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1.
Médéa Locquet Charlotte Beaudart Manon Hajaoui Jean Petermans Jean-Yves Reginster Olivier Bruyère 《Journal of the American Medical Directors Association》2019,20(1):43-46.e2
Objectives
To assess the occurrence of 3 major adverse outcomes of sarcopenia (ie, physical disabilities, institutionalizations and deaths) observed over a 3-year follow-up in older adults and compare the risk of these outcomes using 5 definitions of sarcopenia.Design
The study is a part of the ongoing SarcoPhAge (for Sarcopenia and Physical Impairment with advancing Age) longitudinal project.Setting and Participants
The SarcoPhAge study follows 534 community-dwelling older adults.Measures
Sarcopenia was defined as low muscle mass plus a decreased muscle function. Data on adverse outcomes were collected yearly during the annual follow-up or with a phone call. The association between baseline sarcopenia and the occurrence of undesirable outcomes was tested using the Cox proportional hazards model or a logistic regression model.Results
A total of 534 subjects were recruited into this prospective cohort (73.5 ± 6.2 years, 60.5% female). After 3 years, 33 participants were lost to follow-up. If no association between baseline sarcopenia and physical disabilities or institutionalizations was highlighted, a higher number of deaths occurred in individuals diagnosed with sarcopenia than in those who were not diagnosed (16.2% vs 4.6%, P value <.001). The probability of death within 3 years when presenting with sarcopenia showed an approximately 3-fold increase compared to subjects without sarcopenia.Conclusion
Over a 3-year period, sarcopenia at baseline was associated with an increased risk of mortality. There were some variations in the ability of different definitions of sarcopenia to predict outcomes. 相似文献2.
Marc Sim Richard L. Prince David Scott Robin M. Daly Gustavo Duque Charles A. Inderjeeth Kun Zhu Richard J. Woodman Jonathan M. Hodgson Joshua R. Lewis 《Journal of the American Medical Directors Association》2019,20(1):76-82.e2
Objectives
To investigate the relationship of 4 sarcopenia definitions with long-term all-cause mortality risk in older Australian women.Design
Data from the Perth Longitudinal Study in Aging Women from 2003 to 2013 was examined in this prospective cohort study. The 4 sarcopenia definitions were the United States Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP), and adapted FNIH (AUS-POPF) and EWGSOP (AUS-POPE) definitions using Australian population-specific cut-points [<2 standard deviation (SD)] below the mean of young healthy Australian women. All-cause mortality was captured via linked data systems.Setting and Participants
In total, 903 community-dwelling older Australian women (baseline mean age 79.9 ± 2.6 years) with concurrent measures of muscle strength (grip strength), physical function (timed-up-and-go; TUG) and appendicular lean mass (ALM) were included.Measures
Cox-proportional hazards modeling was used to examine the relationship between sarcopenia definitions and mortality over 5 and 9.5 years.Results
Baseline prevalence of sarcopenia by the 4 definitions differed substantially [FNIH (9.4%), EWGSOP (24.1%), AUS-POPF (12.0%), AUS-POPE (10.7%)]. EWGSOP and AUS-POPE had increased age-adjusted hazard ratios (aHRs) for mortality over 5 years [aHR 1.88 95% confidence interval (CI) (1.24?2.85), P < .01; aHR 2.52 95% CI (1.55?4.09), P < .01, respectively] and 9.5 years (aHR 1.39 95% CI (1.06?1.81), P = .02; aHR 1.94 95% CI (1.40?2.69), P < .01, respectively). No such associations were observed for FNIH or AUS-POPF. Sarcopenia components including weaker grip strength (per SD, 4.9 kg; 17%) and slower TUG (per SD, 3.1 seconds; 40%) but not ALM adjusted-variants (ALM/body mass index or ALM/height2) were associated with greater relative hazards for mortality over 9.5 years.Conclusions/Relevance
Unlike FNIH, the EWGSOP sarcopenia definition incorporating weak muscle strength and/or poor physical function was related to prognosis, as was the regionally adapted version of EWGSOP. Although sarcopenia definitions were not developed based on prognosis, this is an important consideration for globally standardizing the sarcopenia framework. 相似文献3.
