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Rapp K, Roigk P, Becker C, Todd C, Rehm M, Rothenbacher D, Konnopka C, König HH, Friess T, Büchele G. Association of two geriatric treatment systems with anti-osteoporotic drug treatment and second hip fracture in patients with an index hip fracture: retrospective cohort study. BMC Geriatr 2024; 24:395. [PMID: 38702593 PMCID: PMC11069171 DOI: 10.1186/s12877-024-04989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND In Germany, geriatricians deliver acute geriatric care during acute hospital stay and post-acute rehabilitation after transfer to a rehabilitation clinic. The rate patients receive acute geriatric care (AGC) or are transferred to post-acute rehabilitation (TPR) differs between hospitals. This study analyses the association between the two geriatric treatment systems (AGC, TPR) and second hip fracture in patients following an index hip fracture. METHODS Nationwide health insurance data are used to identify the rate of AGC and TPR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes are a second hip fracture after surgery or after discharge within 180 or 360 days and new specific anti-osteoporotic drugs. Cox proportional hazard models and generalised linear models are applied. RESULTS Data from 29,096 hip fracture patients from 652 hospitals were analysed. AGC and TPR are not associated with second hip fracture when follow-up started after surgery. However, during the first months after discharge patients from hospitals with no AGC or low rates of TPR have higher rates of second hip fracture than patients from hospitals with high rates of AGC or high rates of TPR (Hazard Ratio (95% CI) 1.35 (1.01-1.80) or 1.35 (1.03-1.79), respectively). Lower rates of AGC are associated with lower probabilities of new prescriptions of specific anti-osteoporotic drugs. CONCLUSIONS Our study suggests beneficial relationships of geriatric treatment after hip fracture with a) the risk of second hip fractures during the first months after discharge and b) an improvement of anti-osteoporotic drug treatment.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Unit Digitale Geriatrie, Universtiätsklinikum Heidelberg, Heidelberg, Germany
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
- Center for Trauma Research, Ulm University, Ulm, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Friess
- AUC - Akademie der Unfallchirurgie GmbH, Wilhelm-Hale-Straße 46B, Munich, 80639, Germany
| | - Gisela Büchele
- Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK.
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Abel B, Bongartz M, Rapp K, Roigk P, Peiter J, Metz B, Finger B, Büchele G, Wensing M, Roth C, Schmidberger O, König HH, Gottschalk S, Dams J, Deuster O, Immel D, Micol W, Bauer JM, Benzinger P. Multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2024; 24:69. [PMID: 38233746 PMCID: PMC10795216 DOI: 10.1186/s12877-023-04634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation. METHODS The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge. DISCUSSION The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation. TRIAL REGISTRATION German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.
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Grants
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- German Innovation Fund (‘New Forms of Care’) coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- Universitätsklinikum Heidelberg (8914)
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Affiliation(s)
- Bastian Abel
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Bongartz
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janine Peiter
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Brigitte Metz
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Benjamin Finger
- Department of Telemedicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Schmidberger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS) at the University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Désirée Immel
- AOK Baden-Württemberg, Statutory Health Insurance Company, Stuttgart, Germany
| | - William Micol
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany.
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Roigk P, Becker C, Pfeiffer K, Bühl K, Büchele G, Rothenbacher D, König HH, Konnopka C, Fries T, Rapp K. [Cooperation of geriatrics and trauma surgery in certified geriatric trauma centers : Insights into different care models and the implementation of requirements resulting from certification]. Z Gerontol Geriatr 2024:10.1007/s00391-023-02271-3. [PMID: 38214754 DOI: 10.1007/s00391-023-02271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery and geriatrics and if the quality of care had changed since the certification of the centers. METHODS In this study 4 guided focus group interviews (FGI) were conducted in different teams of certified geriatric trauma centers in 3 federal states with 16 participants. To specify the content of the FGI, two additional interviews were conducted with system auditors. Both types of interview were analyzed by content analysis. RESULTS The certification supported the implementation of structures and processes in the different orthogeriatric models; however, the quality of care and cooperation between surgery and geriatrics depends on the spatial proximity and the orthogeriatric care model in the geriatric trauma centers. Simultaneously, challenges in the area of geriatric syndromes and the recruitment of skilled staff became relevant. DISCUSSION The results can help to reflect processes in the certified geriatric trauma centers and to treat geriatric syndromes more effectively. In the future, the challenge will be to establish geriatric care under the existing shortage of skilled staff.
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Affiliation(s)
- Patrick Roigk
- Abteilung für Geriatrie, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland.
| | - Clemens Becker
- Abteilung für Geriatrie, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
| | - Klaus Pfeiffer
- Abteilung für Geriatrie, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
| | - Kerstin Bühl
- Abteilung für Geriatrie, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
| | - Gisela Büchele
- Institut für Epidemiologie und Med. Biometrie, Universität Ulm, Ulm, Deutschland
| | | | - H H König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Claudia Konnopka
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas Fries
- AUC - Akademie der Unfallchirurgie GmbH, München, Deutschland
| | - Kilian Rapp
- Abteilung für Geriatrie, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
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Konnopka C, Büchele G, Jaensch A, Rothenbacher D, Becker C, Rapp K, Henken E, König HH. Evaluation of costs, osteoporosis treatment, and re-fractures in German collaborative orthogeriatric care after fragility fractures. Osteoporos Int 2024; 35:81-91. [PMID: 37940697 PMCID: PMC10786733 DOI: 10.1007/s00198-023-06965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
Orthogeriatric co-management (OGCM) may provide benefits for geriatric fragility fracture patients in terms of more frequent osteoporosis treatment and fewer re-fractures. Yet, we did not find higher costs in OGCM hospitals for re-fractures or antiosteoporotic medication for most fracture sites within 12 months, although antiosteoporotic medication was more often prescribed. PURPOSE Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence for other fractures is rare. The aim of our study was to conduct an evaluation of economic and health outcomes after the German OGCM for geriatric fragility fracture patients. METHODS This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a fragility fracture in 2014-2018, and were treated in hospitals certified for OGCM (ATZ group), providing OGCM without certification (OGCM group) or usual care (control group). Healthcare costs from payer perspective, prescribed medications, and re-fractures were investigated within 6 and 12 months. We used weighted gamma and two-part models and applied entropy balancing to account for the lack of randomization. All analyses were stratified per fracture site. RESULTS We observed 206,273 patients within 12-month follow-up, of whom 14,100 were treated in ATZ, 133,353 in OGCM, and 58,820 in other hospitals. Total average inpatient costs per patient were significantly higher in the OGCM and particularly ATZ group for all fracture sites, compared to control group. We did not find significant differences in costs for re-fractures or antiosteoporotic medication for most fracture sites, although antiosteoporotic medication was significantly more often observed in the OGCM and particularly ATZ group for hip, pelvic, and humerus fractures. CONCLUSION The observed healthcare costs were higher in ATZ and OGCM hospitals within 12 months. Antiosteoporotic medication was prescribed more often in both groups for most fracture sites, although the corresponding medication costs did not increase.
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Affiliation(s)
- Claudia Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Espen Henken
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Braun T, Thiel C, Peter RS, Bahns C, Büchele G, Rapp K, Becker C, Grüneberg C. Association of clinical outcome assessments of mobility capacity and incident disability in community-dwelling older adults - a systematic review and meta-analysis. Ageing Res Rev 2022; 81:101704. [PMID: 35931411 DOI: 10.1016/j.arr.2022.101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 01/31/2023]
Abstract
The objective of the present review is to synthesize all available research on the association between mobility capacity and incident disability in non-disabled older adults. MEDLINE, EMBASE and CINAHL databases were searched without any limits or restrictions until February 2021. Published reports of longitudinal cohort studies that estimated a direct association between baseline mobility capacity, assessed with a standardized outcome assessment, and subsequent development of disability, including initially non-disabled older adults were included. The risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Random-effect models were used to explore the objective. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The main outcome measures were the pooled relative risks (RR) per one conventional unit per mobility assessment for incident disability. A total of 40 reports (85,515 participants at baseline) were included. For usual and fast gait speed, the RR per -0.1 m/s was 1.23 (95% CI: 1.18-1.28; 26,638 participants) and 1.28 (95% CI: 1.19-1.38; 8161 participants), respectively. Each point decrease in Short Physical Performance Battery score increased the risk of incident disability by 30% (RR = 1.30, 95% CI: 1.23-1.38; 9183 participants). The RR of incident disability by each second increase in Timed Up and Go test and Chair Rise Test performance was 1.15 (95% CI: 1.09-1.21; 30,426 participants) and 1.07 (95% CI: 1.04-1.10; 9450 participants), respectively. The review concludes that among community-dwelling non-disabled older adults, poor mobility capacity is a potent modifiable risk factor for incident disability. Mobility impairment should be mandated as a quality indicator of health for older people.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany; Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; HSD Hochschule Döpfer (University of Applied Sciences), Department of Health, Cologne, Germany.
