions to Residential Treatment Centers: Evidence of the Shifting Paradigm to Improved Youth and Community Outcomes. J Evid Inf Soc Work 2015; 13:155-164. [PMID: 25975808 DOI: 10.1080/23761407.2015.1013367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hundreds of thousands of youth are held every year in U.S. juvenile justice detention centers and incarceration facilities. Increasingly it is known that these facility placements are at best ineffective and at worst lead to additional youth recidivism outcomes. What is most concerning, though, is that a majority of these incarcerated youth have one or more mental health/substance abuse disorders, special education disabilities, or maltreatment victimization histories-comorbid situations that negatively impact their involvement with the juvenile courts. In this article the authors summarize the epidemiology of these youth problems within the juvenile justice system. The authors then compare the outcome evidence for the youth placed in juvenile justice facilities with those placed in residential treatment centers, finding significant advantages to addressing the problems through rehabilitative efforts. Recognizing that there are a small number of serious youthful offenders who will need placement, their analysis finds that the juvenile courts must continue (or in many instances begin) reshaping their detention and incarceration facilities reliance on punishment toward a rehabilitative residential model.
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Affiliation(s)
| | - Craig Boitel
- a School of Social Work, Cleveland State University , Cleveland , Ohio , USA
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Abstract
OBJECTIVES recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. DESIGN a cross-sectional retrospective survey was conducted in 2013. SETTING AND PARTICIPANTS coordinating physicians in 3,705 nursing homes in France. MEASUREMENTS a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. RESULTS among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P < 0.001). CONCLUSION our study demonstrates the existence of major differences across regions in France and highlights the need for targeted interventions regarding end-of-life care in nursing home facilities.
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Affiliation(s)
- Lucas Morin
- French National Observatory on End-of-Life Care, Paris, France Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Régis Aubry
- University Hospital of Besancon, Besançon, France
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Solihull reduces decline in checks for looked after children. Nurs Child Young People 2015; 27:6. [PMID: 25959466 DOI: 10.7748/ncyp.27.4.6.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ferrah N, Murphy BJ, Ibrahim JE, Bugeja LC, Winbolt M, LoGiudice D, Flicker L, Ranson DL. Resident-to-resident physical aggression leading to injury in nursing homes: a systematic review. Age Ageing 2015; 44:356-64. [PMID: 25630802 DOI: 10.1093/ageing/afv004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 07/28/2014] [Accepted: 11/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes. OBJECTIVE the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes. METHODS in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions). RESULTS eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression. CONCLUSIONS we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.
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Affiliation(s)
- Noha Ferrah
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Briony J Murphy
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Lyndal C Bugeja
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Margaret Winbolt
- The Victoria and Tasmania Dementia Training Study Centre, Australian Centre for Evidence Based Aged Care, Australian Institute for Primary Care and Ageing, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Dina LoGiudice
- National Ageing Research Institute and Melbourne Health, Melbourne, Victoria, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Western Australian Institute for Medical Research, University of Western Australia, Crawley, Western Australia, Australia Royal Perth Hospital, Perth, Western Australia, Australia
| | - David L Ranson
- Department of Forensic Medicine, Monash University and Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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Tan AH, Scott J. Association of point prevalence diagnosis of delirium on length of stay, 6-month mortality, and level of care on discharge at Waitemata District Health Board, Auckland. N Z Med J 2015; 128:68-76. [PMID: 25820505] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Delirium in hospitalised older persons is common and is correlated with adverse outcomes. Few studies of this have been done in New Zealand. The study aimed to measure the impact of delirium on 6-month mortality, length of inpatient stay and level of care. METHOD We performed a retrospective analysis utilising data from the Delirium Point Prevalence Audit conducted at Waitemata District Health Board. The subjects were older inpatients (>65 years) surveyed between 15/05/2012 to 24/07/2012. Delirium was defined as screening positive on the Confusion Assessment Method (CAM). Patients were dichotomised into those with delirium or without. RESULTS 250 patients were identified. 28(11.2%) were CAM-positive while 222 (88.8%) were CAM-negative. Mortality at 6 months for the CAM-positive group was 39%, compared to 10% in the CAM-negative group (p<0.005). The mean inpatient day stay for the CAM-positive group was 25.4 days; for the CAM-negative group it was 21.6 days (p=0.721). The proportion requiring an increased level of care at discharge was 66.6% for the CAM-positive group, while for CAM-negative persons the rate was 13.8% (p<0.00003). CONCLUSION In hospitalised older adults, the presence of a positive CAM test for delirium was strongly associated with both a higher mortality rate at 6 months and a requirement for an increased level of care at discharge as compared to a negative CAM. No effect was observed on inpatient length of stay.
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Affiliation(s)
- Aik Haw Tan
- Geriatric and Internal Medicine, Waitemata District Health Board, Auckland, New Zealand.
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