Gotaro Kojima 《Journal of the American Medical Directors Association》2018,19(12):1063-1068
Objectives
To quantitatively examine frailty defined by FRAIL scale as a predictor of incident disability risks by conducting a systematic review and meta-analysis.Design
Systematic review and meta-analysis.Setting
A systematic review was conducted using 4 electronic databases (Embase, MEDLINE, CINAHL, and PsycINFO) in April 2018 for prospective cohort studies of middle-aged or older people examining associations between frailty and incident disability. Reference lists of the included studies were hand-searched for additional studies. Authors of potentially eligible studies were contacted for additional data if necessary. Methodological quality was assessed by the Newcastle-Ottawa scale.Participants
Community-dwelling middle-aged and older people.Measurements
Incident risks of activities of daily living (ADL) or instrumental activities of daily living (IADL) disability according the FRAIL scale-defined frailty.Results
Seven studies provided odds ratios of incident disability risks according to frailty and were included in the meta-analysis. A random effects meta-analysis showed that frailty and prefrailty were significant predictors of ADL [pooled odds ratio (OR) = 9.82, 95% confidence interval (CI) = 4.71-20.46, P < .001 for frailty (FRAIL scale = 3-5) and pooled OR = 2.08, 95% CI = 1.77-2.45, P < .001 for prefrailty (FRAIL scale = 1-2) compared with robustness (FRAIL scale = 0); pooled OR = 4.44, 95% CI = 3.26-6.04, P < .001 for frailty compared with nonfrailty (FRAIL scale = 0-2)] and IADL (pooled OR = 2.50, 95% CI = 1.67-3.73, P < .001, for frailty and pooled OR = 1.74, 95% CI = 1.10-2.77, P = .02, for prefrailty compared with robustness). There was no evidence of publication bias.Conclusions/Implications
The current study demonstrated that frailty status defined by the FRAIL scale was a significant predictor of disability among community-dwelling middle-aged and older individuals. In light of feasibility of the FRAIL scale, especially in a clinical setting, it may be a promising tool to facilitate the translation of frailty research into clinical practice. 相似文献4.
Miriam L. Haaksma Debora Rizzuto Inez H.G.B. Ramakers Sara Garcia-Ptacek Alessandra Marengoni Wiesje M. van der Flier Frans R.J. Verhey Marcel G.M. Olde Rikkert René J.F. Melis 《Journal of the American Medical Directors Association》2019,20(2):165-170.e2
Objectives
The predictive value of frailty and comorbidity, in addition to more readily available information, is not widely studied. We determined the incremental predictive value of frailty and comorbidity for mortality and institutionalization across both short and long prediction periods in persons with dementia.Design
Longitudinal clinical cohort study with a follow-up of institutionalization and mortality occurrence across 7 years after baseline.Setting and Participants
331 newly diagnosed dementia patients, originating from 3 Alzheimer centers (Amsterdam, Maastricht, and Nijmegen) in the Netherlands, contributed to the Clinical Course of Cognition and Comorbidity (4C) Study.Measures
We measured comorbidity burden using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and constructed a Frailty Index (FI) based on 35 items. Time-to-death and time-to-institutionalization from dementia diagnosis onward were verified through linkage to the Dutch population registry.Results
After 7 years, 131 patients were institutionalized and 160 patients had died. Compared with a previously developed prediction model for survival in dementia, our Cox regression model showed a significant improvement in model concordance (U) after the addition of baseline CIRS-G or FI when examining mortality across 3 years (FI: U = 0.178, P = .005, CIRS-G: U = 0.180, P = .012), but not for mortality across 6 years (FI: U = 0.068, P = .176, CIRS-G: U = 0.084, P = .119). In a competing risk regression model for time-to-institutionalization, baseline CIRS-G and FI did not improve the prediction across any of the periods.Conclusions
Characteristics such as frailty and comorbidity change over time and therefore their predictive value is likely maximized in the short term. These results call for a shift in our approach to prognostic modeling for chronic diseases, focusing on yearly predictions rather than a single prediction across multiple years. Our findings underline the importance of considering possible fluctuations in predictors over time by performing regular longitudinal assessments in future studies as well as in clinical practice. 相似文献5.
Edward Chong Esther Ho Jewel Baldevarona-Llego Mark Chan Lynn Wu Laura Tay Yew Yoong Ding Wee Shiong Lim 《Journal of the American Medical Directors Association》2018,19(5):450-457.e3
Objectives
Data for the assessment of frailty in acutely ill hospitalized older adults remains limited. Using the Frailty Index (FI) as “gold standard,” we compared (1) the diagnostic performance of 3 frailty measures (FRAIL, Clinical Frailty Scale [CFS], and Tilburg Frailty Indicator [TFI]) in identifying frailty, and (2) their ability to predict negative outcomes at 12 months after enrollment.Design
Prospective cohort study.Participants
We recruited 210 patients (mean age 89.4 ± 4.6 years, 69.5% female), admitted to the Department of Geriatric Medicine in a 1300-bed tertiary hospital.Measurements
Premorbid frailty status was determined. Data on comorbidities, severity of illness, functional status, and cognitive status were gathered. We compared area under receiver operator characteristic curves (AUC) for each frailty measure against the reference FI. Multiple logistic regression was used to examine the independent association between frailty and the outcomes of interest.Results
Frailty prevalence estimates were 87.1% (FI), 81.0% (CFS), 80.0% (TFI), and 50.0% (FRAIL). AUC against FI ranged from 0.81 (95% confidence interval [CI] 0.72–0.90: FRAIL) to 0.91 (95% CI 0.87–0.95: CFS). Only FRAIL was associated with higher in-hospital mortality (6.7% vs 1.0%, P = .031). FRAIL and CFS were significantly associated with increased length of hospitalization (10 [6.0–17.5] vs 8 [5.0–14.0] days, P = .043 and 9 [5.0–17.0] vs 7 [4.25–11.75] days, P = .036, respectively). CFS and FI were highly associated with mortality at 12-month (CFS, frail vs nonfrail: 32.9% vs 2.5%, P < .001, and FI, frail vs nonfrail: 30.6% vs 3.7%, P < .001). CFS also conferred the greatest risk of 12-month mortality (odds ratio [OR] 5.78, 95% CI 3.19–10.48, P < .001) and composite outcomes of institutionalization and/or mortality (OR 3.69, 95% CI 2.31–5.88, P < .001), adjusted for age, sex, and severity of illness.Conclusion
Our study affirms the utility of frailty assessment tools among older persons in acute care. FRAIL conferred highest risk of in-hospital mortality. However, CFS had greatest risk of mortality and institutionalization within 12 months. 相似文献6.