| | - Christian Thiel
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany; Faculty of Sports Science, Ruhr-University Bochum, Bochum, Germany
| | - Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Carolin Bahns
- Department of Therapy Science I, Brandenburg Technical University Cottbus - Senftenberg, Senftenberg, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Digital Geriatric Medicine, Medical Clinic, Heidelberg University, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Rapp K, Becker C, Todd C, Rehm M, Rothenbacher D, Konnopka C, König HH, Friess T, Büchele G. Association of two geriatric treatment systems on care home admission and mortality in patients with hip fracture. BMC Geriatr 2022; 22:459. [PMID: 35624422 PMCID: PMC9145150 DOI: 10.1186/s12877-022-03037-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, geriatricians deliver acute geriatric care during an acute hospital stay and subacute rehabilitation after transfer to a rehabilitation clinic. However, the proportion of patients who receive acute geriatric care (AGC) or are transferred to subacute rehabilitation (TSR) differs considerably between hospitals. The aim of this study was to analyse the association between the two geriatric treatment systems and care home admission or mortality in patients following hip fracture. METHODS Health insurance claims data were used to identify the rate of AGC per hospital and the rate of TSR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes were cumulative admission to a care home and cumulative mortality within 6 months after hospital admission. RESULTS Data from 23,046 hip fracture patients from 561 hospitals were analysed. The rate of AGC was not associated with care home admission. However, compared to high rates of AGC medium rates or no AGC were associated with increased death rates by 12% or 20%, respectively. Treatment in hospitals with low rates of TSR was associated with a 8% higher risk of care home admission and a 10% increased risk of death compared to treatment in hospitals with high rates of TSR. CONCLUSIONS Our study suggests potential effects of geriatric treatment: reduction of mortality in hospitals with high rates of AGC or reduction of care home admission and mortality in hospitals with high rates of TSR.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr.110, 70376, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr.110, 70376, Stuttgart, Germany
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Center for Trauma Research, Ulm University, Ulm, Germany
| | - Claudia Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Friess
- AUC - Akademie der Unfallchirurgie GmbH, Wilhelm-Hale-Straße 46b, 80639, München, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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Werner C, Wolf-Belala N, Nerz C, Abel B, Braun T, Grüneberg C, Thiel C, Büchele G, Muche R, Hendlmeier I, Schäufele M, Dams J, König HH, Bauer JM, Denkinger M, Rapp K. A multifactorial interdisciplinary intervention to prevent functional and mobility decline for more participation in (pre-)frail community-dwelling older adults (PromeTheus): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2022; 22:124. [PMID: 35164686 PMCID: PMC8842871 DOI: 10.1186/s12877-022-02783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background Age-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dwelling older adults are, however, often not yet established and implemented in routine practice. Research on the feasibility, implementation, and (cost-)effectiveness of multifactorial, interdisciplinary intervention programs that take advantage of available services of healthcare providers is also limited. The main aim of this study is to evaluate the effectiveness of such an intervention program (PromeTheus) to prevent functional and mobility decline for more participation in community-dwelling (pre-)frail older adults. Methods The study is designed as a three-center, randomized controlled trial with a 12-month intervention period. Four hundred community-dwelling (pre-)frail (Clinical Frailty Scale score 4–6) older adults (≥70 years) will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will receive the PromeTheus program consisting of obligatory home-based physical exercises (Weight-bearing Exercise for Better Balance) accompanied by physiotherapists and facultative counseling services (person-environment-fit, coping with everyday life, nutrition, group-based activities) delivered via existing healthcare structures (e.g., social workers, nutritionists). The CG will receive usual care and a one-time counseling session on recommendations for physical activity and nutrition. Primary outcomes assessed at months 6 and 12 are the function component of the Late-Life Function and Disability Instrument and the University of Alabama at Birmingham Life-Space Assessment. Secondary outcomes are disability, physical capacity and activity, frailty, nutritional status, falls, fear of falling, health status, and psychosocial components. Process and economic evaluations are also conducted. Primary statistical analyses will be based on the intention-to-treat principle. Discussion Compared to usual care, the PromeTheus program is expected to result in higher function and mobility, greater independence and lower need for care, and more participation. As the PromeTheus program draws on existing German healthcare structures, its large-scale translation and delivery will be feasible, if evidence of (cost-)effectiveness and successful implementation can be demonstrated. Trial registration German Clinical Trials Register, . Registered on March 11, 2021.
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Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | | | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Bastian Abel
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Reiner Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ingrid Hendlmeier
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Martina Schäufele
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Denkinger
- Institute for Geriatric Research, Ulm University, Ulm, Germany.,Agaplesion Bethesda Clinic, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
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Rapp K, Lamb SE, Roigk P, Becker C, Konnopka C, König HH, Peter RS, Rothenbacher D, Büchele G. Effect of an osteoporotic fracture prevention program on fracture incidence in routine care: a cluster-randomized trial. BMC Med 2022; 20:49. [PMID: 35114993 PMCID: PMC8815238 DOI: 10.1186/s12916-021-02226-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fractures are a major health problem in aging societies. Preventive approaches combining bone health and fall prevention are rare. The osteoporotic fracture prevention program in rural areas (OFRA) is a health care fund-driven program for older people in randomly selected districts in Germany. The components of the program were falls prevention exercise classes, examination of bone health by a dual-energy X-ray absorptiometry (DXA) scan, and a consultation about "safety in the living environment." The aim of this study was to evaluate this complex preventive intervention in a routine health care setting. METHODS This cluster-randomized trial was performed from October 2015 to October 2018 and took place in 186 administrative districts in five federal states, 47 districts served as intervention districts, and 139, as controls. Within these districts, we included (a) all community-living women and men aged 70-85 years with prior fragility fractures and (b) all community-living women aged 75-80 years. The analysis used routine data collected by a health insurance company. The primary endpoint was all fragility fractures combined. Fracture types, mortality, and nursing home admission were explorative endpoints. Cox frailty models were used for comparative analyses with a median follow-up time of 365 days (interquartile range: 0 days). RESULTS Nine thousand four hundred eight individuals were approached to participate in one of the program components, 27,318 individuals served as controls. The mean age was 78.7 years. Of those approached to participate, nearly 30% joined the exercise classes. DXA measurement was reimbursed for 13.6%, and 51.8% received advice about measures to increase "safety in the living environment." The incidence of fragility fractures did not differ between the intervention and the control group (HR 0.94; 95% CI 0.80-1.11). However, femoral fractures, the most frequent fracture type, were reduced in the intervention group (HR 0.76; 95% CI 0.59-0.99). Mortality and nursing home admission did not differ between the intervention and the control group. CONCLUSIONS A comprehensive fracture prevention program for older people living in rural areas was implemented. The program did not affect the primary endpoint of all fragility fractures combined. It has to be considered that we used a modified intention to treat approach based on geographic randomization and information about endpoints relied exclusively on routine data of the health care insurance. TRIAL REGISTRATION German Clinical Trials Register DRKS-ID: 00009000.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Sarah E Lamb
- College of Medicine and Health, St Lukes Campus, University of Exeter, Exeter, EX12LU, UK
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Claudia Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
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9
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Schanz M, Kimmel M, Büchele G, Lindemann U, Schricker S, Becker C, Alscher MD, Rapp K. Gender-Specific Differences of Renal Heat Tolerance in Older Adults during Heat Waves. Gerontology 2021; 68:1018-1026. [PMID: 34864733 DOI: 10.1159/000520324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibitor of metalloproteinases-2 [TIMP-2]·insulin-like growth factor binding protein-7 [IGFBP7], a new FDA-cleared renal tubular stress biomarker, was used. MATERIALS AND METHODS 68 residents from facilities of sheltered housing with urine samples collected at heat waves in 2015 and at control visits were included. Urinary [TIMP-2]·[IGFBP7] was compared between the heat waves and the control visits. Multivariate linear models were adjusted for age, frailty index, and functional comorbidity index. RESULTS The median age was 82.0 years, 82.3% were women. The percentage of elevated levels of urinary [TIMP-2]·[IGFBP7] (>0.3 [ng/mL]2/1,000) in the total study population was higher at the heat waves than at the control visits (25.0% vs. 17.7%). The effect of the heat waves on urinary [TIMP-2]·[IGFBP7] was stronger in men than in women: The percentage of elevated levels was 75.0% in men and 14.3% in women. In the multivariate analysis, the mean urinary [TIMP-2]·[IGFBP7] was 0.48 (95% CI 0.25; 0.70) (ng/mL)2/1,000 higher in men than in women. Except gender, a number of additional variables did not show an association with urinary [TIMP-2]·[IGFBP7] at the heat waves or the control visits. CONCLUSIONS At heat waves, urinary [TIMP-2]·[IGFBP7] was elevated and higher in men than in women. This suggests gender-specific differences in renal heat tolerance in older people.
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Affiliation(s)
- Moritz Schanz
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Martin Kimmel
- Division of Nephrology, Department of Internal Medicine, Hypertension and Autoimmune Disorders, Alb-Fils Kliniken, Göppingen, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ulrich Lindemann
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Severin Schricker
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Clemens Becker
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Mark Dominik Alscher
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Kilian Rapp
- Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
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10
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Klimek M, Büchele G, Rehm M, Beyersmann J, Günther KP, Brenner H, Stürmer T, Brenner RE, Rothenbacher D. Long-term mortality of patients with osteoarthritis after joint replacement: Prognostic value of pre- and postoperative pain and function. Arthritis Care Res (Hoboken) 2021; 75:869-875. [PMID: 34738320 DOI: 10.1002/acr.24808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate whether osteoarthritis (OA)-specific assessment values (i.e. Western Ontario and McMaster University Osteoarthritis Index [WOMAC]) and generic pain and function (visual analog scale [VAS], Hanover Functionality Status Questionnaire [FFbH]) measured before and 12 months after arthroplasty are associated with the risk of long-term mortality in a cohort of patients with advanced OA of the hip or knee. METHODS The Ulm Osteoarthritis Study was a prospective cohort study of OA patients with unilateral total hip or knee replacement between January 1995 and December 1996. Correlation coefficients were calculated to describe the agreement between the different assessments. Mortality was assessed during the follow-up period (last update: July 2019). Cox proportional regression models were used to estimate hazard ratios (HRs) for mortality after adjusting for covariates. RESULTS Arthroplasty was accompanied by a clear reduction in pain and improved function throughout all assessments in the 706 included patients. The results of the adjusted Cox models showed no relationship between baseline and follow-up joint-specific WOMAC assessments and long-term mortality. However, an independent increased risk of mortality was found with generic function assessments. In the final adjusted model, the HR for the 12-month follow-up value was 1.79 (95% confidence interval, 1.24-2.60) in the group with clinically relevant impairment versus the reference group. CONCLUSIONS Poor function based on the generic assessment was associated with increased long-term mortality, suggesting that functional impairments in daily life activities may be more important for long-term survival than OA-specific impairments in this patient group. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthias Klimek
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology & Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Germany
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rolf E Brenner
- Department of Orthopedics, Division for Biochemistry of Joint and Connective Tissue Diseases, Ulm University, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Centre for Trauma Research, Ulm University, Ulm, Germany
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11
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Schulz C, Büchele G, Peter RS, Rothenbacher D, Brettschneider C, Liener UC, Becker C, Rapp K, König HH. Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data. Eur J Health Econ 2021; 22:873-885. [PMID: 33813666 PMCID: PMC8275532 DOI: 10.1007/s10198-021-01295-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients. METHODS This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves. RESULTS 14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective. CONCLUSION Survival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.
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Affiliation(s)
- Claudia Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ulrich C Liener
- Departement of Orthopedic and Trauma Surgery, Marienhospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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12
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Dautel A, Gross M, Abel B, Pomiersky R, Eckert T, Hauer K, Schäufele M, Büchele G, Becker C, Pfeiffer K. Psychometric properties of the German version of the Fear of Falling Questionnaire-revised (FFQ-R) in a sample of older adults after hip or pelvic fracture. Aging Clin Exp Res 2021; 33:329-337. [PMID: 32705586 DOI: 10.1007/s40520-020-01657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Identifying patients with maladaptive fear of falling (FOF) is important in the rehabilitation phase after serious fall. The 6-item Fear of Falling Questionnaire-revised (FFQ-R) was seen as promising measurement instrument as it evaluates FOF in a broader way than the one-item-question and independent of physical activities. AIM The purpose of the analysis was to evaluate the psychometric properties of the translated German FFQ-R. METHODS Back-translation method was applied. Confirmatory factor analysis (CFA) with diagonally weighted least square estimation was used to verify the two-factor structure. Data were collected during inpatient rehabilitation from hip and pelvic fracture patients [age 84.3 ± 6.2, Mini-Mental State Examination (MMSE) scores > 23] participating in an RCT (N = 112) and a cross-sectional survey (N = 40). RESULTS Internal consistency was 0.78 (Cronbach´s alpha). No floor or ceiling effects were found. Discriminatory power on item level was moderate to good (r = 0.43-0.65). CFA revealed a good model fit and confirmed the two-factor structure. The German FFQ-R was moderately correlated (r = 0.51) with the Short Falls Efficacy Scale-International (Short FES-I) used as a proxy measure for FOF. Missing rates up to 9% for specific items were because some individuals, independent of cognitive level or age, had problems to rate items with conditional statements on possible negative consequences of a fall. CONCLUSIONS Results demonstrated moderate to good psychometric properties similar to the original English version in a comparable sample of fracture patients.
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13
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Pfeiffer K, Theurer C, Büchele G, Babac A, Dick H, Wilz G. Relieving distressed caregivers (ReDiCare study): study protocol of a randomized pragmatic trial. BMC Geriatr 2021; 21:4. [PMID: 33407195 PMCID: PMC7787127 DOI: 10.1186/s12877-020-01941-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/07/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Providing care for someone with a disease or chronic condition can have a negative psychological, physical, social, and economic impact upon informal caregivers. Despite the socio-economic relevance and more than three decades of caregiver intervention research only very few translational efforts of successful interventions are reported. Still less of these interventions have been implemented into routine services. The aim of the ReDiCare study (German acronym BerTA) is to evaluate the effectiveness of a stepped counselling approach for burdened caregivers delivered by care counsellors of two long-term care insurances and registered psychotherapists. METHODS/ DESIGN A pragmatic randomised controlled trial with 572 caregivers of older adults (≥ 60 years) receiving benefits of one of the two participating long-term care insurances. Participants are assigned (t0) to either the ReDiCare intervention or a control group receiving routine care and counselling. Data are collected at baseline (-t1), 3-month (t1), 9-month (t2) and 15-month (t3). The 9-month post-intervention assessment (t2) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. Depressive symptoms measured with the CES-D are the primary outcome. The main secondary outcomes are physical complaints, utilization of psychosocial resources, caregiver self-efficacy and burden, positive aspects of caregiving and perceived care quality. A process evaluation, including audio tapes, self-report questionnaires and documentation will be conducted to examine internal and external validity of the intervention. Data on direct and indirect costs are collected for the (health) economic evaluation, using a health care perspective and a societal perspective. DISCUSSION While comparable previous caregiver interventions have been developed and evaluated for specific caregiver groups (e.g. dementia caregivers, stroke caregivers), the ReDiCare study will indicate whether a stepped approach will be effective also in a broader group of caregivers. The intervention is one of the very few translational studies in caregiver intervention research and will provide valuable insights into relevant factors for training, intervention protocol adherence, effectiveness, and costs for future implementation steps. TRIAL REGISTRATION Deutsches Register Klinischer Studien (German Clinical Trials Register), DRKS00014593 ( www.drks.de, registered 14 May 2018) and International Clinical Trials Registry Platform, DRKS00014593 ( https://apps.who.int/trialsearch/ ).
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Affiliation(s)
- Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Christina Theurer
- Department of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Helene Dick
- Institute of Health Care and Public Management, University of Hohenheim, Stuttgart, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
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14
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Rehm M, Büchele G, Peter RS, Brenner RE, Günther KP, Brenner H, Koenig W, Rothenbacher D. Relationship between cardiac biomarker concentrations and long-term mortality in subjects with osteoarthritis. PLoS One 2020; 15:e0242814. [PMID: 33264342 PMCID: PMC7710029 DOI: 10.1371/journal.pone.0242814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/23/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is associated with adverse cardio-metabolic features. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponins T and I (hs-cTnT and hs-cTnI) are well-characterized cardiac markers and provide prognostic information. The objective was to assess the association of cardiac biomarker concentrations with long-term mortality in subjects with OA. In a cohort of 679 OA subjects, undergoing hip or knee replacement during 1995/1996, cardiac biomarkers were measured and subjects were followed over 20 years. During a median follow-up of 18.4 years, 332 (48.9%) subjects died. Median of hs-cTnT, hs-cTnI, and NT-proBNP at baseline was 3.2 ng/L, 3.9 ng/L, and 96.8 ng/L. The top quartile of NT-proBNP was associated with increased risk of mortality (Hazard Ratio (HR) 1.79, 95% confidence interval (CI) 1.17–2.73) after adjustment for covariates including troponins (hs-cTnT HR 1.30 (95% CI 0.90–1.89), hs-cTnI HR 1.32 (95% CI 0.87–2.00) for top category). When biomarker associations were evaluated as continuous variables, only NT-proBNP (HR per log-unit increment 1.34, 95% CI 1.16–1.54) and hs-cTnI (HR 1.38, 95% CI 1.11–1.72) showed robust results. Elevated cardiac biomarker concentrations predicted an increased risk of long-term mortality and strongest for NT-proBNP and hs-cTnI. These results might help to identify subjects at risk and target preventive efforts early.
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Affiliation(s)
- Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Rolf Erwin Brenner
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopedics, Ulm University, Ulm, Germany
| | - Klaus-Peter Günther
- University Center of Orthopedic and Trauma Surgery, Technical University of Dresden, Dresden, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- * E-mail:
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15
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Repky S, Büchele G, Günther KP, Huch K, Brenner H, Stürmer T, Beyersmann J, Brenner RE, Rothenbacher D. Five years' trajectories of functionality and pain in patients after hip or knee replacement and association with long-term patient survival. Sci Rep 2020; 10:14388. [PMID: 32873877 PMCID: PMC7463234 DOI: 10.1038/s41598-020-71277-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
To describe the 5 years’ trajectories in functionality and pain of patients with hip or knee osteoarthritis and arthroplasty and analyze the association of these with long-term patients survival. Patients with OA receiving total hip or knee arthroplasty were recruited and completed two sets of standardized questionnaires for functionality and pain 6, 12, and 60 months postoperatively. Multivariate mixed models were conducted to assess trajectories over time and the resulting improvement per month during the last time period was included in a landmark-model to estimate adjusted hazard ratios for mortality. In total 809 patients with joint replacement were included (mean age 65.0 years, 62.2% female), 407 patients died (median follow-up 18.4 years). Both instruments of functionality and pain showed extensive improvement during the first 6 months. Baseline and change in functionality (both p < 0.001) and pain (p = 0.02) during the first 6 months were associated with mortality. Better values in functionality corresponded with improved survival whereas the association with the pain scores was inverse. In patients with hip and knee OA, an explicit improvement in function is seen within the first 6 months after arthroplasty. In addition, especially the functionality scores at baseline as well as their improvement showed an association with long-term patient survival.
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Affiliation(s)
- Stefan Repky
- Institute of Statistics, Ulm University, Ulm, Germany.,Institute of Human Genetics, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, 89081, Ulm, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Klaus Huch
- Birkle Clinic, Department of Orthopedics and Trauma Surgery, Bodenseeklinik, Überlingen, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Rolf E Brenner
- Department of Orthopedics, Division for Biochemistry of Joint and Connective Tissue Diseases, Ulm University, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, 89081, Ulm, Germany. .,Centre for Trauma Research, Ulm University, Ulm, Germany.
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16
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Pfeiffer K, Kampe K, Klenk J, Rapp K, Kohler M, Albrecht D, Büchele G, Hautzinger M, Taraldsen K, Becker C. Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age Ageing 2020; 49:771-778. [PMID: 32832985 DOI: 10.1093/ageing/afaa050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/08/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT. METHODS one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention. RESULTS in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45). CONCLUSIONS the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.
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Affiliation(s)
- Klaus Pfeiffer
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Karin Kampe
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB Hochschule Berlin, Studienzentrum Stuttgart, Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michaela Kohler
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Diana Albrecht
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Martin Hautzinger
- Department of Psychology, Eberhard Karls University, Tubingen, Germany
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
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Engels A, Reber KC, Lindlbauer I, Rapp K, Büchele G, Klenk J, Meid A, Becker C, König HH. Osteoporotic hip fracture prediction from risk factors available in administrative claims data - A machine learning approach. PLoS One 2020; 15:e0232969. [PMID: 32428007 PMCID: PMC7237034 DOI: 10.1371/journal.pone.0232969] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/25/2020] [Indexed: 01/01/2023] Open
Abstract
Objective Hip fractures are among the most frequently occurring fragility fractures in older adults, associated with a loss of quality of life, high mortality, and high use of healthcare resources. The aim was to apply the superlearner method to predict osteoporotic hip fractures using administrative claims data and to compare its performance to established methods. Methods We devided claims data of 288,086 individuals aged 65 years and older without care level into a training (80%) and a validation set (20%). Subsequently, we trained a superlearner algorithm that considered both regression and machine learning algorithms (e.g., support vector machines, RUSBoost) on a large set of clinical risk factors. Mean squared error and measures of discrimination and calibration were employed to assess prediction performance. Results All algorithms used in the analysis showed similar performance with an AUC ranging from 0.66 to 0.72 in the training and 0.65 to 0.70 in the validation set. Superlearner showed good discrimination in the training set but poorer discrimination and calibration in the validation set. Conclusions The superlearner achieved similar predictive performance compared to the individual algorithms included. Nevertheless, in the presence of non-linearity and complex interactions, this method might be a flexible alternative to be considered for risk prediction in large datasets.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical-Centre Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Katrin C. Reber
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical-Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ivonne Lindlbauer
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical-Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Department of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Jochen Klenk
- Department of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Andreas Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical-Centre Hamburg-Eppendorf, Hamburg, Germany
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18
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Schulz C, König HH, Rapp K, Becker C, Rothenbacher D, Büchele G. Analysis of mortality after hip fracture on patient, hospital, and regional level in Germany. Osteoporos Int 2020; 31:897-904. [PMID: 31822928 DOI: 10.1007/s00198-019-05250-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
UNLABELLED Knowledge about risk factors of mortality after hip fracture might encourage prevention and further improvements in care. This study identified patient risk factors as well as hospital and regional characteristics associated with a decreased risk. Variation of mortality was largest on patient level and modest on hospital and regional level. INTRODUCTION Among numerous studies analyzing mortality as worst consequence after hip fracture, the majority focused on patient level and fewer on hospital and regional level. Comprehensive knowledge about contributing factors on all levels might help to reveal relevant inequalities, which would encourage prevention and further improvements in care. This study aimed at investigating variation of mortality after hip fracture on patient, hospital, and regional level in Germany. METHODS We performed a retrospective cohort study on hip fracture patients aged 65 and older using statutory health insurance claims data from Jan 2009 through Dec. 2012 and additional information from the Federal Statistical Office Germany. Regions were classified based on two-digit postal code. We applied a multilevel Cox proportional hazard model with random intercepts on hospital and regional level to investigate the risk factors for mortality within 6 and 12 months after hip fracture. RESULTS The dataset contained information on 123,119 hip fracture patients in 1014 hospitals in 95 German regions. Within 6/12 months, 20.9%/27.6% of the patients died. On patient level, male sex, increasing age, increased pre-fracture care level, and increasing comorbidity were associated with an increased hazard of mortality. Hospitals with increasing hip fracture volume or with orthogeriatric co-management and regions with increased population density were associated with a decreased hazard. Variation was largest on patient level and rather modest on hospital and regional level. CONCLUSIONS The identification of patient-related risk factors enables prognosticating mortality after hip fracture. After adjusting for those, variation seemed to be attributable rather to hospitals than to regions.