Edward Chong Mark Chan Wee Shiong Lim Yew Yoong Ding 《Journal of the American Medical Directors Association》2018,19(5):422-427
Objectives
The relationship between frailty and urinary incontinence (UI) remains highly complex. There is limited data on the impact of frailty on new-onset UI among hospitalized older adults. Thus, we examined the ability of frailty to predict incident UI among them.Design
Prospective cohort study.Setting
Acute geriatric unit at a large teaching hospital.Participants
Older adults hospitalized for an acute medical illness.Measurements
Premorbid frailty was defined as having 3 of 5 items, namely fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL scale). Data on demographics, comorbidities, severity of illness, and functional status were gathered. Premorbid UI and UI at discharge and 6 and 12 months after hospitalization were identified. Logistic regression analysis was performed to examine how well frailty predicted incident UI at discharge and at 6 and 12 months following hospitalization. The independent predictive value of UI on mortality was also examined.Results
Among 210 participants (mean age 89.4 ± 4.6 years; 69.5% female; 50.0% frail), UI was present in 47.6%, with a higher prevalence among frail individuals (64.8% vs 30.5%, P < .001). Incident UI was more common in frail participants (at discharge: 24.3% vs 9.6%, P = .038; 6 months: 43.2% vs 21.7%, P = .020; and 12 months: 56.8% vs 33.3%, P = .020). Death among UI patients increased over time following hospitalization (at discharge: 6.0% vs 1.8%, P = .114; 6 months: 32.0% vs 9.1%, P < .001; and 12 months: 42.0% vs 13.6%, P < .001). Premorbid UI independently predicted mortality [6 months: odds ratio (OR) 3.10, 95% confidence interval (CI) 1.34-7.17, P = .008; 12 months: OR 3.41, 95% CI 1.59-7.32, P = .002], adjusting for age, sex, severity of illness, and frailty. Frailty predicted incident UI and/or death over time (at discharge: OR 2.98, 95% CI 1.00-8.91, P = .050; 6 months: OR 2.86, 95% CI 1.13-7.24, P = .027; 12 months: OR 2.67, 95% CI 1.13-6.27, P = .025), adjusting for age, sex, and severity of illness.Conclusion
Frailty is associated with UI, and predicts incident UI and/or death, even up to 12 months following hospitalization. Hence, greater emphasis should be given to identifying and managing UI during hospitalization and after discharge, especially among frail older adults. 相似文献7.
Lijuan Dong Xiaoxia Qiao Xiaoyu Tian Na Liu Yaru Jin Huaxin Si Cuili Wang 《Journal of the American Medical Directors Association》2018,19(1):12-17
Objective
To cross-culturally adapt and test the FRAIL scale in Chinese community-dwelling older adults.Design
Cross-sectional study.Methods
The Chinese FRAIL scale was generated by translation and back-translation. An urban sample of 1235 Chinese community-dwelling older adults was enrolled to test its psychometric properties, including convergent validity, criterion validity, known-group divergent validity, internal consistency and test-retest reliability.Results
The Chinese FRAIL scale achieved semantic, idiomatic, and experiential equivalence. The convergent validity was confirmed by statistically significant kappa coefficients (0.209-0.401, P < .001) of each item with its corresponding alternative measurement, including the 7th item of the Center for Epidemiologic Studies–Depression Scale, the Timed Up and Go test, 4-m walking speed, polypharmacy, and the Short-Form Mini Nutritional Assessment. Using the Fried frailty phenotype as an external criterion, the Chinese FRAIL scale showed satisfactory diagnostic accuracy for frailty (area under the curve = 0.91). The optimal cut-point for frailty was 2 (sensitivity: 86.96%, specificity: 85.64%). The Chinese FRAIL scale had fair agreement with the Fried frailty phenotype (kappa = 0.274, P < .001), and classified more participants into frailty (17.2%) than the Fried frailty phenotype (3.9%). More frail individuals were recognized by the Chinese FRAIL scale among older and female participants than their counterparts (P < .001), respectively. It had low internal consistency (Kuder-Richardson formula 20 = 0.485) and good test-retest reliability within a 7- to 15-day interval (intraclass correlation coefficient = 0.708).Conclusions
The Chinese FRAIL scale presents acceptable validity and reliability and can apply to Chinese community-dwelling older adults. 相似文献8.