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Affiliation(s)
- C Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - K Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 112, 70376, Stuttgart, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 112, 70376, Stuttgart, Germany
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
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19
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Rapp K, Becker C, Todd C, Rothenbacher D, Schulz C, König HH, Liener U, Hartwig E, Büchele G. The Association Between Orthogeriatric Co-Management and Mortality Following Hip Fracture. Dtsch Arztebl Int 2020; 117:53-59. [PMID: 32036854 DOI: 10.3238/arztebl.2020.0053] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 05/27/2019] [Accepted: 11/04/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND To meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany. METHODS This observational study was based on health insurance claims data from 58 001 patients (79.4% women) aged ≥80 years admitted to the hospital with hip fracture between January 2014 and March 2016. They were treated in 828 German hospitals with or without orthogeriatric co-management. The outcome measure was cumulative mortality with adjustment of the regression analyses. RESULTS The crude 30-day mortality was 10.3% for patients from hospitals with orthogeriatric co-management and 13.4% for patients from hospitals without orthogeriatric co-management. The adjusted 30-day mortality was 22% lower for patients in hospitals with orthogeriatric co-management (rate ratio 0.78; 95% CI [0.74; 0.82]; adjusted absolute difference -2.48%; 95% CI [-2.98; -1.98]). The difference in 30-day mortality remained nearly unchanged over the first 6 months. The risk reduction with orthogeriatric co-management was consistently observed in both women and men, across age groups, and in patients with and without care needs. The mean length of the index stay was 19.8 days in hospitals with orthogeriatric co-management and 14.4 days in hospitals without orthogeriatric co-management. CONCLUSION A multidisciplinary orthogeriatric approach is associated with lower mortality and a longer index stay in hospital after hip fracture.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart; School of Health Sciences, University of Manchester, and Manchester Academic Health Sciences Centre, and Manchester University NHS Foundation Trust, Manchester, UK; Institute of Epidemiology and Medical Biom etry, Ulm University, Ulm; Center for Trauma Research, Ulm University, Ulm; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart; Department of Orthopedics and Trauma Surgery, Diakonissen Hospital Karlsruhe-Rüppurr, Karlsruhe
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20
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Schulz C, Büchele G, Peter RS, Rothenbacher D, Roigk P, Rapp K, Reber KC, König HH. Regional variation of care dependency after hip fracture in Germany: A retrospective cohort study using health insurance claims data. PLoS One 2020; 15:e0230648. [PMID: 32203564 PMCID: PMC7089542 DOI: 10.1371/journal.pone.0230648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/11/2019] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance. Data sources/study setting Patient-level statutory health and long-term care insurance claims data from 2009–2011 and official statistical data from Germany. Study design We performed a retrospective cohort study. Investigated multinomial outcome categories were increase in care dependency (new onset or a higher care dependency than pre-fracture), no change as reference and death as competing risk in the quarterly period following hip fracture (follow-up 3 months). Regional variation was operationalized with the variance of regional-level random intercepts based on generalized linear mixed models. We adjusted for patient and regional characteristics. Principal findings The study included 122,887 hip fracture patients in 95 German postal code regions. Crude outcomes were 30.87% increase in care dependency and 14.35% death. Results indicated modest variation on regional level. Male sex, increasing age, increasing comorbidity, pertrochanteric and subtrochanteric fracture site compared to femoral neck, time from hospital admission to surgery of 3 or more days, as well as increasing inpatient length of stay, non-participation in rehabilitation and regions with lower hospital density were positively associated with an increase in care dependency. Conclusions Several characteristics on patient and regional level associated with the outcome were identified. Variation in the increase in care dependency after hip fracture appeared to be attributable primarily to patient characteristics. Variation on regional level was only modest.
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Affiliation(s)
- Claudia Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Katrin Christiane Reber
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Büchele G, Rapp K, Bauer J, Jaensch A, Becker C, Benzinger P. Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon. Aging Clin Exp Res 2020; 32:441-447. [PMID: 31102254 DOI: 10.1007/s40520-019-01215-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon. AIMS The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status. METHODS The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider. RESULTS Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively). CONCLUSIONS OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.
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22
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Becker C, Rapp K, Rothenbacher D, Schulz C, König HH, Büchele G. Acute care models for hip fracture treatment vs post-acute rehabilitation services in older adults after hip fracture: A comparative claims data analysis from Germany. J Rehabil Med 2020; 52:jrm00024. [PMID: 31748818 DOI: 10.2340/16501977-2630] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Acute geriatric care (geriatric early rehabilitative treatment) and sub-acute (inpatient) geriat-ric rehabilitation are delivered to geriatric patients in Germany after hip fracture. The aim of this study was to compare patients' outcomes after hip fracture between 3 German federal states (Hesse, Bavaria, and Baden-Wuerttemberg) that nearly exclusively offered one of the two geriatric care systems. DESIGN Retrospective cohort study with patient-related health insurance claims data. PATIENTS Analyses were performed with data from 2009-2012 of over 30,000 patients aged ≥80 years with incident hip fracture. METHODS Primary outcomes: "increase in care dependency", "nursing home admission"; secondary outcomes: "rehospitalization", "mortality". Multivariate regression models were applied. RESULTS Compared with Hesse, the state with acute geriatric care, the risks of an "increase in care dependency" were lower in Bavaria (adjusted ratio = 0.84; 95% confidence interval (95% CI) 0.81-0.87) and Baden-Wurttemberg (0.88; 0.85-0.92), the 2 federal states with sub-acute geriatric rehabilitation. A reduction in the risk of nursing home admission was observed in Baden-Wuerttemberg (0.77; 95% CI 0.69-0.87), but not in Bavaria. Rehospitalization rates were lower in Bavaria and Baden-Wuerttemberg compared with Hesse. There was no difference in mortality. CONCLUSION Some, but not all, outcomes were more favourable in the federal states with sub-acute geriatric rehabilitation than in the federal state with acute geriatric care.
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Affiliation(s)
- Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital , , Stuttgart, Germany.
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23
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Klenk J, Peter RS, Rapp K, Dallmeier D, Rothenbacher D, Denkinger M, Büchele G. Correction to: Lazy Sundays: role of day of the week and reactivity on objectively measured physical activity in older people. Eur Rev Aging Phys Act 2019; 16:22. [PMID: 31844465 PMCID: PMC6896255 DOI: 10.1186/s11556-019-0232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s11556-019-0226-1.].
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Affiliation(s)
- Jochen Klenk
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany
| | - Raphael Simon Peter
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | - Kilian Rapp
- 2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany
| | | | - Dietrich Rothenbacher
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | | | - Gisela Büchele
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
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Eckert T, Kampe K, Kohler M, Albrecht D, Büchele G, Hauer K, Schäufele M, Becker C, Pfeiffer K. Correlates of fear of falling and falls efficacy in geriatric patients recovering from hip/pelvic fracture. Clin Rehabil 2019; 34:416-425. [PMID: 31789060 DOI: 10.1177/0269215519891233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To gain a better understanding about the nature of fear of falling, this study analyzed associations between psychological and physical aspects related to fear of falling and falls efficacy in hip/pelvic fracture patients. DESIGN Baseline data of a randomized controlled trial. SETTING Geriatric inpatient rehabilitation hospital. SUBJECTS In all, 115 geriatric patients with hip/pelvic fracture (mean age: 82.5 years) reporting fear of falling within first week of inpatient rehabilitation. INTERVENTIONS None. MAIN MEASURES Falls efficacy (Short Falls Efficacy Scale-International; Perceived Ability to Manage Falls), fear of falling (one-item question), fall-related post-traumatic stress symptoms (six items based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria), physical performance (Short Physical Performance Battery) and psychological inflexibility (Acceptance and Action Questionnaire-II) were assessed. RESULTS Path analyses demonstrated that low falls efficacy (Short Falls Efficacy Scale International) was significantly related to poor physical performance (β* = -.277, P ⩽ .001), but not to psychological inflexibility and fall-related post-traumatic stress symptoms (P ⩾ .05.). Fear of falling was directly associated with fall-related post-traumatic stress symptoms (β*= .270, P = .007) and indirectly with psychological inflexibility (β*= .110, P = .022). Low perceived ability to manage falls was significantly related to previous falls (β* = -.348, P ⩽ .001), psychological inflexibility (β* = -.216, P = .022) and female gender (β* = -.239, P ⩽ .01). CONCLUSION Falls efficacy and fear of falling constitute distinct constructs. Falls efficacy measured with the Short Falls Efficacy Scale International reflects the appraisal of poor physical performance. Fear of falling measured by the single-item question constitutes a fall-specific psychological construct associated with psychological inflexibility and fall-related post-traumatic stress symptoms.
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Affiliation(s)
- Tobias Eckert
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Karin Kampe
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michaela Kohler
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Diana Albrecht
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Martina Schäufele
- Department of Social Work, Mannheim University of Applied Sciences, Mannheim, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
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25
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Klenk J, Peter RS, Rapp K, Dallmeier D, Rothenbacher D, Denkinger M, Büchele G, Becker T, Böhm B, Scharffetter-Kochanek K, Stingl J, Koenig W, Riepe M, Peter R, Geiger H, Ludolph A, von Arnim C, Nagel G, Weinmayr G, Steinacker JM, Laszlo R. Lazy Sundays: role of day of the week and reactivity on objectively measured physical activity in older people. Eur Rev Aging Phys Act 2019; 16:18. [PMID: 31673299 PMCID: PMC6815398 DOI: 10.1186/s11556-019-0226-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to assess the effect of day of the week and wearing a device (reactivity) on objectively measured physical activity (PA) in older people. Methods Walking duration as a measure for PA was recorded from 1333 German community-dwelling older people (≥65 years, 43.8% women) over 5 days using accelerometers (activPAL). Least-square means of PA with 95%-confidence intervals (95%-CI) from multi-level analysis were calculated for each day of the week and each measurement day (days after sensor attachment). Results Walking duration on Sundays was significantly lower compared to working days (Sunday vs. Monday-Friday: − 12.8 min (95%-CI: − 14.7; − 10.9)). No statistically significant difference compared to working days was present for Saturdays. The linear slope for measurement day and walking duration was marginal and not statistically significant. Conclusions Studies using PA sensors in older people should assess Sundays and working days to adequately determine the activity level of the participants.
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Affiliation(s)
- Jochen Klenk
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany
| | - Raphael Simon Peter
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | - Kilian Rapp
- 2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany
| | | | - Dietrich Rothenbacher
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | | | - Gisela Büchele
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | | | - T Becker
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - B Böhm
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - K Scharffetter-Kochanek
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - J Stingl
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - W Koenig
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - M Riepe
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - R Peter
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - H Geiger
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - A Ludolph
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - C von Arnim
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - G Nagel
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - G Weinmayr
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - J M Steinacker
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - R Laszlo
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
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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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Dautel A, Eckert T, Gross M, Hauer K, Schäufele M, Lacroix A, Hendlmeier I, Abel B, Pomiersky R, Gugenhan J, Büchele G, Reber KC, Becker C, Pfeiffer K. Multifactorial intervention for hip and pelvic fracture patients with mild to moderate cognitive impairment: study protocol of a dual-centre randomised controlled trial (OF-CARE). BMC Geriatr 2019; 19:125. [PMID: 31039754 PMCID: PMC6492424 DOI: 10.1186/s12877-019-1133-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background A hip or pelvic fracture is a major fall-related injury which often causes a decline in mobility performance and physical activity. Over 40% of patients with hip fracture have cognitive impairment or dementia and poorer rehabilitation outcomes than those without cognitive impairment. In this subgroup, there is a lack of evidence on the best practices supporting recovery. The main aim of this study is to investigate the effects of a transitional care intervention after inpatient rehabilitation on physical activity and functional performance in this group of cognitively impaired patients. Methods/design This dual-centre, randomised controlled trial compares a multifactorial intervention with usual care as control condition. Two hundred and forty community-dwellers (≥ 65 years) with a hip or pelvic fracture and mild to moderate cognitive impairment (MMSE 17–26) are recruited at the end of inpatient rehabilitation. The four-month intervention consists of (a) an individually tailored, progressive home exercise program and physical activity promotion delivered by professional instructors and lay instructors (two home visits per week) and (b) a long-term care counselling approach addressing unmet care needs, pleasurable activities, and caregiver issues if needed. Primary outcome parameters are physical activity, measured as daily walking duration with an accelerometer-based activity monitor (activPAL™) over 72 h, and functional performance, assessed with Short Physical Performance Battery sum scores. Secondary outcome parameters are fear of falling, fall related self-efficacy, falls, quality of life, depression and activity of daily living. Data are collected at the end of rehabilitation, before the intervention at the patient’s home (baseline), after four months (post-intervention), and seven months (follow-up). In addition to completer and intent-to-treat analyses of outcomes, economic data and incremental cost-effectiveness are analysed. Discussion Existing service models of volunteer services and legal counselling provided by care counsellors were considered when developing the intervention protocol. Therefore, it should be feasible to translate and deliver the intervention into real-world practice if it has been demonstrated to be effective. Trial registration German Clinical Trials Register, DRKS00008863 (Accessed 17 Apr 2019), ISRCTN registry, ISRCTN69957256 (Accessed 17 Apr 2019).
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Affiliation(s)
- Anja Dautel
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | | | - Michaela Gross
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Martina Schäufele
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | | | - Ingrid Hendlmeier
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Bastian Abel
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Rebekka Pomiersky
- Agaplesion Bethanien Hospital, Heidelberg, Germany.,Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Katrin C Reber
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg, Hamburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany.
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Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures : Systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr 2019; 52:10-16. [PMID: 29594444 PMCID: PMC6353815 DOI: 10.1007/s00391-018-1382-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [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] [Received: 11/22/2017] [Revised: 01/23/2018] [Accepted: 03/02/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature. METHODS The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed. Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects of the epidemiology of hip fractures. RESULTS Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in age-standardized hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors, diseases and drugs have been found to be associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10-40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures. CONCLUSION The epidemiology of hip fractures is characterized by a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Karsten Dreinhöfer
- Department of Musculoskeletal Rehabilitation, Prevention and Health Service Research, Center for Sport Science and Sport Medicine (CSSB), Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin, Berlin, Germany
- Department of Orthopedics and Traumatology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Benjamin Bücking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstraße, 35043, Marburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Petra Benzinger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
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Schulz C, Büchele G, Rehm M, Rothenbacher D, Roigk P, Rapp K, Günster C, König HH, Reber K. Patient Characteristics as Indicator for Care Dependence after Hip Fracture: A Retrospective Cohort Study Using Health Insurance Claims Data From Germany. J Am Med Dir Assoc 2018; 20:451-455.e3. [PMID: 30448158 DOI: 10.1016/j.jamda.2018.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011. MEASURES The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome. RESULTS Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level. CONCLUSIONS/IMPLICATIONS This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures.
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Affiliation(s)
- Claudia Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Patrick Roigk
- Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany
| | - Kilian Rapp
- Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Reber
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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30
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Roigk P, Büchele G, Kampe K, Rupp K, Rapp K. [The osteoporotic fracture prevention program in rural areas (OFRA): analysis of 1092 mobility courses in rural areas]. Z Gerontol Geriatr 2018; 52:68-74. [PMID: 30073417 DOI: 10.1007/s00391-018-1434-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/08/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Specific training reduces the risk of falls and fall-related injuries in older persons. The availability of specific exercise programs in Germany, especially in rural areas is scarce. Therefore, a healthcare fund driven program osteoporotic fracture prevention program in rural areas (OFRA) (German name: "Trittsicher durchs Leben") was implemented in rural areas in 47 counties of 5 federal states. The most important components of the program are the "Trittsicher" mobility course and falls prevention classes organized by members of the German Association of Rural Women and executed by exercise instructors of the German Gymnastics Association or physiotherapists. Since the start of the program in October 2015 more than 2300 classes have been carried out. AIM The study analyzed the structural characteristics of the first 1092 "Trittsicher" mobility courses and the characteristics of the 12,246 participants. METHOD The analysis is based on data of a standardized course documentation sheet and information from an internal database of a health insurance company. Additionally, the distance between the location of the course and place of residence was determined for a subgroup of the participants. RESULTS The classes were conducted in communal and confessional rooms, in sports associations, kindergartens and restaurants. The majority of the 12,246 participants were female (89.1%), the median age was 75 years. The average size of the classes was 11.2 participants per course. More than half of the participants attended all six sessions. Half of the participants of the courses had to travel less than 1.7 km between the place of residence and the location of the courses. CONCLUSION "Trittsicher" mobility courses are a new specific offer to improve mobility and reduce the risk of falling. They contribute to a better care of older people in rural areas.
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Affiliation(s)
- Patrick Roigk
- Klinik für Geriatrie und Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Deutschland.
| | - Gisela Büchele
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Helmholtzstr. 22, 89069, Ulm, Deutschland
| | - Karin Kampe
- Klinik für Geriatrie und Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Deutschland
| | - Karin Rupp
- Klinik für Geriatrie und Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Deutschland
| | - Kilian Rapp
- Klinik für Geriatrie und Rehabilitation, Robert-Bosch-Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Deutschland
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31
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Reber KC, König HH, Becker C, Rapp K, Büchele G, Mächler S, Lindlbauer I. Development of a risk assessment tool for osteoporotic fracture prevention: A claims data approach. Bone 2018; 110:170-176. [PMID: 29421456 DOI: 10.1016/j.bone.2018.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/03/2017] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In aging societies osteoporotic fractures are a major health problem with high economic costs. Targeting prevention at individuals at high risk is important to reduce the future burden of fractures. Available risk assessment tools (e.g., FRAX®, QFracture, the algorithm provided by the German Osteology Society (DVO-Tool)) rely on self-reported patient information to predict fracture risk. Time and resource constraints, limited access to clinical data, and (un)willingness to participate may hamper the use of these tools. To overcome such obstacles, the aim is to develop a fracture risk assessment tool based on claims data that may be directly used on an institutional level. METHODS Administrative claims data of an elderly (≥65years) population (N=298,530) for the period from 2006 through 2014 was used. Major osteoporotic fractures (MOF) were identified based on hospital diagnoses. We applied Cox proportional hazard regression to determine the association of individual risk factors and fracture risk. Hazard ratios were used to construct a risk score. The discriminative ability of the score was evaluated using C-statistics. RESULTS We identified 7864 MOF during follow-up. The median time to first fracture during follow-up was 371.5days. Individuals with a MOF during follow-up had a higher mean and median risk score (mean: 4.53; median: 4) than individuals without MOF (mean: 3.07; median: 3). Adding drug-related risk factors slightly improved discrimination compared to a simple model with age, gender, and prior fracture. CONCLUSION We developed a fracture risk score model based on in-hospital treated subjects to predict MOF that can be used on an institutional level. The score included age, sex and prior fracture as risk factors. Adding other risk factors involved very small improvement in discrimination.
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Affiliation(s)
- Katrin C Reber
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Sarah Mächler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - Ivonne Lindlbauer
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
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Büchele G, Günther KP, Brenner H, Puhl W, Stürmer T, Rothenbacher D, Brenner RE. Osteoarthritis-patterns, cardio-metabolic risk factors and risk of all-cause mortality: 20 years follow-up in patients after hip or knee replacement. Sci Rep 2018; 8:5253. [PMID: 29588472 PMCID: PMC5869736 DOI: 10.1038/s41598-018-23573-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/12/2018] [Indexed: 11/23/2022] Open
Abstract
Osteoarthritis (OA) is a common musculoskeletal disorder and occur in different patterns. However, its impact on long-term all-cause-mortality is inconclusive. Study aims: Investigate 20-year all-cause-mortality in patients with hip/knee arthroplasty (recruited 1995/1996, N = 809) from the Ulm Osteoarthritis Study-cohort, in comparison to general population. Furthermore, to enlighten the triangle between baseline life-style and cardio-metabolic risk factors, phenotypic OA-patterns (laterality, generalization, cause) and all-cause-mortality. Mortality was assessed during 20 years follow-up. Standardized mortality ratios (SMR), adjusted odds ratios and hazard ratios (aHR) were calculated. After five years cohort-mortality was reduced compared to the general population, however 20 years later assimilated (SMR = 1.11; 95%-CI 0.73-1.49). OA-patterns were associated with age, cholesterol, and overweight/obesity. In comparison to primary OA decreased mortality was observed for patients with secondary OA (aHR = 0.76; 95%-CI 0.61-0.95) adjusted for age, smoking, overweight/obesity, diabetes, hypertension, cardiac insufficiency, uric acid, and lower cholesterol. There was no increased mortality in patients after 20 years follow-up compared to general population. Significantly decreased mortality in secondary compared to primary OA suggests a subtype-specific involvement of systemic co-factors in determination of all-cause-mortality. Because cardio-metabolic risk factors were associated with increased risk of bilateral OA and lower long-term survival, those risk factors should be consequently targeted in OA-patients.