Ivan Aprahamian Sumika Mori Lin Claudia Kimie Suemoto Daniel Apolinario Natália Oiring de Castro Cezar Serpui Marie Elmadjian Wilson Jacob Filho Mônica Sanches Yassuda 《Journal of the American Medical Directors Association》2017,18(4):367.e11-367.e18
Objectives
The aim of the present study was to (1) evaluate a geriatric outpatient sample with the FRAIL scale; (2) investigate the psychometric properties of the scale; and (3) characterize different associations of the subdimensions of the scale with demographic and clinical data.Design
Cross-sectional observational study.Setting
Geriatric outpatient center a university-based hospital in São Paulo, Brazil.Participants
A total of 811 men and women aged 60 years or older evaluated between March 2015 and September 2015.Measurements
A translated version of the FRAIL scale was used to evaluate frailty. A review of sociodemographic data, medical records, medication, and laboratory data was conducted. A multivariate ordinal logistic regression model was used to investigate the association between frailty categories and clinical variables. Exploratory factor analysis and 2-parameter logistic item response theory was used to evaluate the psychometric properties of the FRAIL scale.Results
The sample was distributed as 13.6% robust, 48.7% prefrail, and 37.7% frail older adults. Most participants reported fatigue (72.3%). Frailty was associated with older age (P = .02), depression (P = .02), dementia (P < .001), and number of medications taken (P < .001). A 2-factor model of the FRAIL scale (“ambulation” and “resistance” namely physical performance; “fatigue,” “weight loss,” and “illnesses” namely health status) provided independent classifications of frailty status. Physical performance (ambulation and resistance) was strongly associated with higher age and dementia, whereas health status (fatigue, weight loss, and illnesses) was more associated with female sex and depression.Conclusions
Our results suggest the existence of 2 subdimensions of the scale, suggesting different pathways to frailty. Frailty was associated with older age, depression, dementia, and number of medications in this outpatient sample. 相似文献9.
Cristina Reverberi Francesco Lombardi Mirco Lusuardi Alessandra Pratesi Mauro Di Bari 《Journal of the American Medical Directors Association》2019,20(4):470-475.e1
Objectives
Patients with acquired brain injuries (ABIs) often need tracheostomy because of dysphagia. However, many of them may recover over time and be eventually decannulated during post-acute rehabilitation. We developed the Decannulation Prediction Tool (DecaPreT) to identify, early in the post-acute course, patients with ABIs who can be safely decannulated.Design
Nonconcurrent cohort study.Setting and Participants
Patients with ABI, as well as with dysphagia and tracheostomy, were retrospectively selected from the database of a neurorehabilitation unit in Correggio, Reggio Emilia, Italy.Measures
Potential bivariate predictors of decannulation were screened from variables collected on admission during clinical examination, conducted by an expert speech therapist. Multivariable prediction was then obtained in 2 separate random subsamples to develop and validate the logistic regression model of the DecaPreT.Results
Of 463 patients with ABI (mean age 52.2 years) selected, 73.0% could be safely decannulated before discharge. After bivariate screening, multivariable predictors of decannulation were identified in the development subsample and confirmed in the validation subsample, each with its odds ratio and 95% confidence interval as follows: age tertile (1.77, 1.08–2.89; P = .024), no saliva aspiration (3.89, 1.73–8.64; P = .001), pathogenesis of ABI (trauma vs other causes vs stroke vs anoxia: 2.23, 1.41–3.54; P = .001), no vegetative status (8.47; 2.91–24.63; P < .001), and coughing score (voluntary and reflex vs voluntary vs reflex vs neither voluntary nor reflex cough: 2.62, 1.70–4.05; P < .001). In the validation subsample, the predicting equation obtained an area under the receiver operating characteristics curve of 0.836.Implications
The DecaPreT predicts safe decannulation in patients with dysphagia and tracheostomy, using simple clinical variables detected early in the post-acute phase of ABI. The tool can help clinicians choose timing and intensity of rehabilitation interventions and plan discharge. 相似文献10.
Davide L. Vetrano Maria S. Pisciotta Alice Laudisio Maria R. Lo Monaco Graziano Onder Vincenzo Brandi Domenico Fusco Beatrice Di Capua Diego Ricciardi Roberto Bernabei Giuseppe Zuccalà 《Journal of the American Medical Directors Association》2018,19(6):523-527
Objectives
In Parkinson disease (PD), sarcopenia may represent the common downstream pathway that from motor and nonmotor symptoms leads to the progressive loss of resilience, frailty, and disability. Here we (1) assessed the prevalence of sarcopenia in older adults with PD using 3 different criteria, testing their agreement, and (2) evaluated the association between PD severity and sarcopenia.Design
Cross-sectional, observation study.Setting
Geriatric day hospital.Participants
Older adults with idiopathic PD.Measurements
Body composition was evaluated through dual energy x-ray absorptiometry. Handgrip strength and walking speed were measured. Sarcopenia was operationalized according to the Foundation for the National Institutes of Health, the European Working Group on Sarcopenia in Older Persons, and the International Working Group. Cohen k statistics was used to test the agreement among criteria.Results
Among the 210 participants (mean age 73 years; 38% women), the prevalence of sarcopenia was 28.5%–40.7% in men and 17.5%–32.5% in women. The prevalence of severe sarcopenia was 16.8%–20.0% in men and 11.3%–18.8% in women. The agreement among criteria was poor. The highest agreement was obtained between the European Working Group on Sarcopenia in Older Persons (severe sarcopenia) and International Working Group criteria (k = 0.52 in men; k = 0.65 in women; P < .01 for both). Finally, severe sarcopenia was associated with PD severity (odds ratio 2.30; 95% confidence interval 1.15–4.58).Conclusions
Sarcopenia is common in PD, with severe sarcopenia being diagnosed in 1 in every 5 patients with PD. We found a significant disagreement among the 3 criteria evaluated, in detecting sarcopenia more than in ruling it out. Finally, sarcopenia is associated with PD severity. Considering its massive prevalence, further studies should address the prognosis of sarcopenia in PD. 相似文献11.
Oscar H. Del Brutto Robertino M. Mera Mauricio Zambrano Mark J. Sedler 《Journal of the American Medical Directors Association》2019,20(2):213-216
Objective
To assess the influence of frailty on cognitive decline.Design
Population-based prospective cohort study.Settings/participants
Community-dwelling older adults living in a rural Ecuadorian village, fulfilling the following criteria: age ≥60 years at baseline Montreal Cognitive Assessment (MoCA) and frailty assessment, a baseline brain magnetic resonance imaging, and a follow-up MoCA performed at least 12 months after the baseline.Measures
Frailty was evaluated by the Edmonton Frailty Scale (EFS) and cognitive performance by MoCA. The relationship between baseline EFS and MoCA decline was assessed by longitudinal linear and fractional polynomial models, adjusted for relevant confounders. The score of the cognitive component of the EFS was subtracted, and an alternative fractional polynomial model was fitted to settle the impact of such cognitive question on the model.Results
A total of 252 individuals, contributing 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years) were included. The mean EFS score was 4.7 ± 2.5 points. The mean baseline MoCA score was 19.5 ± 4.5 points, and that of the follow-up MoCA was 18.1 ± 4.9 points (P = .001). Overall, 154 (61%) individuals had lower MoCA scores in the follow-up. The best fitted longitudinal linear model showed association between baseline EFS score and MoCA decline (P = .027). There was a continuous increase in MoCA decline in persons with an EFS ≥7 points (nonlinear relationship). Fractional polynomials explained the effect of the EFS on MoCA decline. For the complete EFS score, the β coefficient was 2.43 (95% confidence interval 1.22–3.63). For the effect of the EFS (without its cognitive component) on MoCA decline, the relationship was still significant (β 4.86; 95% confidence interval 2.6–7.13).Conclusions/implications
Over a 3.7-year period, 61% of older adults living in Atahualpa experienced cognitive decline. Such decline was significantly associated with frailty status at baseline. Region-specific risk factors influencing this relationship should be further studied to reduce its burden in rural settings. 相似文献12.
Shinya Tanaka Kentaro Kamiya Nobuaki Hamazaki Ryota Matsuzawa Kohei Nozaki Emi Maekawa Chiharu Noda Minako Yamaoka-Tojo Atsuhiko Matsunaga Takashi Masuda Junya Ako 《Journal of the American Medical Directors Association》2017,18(2):176-181
Objectives
A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function.Design
Cross-sectional study.Setting
Single university hospital.Participants
A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD.Measurements
SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group).Results
The sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates.Conclusion
The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings. 相似文献13.