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Affiliation(s)
- G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| | - K P Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - H Brenner
- Division of Clinical Epidemiology & Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - W Puhl
- Department of Orthopedics(emeritus), University of Ulm, Ulm, 89081, Germany
| | - T Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany.
| | - R E Brenner
- Department of Orthopedics, Division for Biochemistry of Joint and Connective Tissue Diseases, University of Ulm, Ulm, 89081, Germany
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Högel J, Rodloff AC, Büchele G, Gaus W. Randomized Observational Studies on the Economics of Therapies – Biometrical Experience of Two Trials. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract:Economic studies in medicine are intended to investigate costs, associated with a particular problem dealing with the indication, diagnosis or therapy, for instance, whether the high costs involved in a highly intensive or innovative therapy could be balanced by the eventual savings made, due to the shorter periods of treatment. In such situations a randomized controlled trial is necessary to find out which therapy or which therapeutical strategy is least expensive in the long run. Economic studies do, however, present some specific problems. Making a list of all the cost-relevant treatment items can be very laborious, but the use of flat rates and lump sums alone cannot lead to a complete cost analysis. Often, costs between hospitals vary more than between treatment regimens.Early and sudden deaths incur low costs and may bias the results. Furthermore, costs are distributed with a long and heavy upper tail incltJding extreme outliers. This does, in fact, complicate the estimation of the sample size. In this article, these problems are outlined and, with the help ofthe data obtained from two randomized economic trials in health care, solutions are proposed and discussed.
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Büchele G, Becker C, Cameron ID, Auer R, Rothenbacher D, König HH, Rapp K. Fracture risk in people with developmental disabilities: results of a large claims data analysis. Osteoporos Int 2017; 28:369-375. [PMID: 27553444 DOI: 10.1007/s00198-016-3733-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/18/2016] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Age- and sex-specific fracture rates of 18,000 people with developmental disabilities aged 0-69 years were compared to the general population. Age-standardized incidence of femoral fracture was 4.8- and 7.1-fold higher in women and men, respectively. Comparable fracture risks to the general population occurred 10-15 years earlier in females and 20-40 years earlier in males. INTRODUCTION Previous studies suggested that fracture risks in people with developmental disabilities (DD) may be higher than in people in the general population. However, there are no current sufficiently large studies to compare age- and sex-specific fracture rates of single fracture types. METHODS People with DD and incident fractures were identified by routine data of a health insurance company. Fractures in the general population were derived from the official fracture statistics. Age-specific and age-standardized fracture incidences were analyzed. To compare fracture risks in people with DD with that of the general population incidence ratios were calculated. RESULTS Between 2008 and 2010, 148 femoral fractures and 469 other fractures were observed in nearly 18,000 people with DD aged 0-69 years. The three most frequent fracture types leading to hospital admission were fractures of the femur, lower leg/ankle, and shoulder/arm. For femoral fractures, a particularly high risk was observed in children and adolescents with DD. In adults with DD, the risk of femoral fractures increased with increasing age. Even if the youngest age category was not considered, the age-standardized incidence was 4.8- and 7.1-fold higher in women and men, respectively. For all other fracture types, except fractures of forearm/hand and of pelvis, people with DD had also higher fracture incidences than the general population. CONCLUSIONS People with DD have a high fracture burden. Comparable risks of femoral fracture, for example, occurred about 10-15 years earlier in females and even 20-40 years earlier in males with DD than in the general population.
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Affiliation(s)
- G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - C Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, St Leonards, NSW 2065, Australia
| | - R Auer
- Department of care management, AOK Baden-Württemberg, Presselstr. 19, 70191, Stuttgart, Germany
| | - D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - H H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - K Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
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Rapp K, Kampe K, Roigk P, Kircheisen H, Becker C, Lindlbauer I, König HH, Rothenbacher D, Büchele G. The osteoporotic fracture prevention program in rural areas (OFRA): a protocol for a cluster-randomized health care fund driven intervention in a routine health care setting. BMC Musculoskelet Disord 2016; 17:458. [PMID: 27821102 PMCID: PMC5100272 DOI: 10.1186/s12891-016-1308-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/25/2016] [Indexed: 11/21/2022] Open
Abstract
Background Fragility fractures are one of the leading causes for disability in old people. The main underlying mechanisms are osteoporosis and falls. Evidence-based measures to prevent either falls or fractures are available. However, coordinated preventive approaches combining bone health and fall prevention are rare. The objective of the study is to evaluate a health care fund driven program, which encourages insured persons to adhere to national guidelines regarding bone health and physical activity and falls prevention. The health care fund cooperates with the ‘German Association of Rural Women’ and the ‘German Gymnastics Association’. The program consists of mobility and falls prevention classes, the examination of bone health by a DXA scan, and a consultation about ‘safety in the living environment’. Methods Cluster-randomized study in 47 intervention and 143 control districts in 5 federal states of Germany. The program is offered to a) community-living women and men aged 70 to <85 years with a prior fragility fracture or b) community-living women aged 75 to <80 years. Within two years more than 10,000 persons will be directly contacted and motivated to make use of the components of the program. The primary outcome is a combined measure of incident osteoporotic fractures. Secondary outcomes include the rate of referrals to a mobility and falls prevention class or a bone mass density measurement. An economic evaluation will be conducted. Discussion The study evaluates a complex preventive intervention in a routine health care setting which may serve as model for similar approaches in other areas or countries. Trial registration DRKS-ID: DRKS00009000; date of registration: 06.08.2015
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
| | - Karin Kampe
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Hella Kircheisen
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Ivonne Lindlbauer
- Department of Medical Sociology and Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
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Bluhmki T, Peter RS, Rapp K, König HH, Becker C, Lindlbauer I, Rothenbacher D, Beyersmann J, Büchele G. Understanding Mortality of Femoral Fractures Following Low-Impact Trauma in Persons With and Without Care Need. J Am Med Dir Assoc 2016; 18:221-226. [PMID: 27776984 DOI: 10.1016/j.jamda.2016.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Persons with osteoporotic fracture history are subject to an increased risk for subsequent fractures and mortality. The aim of this retrospective study was to investigate the impact of a previous osteoporotic low-impact (fragility) index fracture (eg, forearm, lower leg) on mortality of a subsequent femoral fracture. DESIGN Retrospective cohort study. PARTICIPANTS/MEASUREMENTS Claims data of a German health insurance agency including >1.2 million insurants aged 65 years or older and observed between 2004 and 2009. METHODS A multistate model was developed handling index fractures and care need as time-dependent exposures, while age was chosen as the underlying time scale. Excess risks were expressed as differences in cause-specific hazards. Nelson-Aalen estimates were used for their nonparametric estimation. Time-simultaneous statistical inference was based on confidence bands provided by wild bootstrap resampling. RESULTS Excess femoral fracture risk increased with progressive age and was highest in persons with care need. It was observed starting from an age of 79 years in women and 85 years in men onward. A prior index fracture increased mortality after a femoral fracture by increasing femoral fracture risk, while leaving the hazard of death after a subsequent femoral fracture unchanged. CONCLUSIONS The results indicated that increased mortality of a subsequent femoral fracture is not triggered by an intrinsically increased mortality hazard but an increased femoral fracture incidence.
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Affiliation(s)
- Tobias Bluhmki
- Department of Mathematics and Economics, Institute of Statistics, Ulm University, Ulm, Germany
| | - Raphael Simon Peter
- Department of Medicine, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Department for Geriatric Rehabilitation, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center, Hamburg, Germany
| | - Clemens Becker
- Department for Geriatric Rehabilitation, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Ivonne Lindlbauer
- Department of Health Economics and Health Services Research, University Medical Center, Hamburg, Germany
| | - Dietrich Rothenbacher
- Department of Medicine, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jan Beyersmann
- Department of Mathematics and Economics, Institute of Statistics, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Department of Medicine, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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Büchele G, Rapp K, König HH, Jaensch A, Rothenbacher D, Becker C, Benzinger P. The Risk of Hospital Admission Due to Traumatic Brain Injury Is Increased in Older Persons With Severe Functional Limitations. J Am Med Dir Assoc 2016; 17:609-12. [PMID: 27073040 DOI: 10.1016/j.jamda.2016.02.032] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hospital admissions due to traumatic brain injuries (TBIs) in older persons are increasing. Falls are the leading mechanism of injury in this age group. TBIs are associated with unfavorable outcomes such as mortality and institutionalization. OBJECTIVES To estimate rates of TBIs in older persons with severe functional limitations, expressed as "care need," living in the community, and in older persons with care need living in nursing homes compared with older persons without care need. PARTICIPANTS More than 1.2 million persons aged 65 years and older living in Bavaria, Germany, and insured with one of the largest German health insurances (health care and long-term care insurance). METHODS Age-standardized rates were calculated based on hospital claims data and claims data of the long-term care insurance and were compared between groups. The 3 groups were defined by claims data of the long-term care insurance. RESULTS TBI in older persons account for 4.8 hospital admissions per 1000 person-years. Overall TBI rates do not differ significantly between men and women. TBI rates are lowest in persons without care need and are highest for older persons living in nursing homes. Their contribution to the overall burden of TBI is lower than their contribution to the burden of fragility fractures. CONCLUSION TBIs in older persons are common. Those with severe functional limitations are at increased risk for TBI. Nursing home residents have the highest rates of TBI. Fall prevention programs should seek to prevent not only fragility fractures but also head impact.
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Affiliation(s)
- Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany
| | - Petra Benzinger
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany.