Palmira Bernocchi Alessandro Giordano Giuseppe Pintavalle Tiziana Galli Eleonora Ballini Spoglia Doriana Baratti Simonetta Scalvini 《Journal of the American Medical Directors Association》2019,20(3):340-346
Objectives
The aim of this study was to determine the feasibility and efficacy of a 6-month tele-rehabilitation home-based program, designed to prevent falls in older adults with 1 or more chronic diseases (cardiac, respiratory, neuromuscular or neurologic) returning home after in-hospital rehabilitation for their chronic condition. Patients were eligible for selection if they had experienced a fall during the previous year or were at high risk of falling.Design
Randomized controlled trial. Tele-rehabilitation consisted of a falls prevention program run by the physiotherapist involving individual home exercise (strength, balance, and walking) and a weekly structured phone-call by the nurse inquiring about the disease status and symptoms and providing patient support.Setting and Participants
Two hundred eighty-three patients (age 79 ± 6.6 years; F = 59%) with high risk of falls and discharged home after in-hospital rehabilitation were randomized to receive home-based program (intervention group, n = 141) or conventional care (control group, n = 142).Measures
Incidence of falls at home in the 6-month period (primary outcome); time free to the first fall and proportion of patients sustaining ≥2 falls (secondary outcomes).Results
During the 6 months, 85 patients fell at least once: 29 (20.6%) in the Intervention Group versus 56 (39.4%) in the control group (P < .001). The risk of falls was significantly reduced in the intervention group (relative risk =0.60, 95% confidence interval: 0.44-0.83; P < .001). The mean ± standard deviation time to first fall was significantly longer in intervention group than control group (152 ± 58 vs 134 ± 62 days; P = .001). Significantly, fewer patients experienced ≥2 falls in the intervention group than in the control group: 11 (8%) versus 24 (17%), P = .020.Conclusions
A 6-month tele-rehabilitation home-based program integrated with medical/nursing telesurveillance is feasible and effective in preventing falls in older chronic disease patients with a high risk of falling. 相似文献14.
Ming Yang Xiaoyi Hu Lingling Xie Luoying Zhang Jie Zhou Jing Lin Ying Wang Yaqi Li Zengli Han Daipei Zhang Yun Zuo Ying Li 《Journal of the American Medical Directors Association》2019,20(1):53-57
Objective
The Mini Sarcopenia Risk Assessment (MSRA), a new sarcopenia screening tool, has 2 versions: MSRA-7 (full version, 7 items) and MSRA-5 (short version, 5 items). We aimed to compare the diagnostic values of MSRA-7 and MSRA-5 to SARC-F for screening sarcopenia.Design
A diagnostic accuracy study.Setting
A community in Chengdu, China.Participants
Older adults.Measurements
Muscle mass, strength, and physical performance were tested using a bioimpedance analysis (BIA) device, handgrip strength, and walking speed, respectively. Using the Asian Working Group for Sarcopenia (AWGS) criteria as the gold standard, the sensitivity/specificity analyses of the 3 scales were assessed. Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were used to compare the overall diagnostic accuracy of the 3 scales.Results
We recruited 384 participants. Against the AWGS criteria, SARC-F had a sensitivity of 29.5% and a specificity of 98.1%, and the MSRA-7 had a sensitivity of 86.9% and a specificity of 39.6%, whereas the MSRA-5 had a sensitivity of 90.2% and a specificity of 70.6%. The AUCs of SARC-F, MSRA-7, and MSRA-5 were 0.89 [95% confidence interval (CI), 0.86-0.92], 0.70 (95% CI, 0.65-0.74), and 0.85 (95% CI, 0.81-0.89), respectively. The differences in AUCs between SARC-F and MSRA-7 and in those between MSRA-7 and MSRA-5 were statistically significant (P <.001), but the difference between SARC-F and MSRA-5 was not statistically significant (P = .130).Conclusion
MSRA-5 may serve as a novel screening tool for sarcopenia in Chinese community-dwelling older adults. SARC-F, a class screening tool, is also suitable for this population. MSRA-5 and SARC-F demonstrated a similar diagnostic accuracy in our study population. MSRA-5 has better sensitivity, whereas SARC-F has better specificity. However, the diagnostic value of MSRA needs to be further validated in different populations. 相似文献15.
Helena Temkin-Greener Tiffany Lee Thomas Caprio Shubing Cai 《Journal of the American Medical Directors Association》2019,20(4):476-480.e1
Objective
Ultrahigh therapy use has increased in SNFs without concomitant increases in residents' characteristics. It has been suggested that this trend may also have influenced the provision of high-intensity rehabilitation therapies to residents who are at the end of life (EOL). Motivated by lack of evidence, we examined therapy use and intensity among long-stay EOL residents.Design
An observational study covering a time period 2012-2016.Setting and participants
New York State nursing homes (N = 647) and their long-stay decedent residents (N = 55,691).Methods
Data sources included Minimum Data Set assessments, vital statistics, Nursing Home Compare website, LTCfocus, and Area Health Resource File.Therapy intensity in the last month of life was the outcome measure. Individual-level covariates were used to adjust for health conditions. Facility-level covariates were the key independent variables of interest. Multinomial logistic regression models with facility random effects were estimated.Results
Overall, 13.6% (n = 7600) of long-stay decedent residents had some therapy in the last month of life, 0% to 45% across facilities. Of those, almost 16% had very high/ultrahigh therapy intensity (>500 minutes) prior to death. Adjusting for individual-level covariates, decedents in the for-profit facilities had 18% higher risk of low/medium therapy [relative risk ratio (RRR) = 1.182, P < .001], and more than double the risk of high/ultrahigh therapy (RRR = 2.126, P < .001), compared to those with no therapy use in the last month of life. In facilities with higher physical therapy staffing, decedents had higher risk (RRR = 16.180, P = .002) of high/ultrahigh therapy, but not of low/medium therapy intensity. The use of high/ultrahigh therapy in this population has increased over time.Conclusions and Relevance
This is a first study to empirically demonstrate that facility characteristics are associated with the provision of therapy intensity to EOL residents. Findings suggest that facilities with a for-profit mission, and with higher staffing of therapists, may be more incentivized to maximize therapy use, even among the sickest of the residents. 相似文献16.
Masahiro Waza Keisuke Maeda Chihiro Katsuragawa Atsuko Sugita Ryotarou Tanaka Asako Ohtsuka Tomo Matsui Keiko Kitagawa Taiki Kishimoto Hiroko Fukui Katsuhisa Kawai Masahiko Yamamoto Michio Isono 《Journal of the American Medical Directors Association》2019,20(4):426-431
Objective
To determine the influence of the Kuchi-kara Taberu (KT) index on rehabilitation outcomes during hospitalized convalescent rehabilitation.Design
A historical controlled study.Setting and Participants
A rehabilitation hospital.Participants
Patients who were admitted to a convalescent rehabilitation ward from June 2014 to May 2017.Measures
Patients’ background characteristics included age, sex, nutritional status, activities of daily living (ADL) assessed using the Functional Impedance Measure (FIM), dysphagia assessed using the Functional Oral Intake Scale (FOIS), and reasons for rehabilitation. The following values before (control group) and after initiation of the KT index intervention period (intervention group) were compared: gain of FIM, length of stay, accumulated rehabilitation time, discharge destination, gain of FOIS, gain of body weight (BW), and nutritional intake (energy and protein).Results
Mean age was 76.4 ± 12.3 years (n = 233). There were no significant differences in the baseline characteristics of the patients at admission between the control and intervention groups, except for reason of rehabilitation. The intervention group demonstrated statistically higher values for the total (P = .004) and motor FIM gain (P = .003), total (P = .018) and motor FIM efficiency (P = .016), and FOIS gain (P < .001), compared with values in the control group. The proportion of patients returning home was statistically more frequent in the intervention group compared with that in the control group (73.4% vs 85.5%, odds ratio 2.135, 95% confidence interval [CI] 1.108-4.113, P = .022). Multivariate analyses indicated that intervention using the KT index was a significant independent factor for increased FIM gain (β coefficient = 0.163, 95% CI 1.379-8.329, P = .006) and returning home (adjusted odds ratio 2.570, 95% CI 1.154-5.724, P = .021).Conclusions/Implications
A rehabilitation program using the KT index may lead to improvement of inpatient outcomes in post-acute care. Further prospective research is warranted to confirm the efficacy of this program. 相似文献17.
Ting Hway Wong Yu Jie Wong Zheng Yi Lau Nivedita Nadkarni Gek Hsiang Lim Dennis Chuen Chai Seow Marcus Eng Hock Ong Kelvin Bryan Tan Hai V. Nguyen Chek Hooi Wong 《Journal of the American Medical Directors Association》2019,20(2):201-207.e3
Objectives
Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at increased risk for long-term mortality, compared to patients by high-velocity blunt trauma (higher fall heights, road injuries, and other blunt trauma). We hypothesized that these patients are also at higher risk of readmission, compared to patients injured by high-velocity mechanisms.Design and Measures
Competing risks regression (all-cause unplanned readmission or death) was performed.Setting and Participants
Data for 5671 patients from the Singapore National Trauma Registry data who were injured from 2011-2013 and aged 55 and over were matched to Ministry of Health admissions data. The registry uses standardized conversion metrics to convert patient histories to fall heights.Results
Patients injured after a low fall were more likely to be readmitted to a hospital, compared to those sustaining injuries by high-velocity blunt trauma. On competing risks analysis, low fall [subdistribution hazard ratio (SHR) 1.52, 95% confidence interval (CI) 1.20-1.93, P < .01], Charlson Comorbidity Score (CCS≥3 relative to CCS = 0, SHR 1.46, 95% CI 1.04-2.04, P = .03), and Modified Frailty Index (MFI≥3 relative to MFI = 0, SHR 1.98, 95% CI 1.44-2.72, P < .001) were associated with higher risk of 30-day readmission. Rehabilitation was associated with reduced 30-day (SHR 0.64, 95% CI 0.48-0.86, P < .001) and 1-year (SHR 0.84, 95% CI 0.72-0.99, P = .04) readmission.Conclusions/Implications
Our study sheds light on the interpretation of trauma data in aging populations. The detailed fall height information in our registry makes it uniquely placed to facilitate understanding of the paradoxical finding that injuries sustained by low-energy falls are higher risk than those sustained by higher-velocity mechanisms. Low-fall patients should be prioritized for rehabilitation and postdischarge support. The proportion of low-fall patients in a trauma registry should be included in the factors considered for benchmarking. 相似文献18.