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Rapp K, Rothenbacher D, Magaziner J, Becker C, Benzinger P, König HH, Jaensch A, Büchele G. Risk of Nursing Home Admission After Femoral Fracture Compared With Stroke, Myocardial Infarction, and Pneumonia. J Am Med Dir Assoc 2015; 16:715.e7-715.e12. [PMID: 26142060 DOI: 10.1016/j.jamda.2015.05.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the burden of institutionalizations after femoral fracture and compare it with other "catastrophic" disease entities like stroke, myocardial infarction, or pneumonia. DESIGN/SETTING/PARTICIPANTS Routine data of 414,000 hospitalized German patients aged 66 years and older were used to calculate institutionalization risks after femoral fracture, stroke, myocardial infarction, pneumonia or a combined group of "all other hospitalizations." MEASUREMENTS Institutionalization was defined as nursing home admission within 6 months after discharge from hospital. Age- and sex-specific incidence and incidence rates of institutionalization were calculated. To compare the risk of institutionalization between the disease entities, age-standardized rates were computed and proportional hazards models were applied. In-house mortality and mortality after discharge from hospital were also calculated. RESULTS The risk of institutionalization increased exponentially with age in all disease entities. For example, the risk of institutionalization after femoral fracture increased from 3.6% in women aged 65 to 69 years to 34.8% in women aged 95 years and older. The highest institutionalization rates were observed in patients with stroke, followed by femoral fracture, pneumonia, and myocardial infarction. In men, the age-standardized risk of institutionalization was almost as high after femoral fracture as after stroke (7.5% vs 8.0%). In contrast to myocardial infarction and pneumonia, femoral fracture and stroke were more likely to be followed by institutionalization rather than death. CONCLUSION Femoral fractures result in high burden of institutionalizations. Prevention of falls, diagnosis and treatment of osteoporosis, and high-quality rehabilitation are challenges to tackle the burden of institutionalization in these patients in the future.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany.
| | | | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Petra Benzinger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Institute of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany
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Weinmayr G, Forastiere F, Büchele G, Jaensch A, Strachan DP, Nagel G. Correction: Overweight/Obesity and Respiratory and Allergic Disease in Children: International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two. PLoS One 2015; 10:e0126678. [PMID: 25901748 PMCID: PMC4406753 DOI: 10.1371/journal.pone.0126678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Benzinger P, Rapp K, König HH, Bleibler F, Globas C, Beyersmann J, Jaensch A, Becker C, Büchele G. Risk of osteoporotic fractures following stroke in older persons. Osteoporos Int 2015; 26:1341-9. [PMID: 25572044 DOI: 10.1007/s00198-014-3005-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 08/11/2014] [Accepted: 12/11/2014] [Indexed: 01/28/2023]
Abstract
UNLABELLED The aim of this study was to explore the increased risk of stroke survivors to different sustained osteoporotic fractures. We used hospital data and data on functional impairment. We found a higher risk in stroke survivors without functional impairment with the risk higher for lower than for upper extremity fractures. INTRODUCTION Stroke survivors are at high risk of osteoporotic fractures due to frequent falls and an increased risk to develop osteoporosis. Data on their relative risk to sustain other than hip fractures is limited. Furthermore, the role of severe functional impairment on their fracture risk has not been considered yet. The aim of this study was to determine the relative risk of stroke survivors to sustain different osteoporotic fractures with regard to the presence of severe functional impairment. METHODS Data from 2004 to 2009 of more than 1.2 million individuals aged 65 years or older and insured at a large German health insurance company were used for the analyses. Incident stroke and fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment. Persons without preceding incident stroke were used as the reference group. Multistate models were used to estimate hazard ratios. RESULTS Stroke survivors had a higher risk for fractures. However, a strong effect modification by functional impairment was apparent. Stroke survivors with functional impairment had no significantly increased risk for any fractures site compared to the corresponding reference group with functional impairment. In contrast, stroke survivors without functional impairment had a clearly and significantly increased fracture risk for most fracture sites. In these persons, the relative fracture risk for fractures of the lower extremities was higher than for fractures of the upper extremities. CONCLUSION To evaluate the relative risk of stroke survivors for osteoporotic fractures, functional status appears to be a relevant parameter.
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Affiliation(s)
- P Benzinger
- Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany,
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Weinmayr G, Forastiere F, Büchele G, Jaensch A, Strachan DP, Nagel G. Overweight/obesity and respiratory and allergic disease in children: international study of asthma and allergies in childhood (ISAAC) phase two. PLoS One 2014; 9:e113996. [PMID: 25474308 PMCID: PMC4256390 DOI: 10.1371/journal.pone.0113996] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/02/2014] [Indexed: 01/01/2023] Open
Abstract
Background Childhood obesity and asthma are increasing worldwide. A possible link between the two conditions has been postulated. Methods Cross-sectional studies of stratified random samples of 8–12-year-old children (n = 10 652) (16 centres in affluent and 8 centres in non-affluent countries) used the standardized methodology of ISAAC Phase Two. Respiratory and allergic symptoms were ascertained by parental questionnaires. Tests for allergic disease were performed. Height and weight were measured, and overweight and obesity were defined according to international definitions. Prevalence rates and prevalence odds ratios were calculated. Results Overweight (odds ratio = 1.14, 95%-confidence interval: 0.98; 1.33) and obesity (odds ratio = 1.67, 95%-confidence interval: 1.25; 2.21) were related to wheeze. The relationship was stronger in affluent than in non-affluent centres. Similar results were found for cough and phlegm, rhinitis and eczema but the associations were mostly driven by children with wheeze. There was a clear association of overweight and obesity with airways obstruction (change in FEV1/FVC, −0.90, 95%-confidence interval: −1.33%; −0.47%, for overweight and −2.46%, 95%-confidence interval: −3.84%; −1.07%, for obesity) whereas the results for the other objective markers, including atopy, were null. Conclusions Our data from a large international child population confirm that there is a strong relation of body mass index with wheeze especially in affluent countries. Moreover, body mass index is associated with an objective marker of airways obstruction (FEV1/FVC) but no other objective markers of respiratory and allergic disorders.
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Affiliation(s)
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- * E-mail:
| | | | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - David P. Strachan
- Division of Community Health Sciences, St. Georges’, University of London, London, United Kingdom
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Büchele G, Becker C, Cameron ID, König HH, Robinovitch S, Rapp K. Predictors of Serious Consequences of Falls in Residential Aged Care: Analysis of More Than 70,000 Falls From Residents of Bavarian Nursing Homes. J Am Med Dir Assoc 2014; 15:559-63. [DOI: 10.1016/j.jamda.2014.03.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
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Klein D, Rapp K, Küpper M, Becker C, Fischer T, Büchele G, Benzinger P. A population-based intervention for the prevention of falls and fractures in home dwelling people 65 years and older in South Germany: protocol. JMIR Res Protoc 2014; 3:e19. [PMID: 24686959 PMCID: PMC4004152 DOI: 10.2196/resprot.3126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/03/2014] [Accepted: 03/14/2014] [Indexed: 11/13/2022] Open
Abstract
Background Falls and fall-related injuries pose a major threat to older peoples’ health, and are associated with increased morbidity and mortality. In the course of demographic changes, development and implementation of fall prevention strategies have been recognized as an urgent public health challenge. Various risk factors for falls and a number of effective interventions have been recognized. A substantial proportion of falls occur for people who are neither frail nor at high risk. Therefore, population-based approaches reaching the entire older population are needed. Objective The objective of the study presented is the development, implementation, and evaluation of a population-based intervention for the prevention of falls and fall-related injuries in a medium sized city in Germany. Methods The study is designed as a population-based approach. The intervention community is a mid sized city named Reutlingen in southern Germany with a population of 112,700 people. All community dwelling inhabitants 65 years and older are addressed. There are two main measures that are defined: (1) increase of overall physical activity, and (2) reduction of modifiable risk factors for falls such as deficits in strength and balance, home and environmental hazards, impaired vision, unsafe footwear, and improper use of assistive devices. The implementation strategies are developed in a participatory community planning process. These might include, for example, training of professionals and volunteers, improved availability of exercise classes, and education and raising awareness via newspaper, radio, or lectures. Results The study starts in September 2010 and ends in December 2013. It is evaluated primarily by process evaluation as well as by telephone survey. Conclusions Physical activity as a key message entails multiple positive effects with benefits on a range of geriatric symptoms. The strength of the design is the development of implementation strategies in a participatory community planning. The problems that we anticipate are the dependency on the stakeholders’ willingness to participate, and the difficulty of evaluating population-based programs by hard end points.
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Affiliation(s)
- Diana Klein
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
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Weinmayr G, Gehring U, Genuneit J, Büchele G, Kleiner A, Siebers R, Wickens K, Crane J, Brunekreef B, Strachan DP. Dampness and moulds in relation to respiratory and allergic symptoms in children: results from Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC Phase Two). Clin Exp Allergy 2014; 43:762-74. [PMID: 23786283 DOI: 10.1111/cea.12107] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/21/2013] [Accepted: 01/24/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many studies report that damp housing conditions are associated with respiratory symptoms. Less is known about mechanisms and possible effect modifiers. Studies of dampness in relation to allergic sensitization and eczema are scarce. OBJECTIVE We study the influence of damp housing conditions world-wide on symptoms and objective outcomes. METHODS Cross-sectional studies of 8-12-year-old children in 20 countries used standardized methodology from Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC). Symptoms of asthma, rhinitis and eczema, plus residential exposure to dampness and moulds, were ascertained by parental questionnaires (n = 46 051). Skin examination, skin prick tests (n = 26 967) and hypertonic saline bronchial challenge (n = 5713) were performed. In subsamples stratified by wheeze (n = 1175), dust was sampled and analysed for house dust mite (HDM) allergens and endotoxin. RESULTS Current exposure to dampness was more common for wheezy children (pooled odds ratio 1.58, 95% CI 1.40-1.79) and was associated with greater symptom severity among wheezers, irrespective of atopy. A significant (P < 0.01) adverse effect of dampness was also seen for cough and phlegm, rhinitis and reported eczema, but not for examined eczema, nor bronchial hyperresponsiveness. HDM sensitization was more common in damp homes (OR 1.16, 1.03-1.32). HDM-allergen levels were higher in damp homes and were positively associated with HDM-sensitization, but not wheeze. CONCLUSION A consistent association of dampness with respiratory and other symptoms was found in both affluent and non-affluent countries, among both atopic and non-atopic children. HDM exposure and sensitization may contribute, but the link seems to be related principally to non-atopic mechanisms.
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Affiliation(s)
- G Weinmayr
- Institute of Epidemiology, Ulm University, 89081 Ulm, Germany.
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MacNeill SJ, Sozanska B, Danielewicz H, Debinska A, Kosmeda A, Boznanski A, Illi S, Depner M, Strunz-Lehner C, Waser M, Büchele G, Horak E, Genuneit J, Heederik D, Braun-Fahrländer C, von Mutius E, Cullinan P. Asthma and allergies: is the farming environment (still) protective in Poland? The GABRIEL Advanced Studies. Allergy 2013; 68:771-9. [PMID: 23621318 DOI: 10.1111/all.12141] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence exists that a farming environment in childhood may provide protection against atopic respiratory disease. In the GABRIEL project based in Poland and Alpine regions of Germany, Austria and Switzerland, we aimed to assess whether a farming environment in childhood is protective against allergic diseases in Poland and whether specific exposures explain any protective effect. METHODS In rural Poland, 23 331 families of schoolchildren completed a questionnaire enquiring into farming practices and allergic diseases (Phase I). A subsample (n = 2586) participated in Phase II involving a more detailed questionnaire on specific farm exposures with objective measures of atopy. RESULTS Farming differed between Poland and the Alpine centres; in the latter, cattle farming was prevalent, whereas in Poland 18% of village farms kept ≥1 cow and 34% kept ≥1 pig. Polish children in villages had lower prevalences of asthma and hay fever than children from towns, and in the Phase II population, farm children had a reduced risk of atopy measured by IgE (aOR = 0.72, 95% CI 0.57, 0.91) and skin prick test (aOR = 0.65, 95% CI 0.50, 0.86). Early-life contact with grain was inversely related to the risk of atopy measured by IgE (aOR = 0.66, 95% CI 0.47, 0.92) and appeared to explain part of the farming effect. CONCLUSION While farming in Poland differed from that in the Alpine areas as did the exposure-response associations, we found in communities engaged in small-scale, mixed farming, there was a protective farming effect against objective measures of atopy potentially related to contact with grain or associated farm activities.