Phillip J. Tully Catherine Helmer Ruth Peters Christophe Tzourio 《Journal of the American Medical Directors Association》2019,20(2):188-194.e4
Objectives
The objective was to test the hypothesis that antihypertensive drugs have a differential effect on cognition in carriers and noncarriers of the apolipoprotein ε4 (APOE4) polymorphism.Design
Prospective population-based cohort, France.Setting and participants
A total of 3359 persons using antihypertensive drugs (median age 74 years, 62% women) were serially assessed up to 10 years follow-up.Measures
Exposure to antihypertensive drug use was established in the first 2 years. Cognitive function was assessed at baseline, 2, 4, 7, and 10 years with a validated test battery covering global cognition, verbal fluency, immediate visual recognition memory, processing speed, and executive function. Clinically significant change in cognitive function was determined using reliable change indices represented as z scores and analyzed with linear mixed-models.Results
From 3359 persons exposed to antihypertensive drugs, 653 were APOE4 carriers (5.1% homozygous, 94.9% heterozygous) and median follow-up was 5.2 years (interquartile range 3.7–8.0). In APOE4 carriers, improved general cognitive function over time was associated with exposure to angiotensin converting enzyme inhibitors [β = .14; 95% confidence interval (CI) .06–.23, P = .001] and angiotensin receptor blockers (β = .11; 95% CI .02–.21, P = .019). Improved verbal fluency was associated with angiotensin converting enzyme inhibitors (β = .11; 95% CI .03–.20, P = .012).Conclusions
Renin-angiotensin-system blockade was associated with improved general cognitive function in APOE4 carriers. Findings did not support renin-angiotensin-system drugs' lipophilicity or ability to cross the blood-brain barrier as potential mechanisms. The findings have implications for selecting the optimal antihypertensive drug in older populations at risk of cognitive decline and dementia. 相似文献19.
Efstathios Papachristou S. Goya Wannamethee Lucy T. Lennon Olia Papacosta Peter H. Whincup Steve Iliffe Sheena E. Ramsay 《Journal of the American Medical Directors Association》2017,18(2):152-157
Background
Frailty is a state of increased vulnerability to disability, falls, and mortality. The Fried frailty phenotype includes assessments of grip strength and gait speed, which are complex or require objective measurements and are challenging in routine primary care practice. In this study, we aimed to develop a simple assessment tool based on self-reported information on the 5 Fried frailty components to identify older people at risk of incident disability, falls, and mortality.Methods
Analyses are based on a prospective cohort comprising older British men aged 71–92 years in 2010–2012. A follow-up questionnaire was completed in 2014. The discriminatory power for incident disability and falls was compared with the Fried frailty phenotype using receiver operating characteristic-area under the curve (ROC-AUC); for incident falls it was additionally compared with the FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight). Predictive ability for mortality was assessed using age-adjusted Cox proportional hazard models.Results
A model including self-reported measures of slow walking speed, low physical activity, and exhaustion had a significantly increased ROC-AUC [0.68, 95% confidence interval (CI) 0.63–0.72] for incident disability compared with the Fried frailty phenotype (0.63, 95% CI 0.59–0.68; P value of ΔAUC = .003). A second model including self-reported measures of slow walking speed, low physical activity, and weight loss had a higher ROC-AUC (0.64, 95% CI 0.59–0.68) for incident falls compared with the Fried frailty phenotype (0.57, 95% CI 0.53–0.61; P value of ΔAUC < .001) and the FRAIL scale (0.56, 95% CI 0.52–0.61; P value of ΔAUC = .001). This model was also associated with an increased risk of mortality (Harrell's C = 0.73, Somer's D = 0.45; linear trend P < .001) compared with the Fried phenotype (Harrell's C = 0.71; Somer's D = 0.42; linear trend P < .001) and the FRAIL scale (Harrell's C = 0.71, Somer's D = 0.42; linear trend P < .001).Conclusions
Self-reported information on the Fried frailty components had superior discriminatory and predictive ability compared with the Fried frailty phenotype for all the adverse outcomes considered and with the FRAIL scale for incident falls and mortality. These findings have important implications for developing interventions and health care policies as they offer a simple way to identify older people at risk of adverse outcomes associated with frailty. 相似文献20.
Kazuki Uemura Takehiko Doi Sungchul Lee Hiroyuki Shimada 《Journal of the American Medical Directors Association》2019,20(1):90-93