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Affiliation(s)
- S. J. MacNeill
- Department of Occupational and Environmental Medicine; National Heart and Lung Istitute; Imperial College London; London; UK
| | - B. Sozanska
- Department of Paediatrics, Allergology and Cardiology; Wrocław Medical University; Wrocław; Poland
| | - H. Danielewicz
- Department of Paediatrics, Allergology and Cardiology; Wrocław Medical University; Wrocław; Poland
| | - A. Debinska
- Department of Paediatrics, Allergology and Cardiology; Wrocław Medical University; Wrocław; Poland
| | - A. Kosmeda
- Department of Paediatrics, Allergology and Cardiology; Wrocław Medical University; Wrocław; Poland
| | - A. Boznanski
- Department of Paediatrics, Allergology and Cardiology; Wrocław Medical University; Wrocław; Poland
| | - S. Illi
- Asthma and Allergy Research Group; University Children's Hospital; Munich; Germany
| | - M. Depner
- Asthma and Allergy Research Group; University Children's Hospital; Munich; Germany
| | - C. Strunz-Lehner
- Asthma and Allergy Research Group; University Children's Hospital; Munich; Germany
| | | | - G. Büchele
- Institute of Epidemiology and Medical Biometry; University of Ulm; Ulm; Germany
| | - E. Horak
- Department of Paediatrics and Adolescents; Division of Cardiology and Pulmonology; Innsbruck Medical University; Innsbruck; Austria
| | - J. Genuneit
- Institute of Epidemiology and Medical Biometry; University of Ulm; Ulm; Germany
| | - D. Heederik
- Division of Environmental Epidemiology; Institute for Risk Assessment Sciences; Utrecht University; Utrecht; The Netherlands
| | | | - E. von Mutius
- Asthma and Allergy Research Group; University Children's Hospital; Munich; Germany
| | - P. Cullinan
- Department of Occupational and Environmental Medicine; National Heart and Lung Istitute; Imperial College London; London; UK
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Benzinger P, Becker C, Kerse N, Bleibler F, Büchele G, Icks A, Rapp K. Pelvic fracture rates in community-living people with and without disability and in residents of nursing homes. J Am Med Dir Assoc 2013; 14:673-8. [PMID: 23680402 DOI: 10.1016/j.jamda.2013.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES There are limited data on the epidemiology of pelvic fractures. The purpose of this study was to calculate incidence rates of pelvic fractures leading to hospital admission and to compare incidence rates between residents of nursing homes and community-dwelling persons with and without care need. METHODS Data were retrieved from a database of the largest health insurance company in Bavaria, Germany. Between 2004 and 2009, 10,170 pelvic fractures were observed in 751,101 women and 491,098 men. Age- and gender-specific incidence rates were calculated. Incidence rates were further stratified by setting (nursing home versus community) and functional status (no care need versus care need for those in the community). In addition, the average cumulative risk for a pelvic fracture at different ages was calculated. RESULTS The incidence rate increased from 0.54 and 0.38 per 1000 person-years in women and men aged 65 to 69 years to 9.35 and 4.45 per 1000 person-years in women and men aged 90 years and older, respectively. Persons living in a nursing home or living at home with care need had considerably higher incidence rates than community-dwelling older persons without care need. The average cumulative risk at the age of 65 years for an incident pelvic fracture until the age of 90 years was 6.9% in women and 2.8% in men. CONCLUSION The incidence of pelvic fractures leading to hospital admission is higher in women than in men and rises dramatically with increasing age. Persons with care need have a particularly high risk for pelvic fracture.
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Affiliation(s)
- Petra Benzinger
- Department for Geriatric Rehabilitation, Robert Bosch Krankenhaus, Stuttgart, Germany.
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47
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Genuneit J, Strachan DP, Büchele G, Weber J, Loss G, Sozanska B, Boznanski A, Horak E, Heederik D, Braun-Fahrländer C, von Mutius E. The combined effects of family size and farm exposure on childhood hay fever and atopy. Pediatr Allergy Immunol 2013; 24:293-8. [PMID: 23551831 DOI: 10.1111/pai.12053] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Exposure to farming environments and siblings is associated with reduced risks of childhood hay fever and atopy. We explored the independence and interaction of these protective effects in the GABRIELA study. METHODS Questionnaire surveys on farming, asthma, and allergies were conducted in four central European areas among 79,888 6-12-yr-old children. Aeroallergen-specific serum IgE was measured in a stratified sample of 8,023 children. Multiple logistic regression was used to compare gradients in allergy prevalence by sibship size across three categories of exposure to farming environments. RESULTS The prevalence of hay fever ranged from 2% (95% confidence interval 1.6%; 2.7%) among farmers' children with more than two siblings to 12% (11.2%; 13.0%) among children with no farm exposure and no siblings. Farming families were larger on average. More siblings and exposure to farming environments independently conferred protection from hay fever and atopy. There was no substantial effect modification between family size and exposure to farming environments. The odds ratios for hay fever per additional sibling were 0.79 among unexposed non-farm children, 0.77 among farm-exposed non-farm children, and 0.72 among children from farming families (2df interaction test: p = 0.41). CONCLUSION The inverse association of exposure to farming environments with hay fever is found in all sizes of family, with no substantial tendency to saturation or synergism. This suggests that different biological mechanisms may underlie these two protective factors. Combinations of a large family and exposure to farming environments markedly reduce the prevalence of hay fever and indicate the strength of its environmental determinants.
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Affiliation(s)
- Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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Karvonen AM, Hyvärinen A, Gehring U, Korppi M, Doekes G, Riedler J, Braun-Fahrländer C, Bitter S, Schmid S, Keski-Nisula L, Roponen M, Kaulek V, Dalphin JC, Pfefferle PI, Renz H, Büchele G, von Mutius E, Pekkanen J. Exposure to microbial agents in house dust and wheezing, atopic dermatitis and atopic sensitization in early childhood: a birth cohort study in rural areas. Clin Exp Allergy 2012; 42:1246-56. [PMID: 22805472 DOI: 10.1111/j.1365-2222.2012.04002.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Early-life exposure to environmental microbial agents may be associated with development of wheezing and allergic diseases. OBJECTIVE To assess the association of microbial exposure in rural homes with the risk of asthma, wheezing, atopic dermatitis and sensitization. METHODS Birth cohorts of rural children (n = 1133), half from farmer families, were followed up from birth to 2 years of age by questionnaires in five European centres. Endotoxin and extracellular polysaccharides (EPS) of Penicillium and Aspergillus spp. were determined from living room floor and mother's mattress dust samples collected at 2 months of age. Specific IgE against 19 allergens was measured at 1 year of age. Discrete-time hazard models, generalized estimations equations (GEE) and logistic regression were used for statistical analyses. RESULTS The incidence of asthma was inversely associated with the amount of dust (adjusted odds ratio (aOR) 0.73, 95% CI 0.58-0.93) and the loads (units/m(2)) of EPS (aOR 0.75, 95% CI 0.55-1.04) and endotoxin (aOR 0.79, 95% CI 0.60-1.05) in the mother's mattress. Similar associations were seen with wheezing and with living room floor dust. The microbial markers were highly correlated and their effects could not be clearly separated. The inverse associations were seen especially among non-farmers. The risk of sensitization to inhalant allergens increased with increasing endotoxin exposure from mattress dust. No associations were observed with concentrations (units/g) or with atopic dermatitis. CONCLUSION AND CLINICAL RELEVANCE The amount and microbial content of house dust were inversely associated with asthma and wheezing, but due to high correlations between microbial agents and amount of dust, it was not possible to disentangle their individual effects. New ways to better measure and represent exposure to environmental microbes, including indexes of biodiversity, are needed especially among farmers.
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Affiliation(s)
- A M Karvonen
- Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
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Rapp K, Becker C, Cameron ID, Klenk J, Kleiner A, Bleibler F, König HH, Büchele G. Femoral fracture rates in people with and without disability. Age Ageing 2012; 41:653-8. [PMID: 22431152 DOI: 10.1093/ageing/afs044] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to estimate femoral fracture rates in community-dwelling older people without care need (CCN(-)), in community-dwelling older people with care need (CCN(+)) and in residents of nursing homes (RNH) and to determine their contribution to the overall burden of femoral fractures. METHODS routine data of more than 1.2 million German people aged 65 years and more were used to calculate sex- and age-specific femoral fracture rates in the three groups CCN(-), CCN(+) and RNH. Those people receiving benefits of the long-term care insurance were defined as having care need. The percentile contribution of the three subpopulations to the overall burden of femoral fractures was determined. RESULTS during 5,319,438 person-years, 44,000 femoral fractures were recorded. In each of the three subpopulations female and male fracture rates increased with increasing age. Femoral fracture rates of the total subpopulations were 6.13, 34.53 and 43.05 femoral fractures/1,000 person-years in CCN(-), CCN(+) and RNH in women and 2.66, 20.34 and 31.09 in men, respectively. The contribution of people with care need to the overall burden of femoral fractures in older people was about 50%. CONCLUSION the incidence of femoral fractures was considerably higher in people with care need than in people without care need. This should be considered when planning medical care or targeting preventive measures.
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Bergroth E, Remes S, Pekkanen J, Kauppila T, Büchele G, Keski-Nisula L. Respiratory tract illnesses during the first year of life: effect of dog and cat contacts. Pediatrics 2012; 130:211-20. [PMID: 22778307 DOI: 10.1542/peds.2011-2825] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate the effect of dog and cat contacts on the frequency of respiratory symptoms and infections during the first year of life. METHODS In this birth cohort study, 397 children were followed up from pregnancy onward, and the frequency of respiratory symptoms and infections together with information about dog and cat contacts during the first year of life were reported by using weekly diaries and a questionnaire at the age of 1 year. All the children were born in eastern or middle Finland between September 2002 and May 2005. RESULTS In multivariate analysis, children having dogs at home were healthier (ie, had fewer respiratory tract symptoms or infections) than children with no dog contacts (adjusted odds ratio, [aOR]: 1.31; 95% confidence interval [CI]: 1.13-1.52). Furthermore, children having dog contacts at home had less frequent otitis (aOR: 0.56; 95% CI: 0.38-0.81) and tended to need fewer courses of antibiotics (aOR: 0.71; 95% CI: 0.52-0.96) than children without such contacts. In univariate analysis, both the weekly amount of contact with dogs and cats and the average yearly amount of contact were associated with decreased respiratory infectious disease morbidity. CONCLUSIONS These results suggest that dog contacts may have a protective effect on respiratory tract infections during the first year of life. Our findings support the theory that during the first year of life, animal contacts are important, possibly leading to better resistance to infectious respiratory illnesses during childhood.
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Affiliation(s)
- Eija Bergroth
- Department of Pediatrics, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland.
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