Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

ObjectivesTo determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge.DesignProspective observational cohort study conducted in 2015–2017.Setting and ParticipantsOlder adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals.MethodsSteps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index.ResultsThe analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250–1146] at the last day of hospitalization. This increased to 1750 (IQR 675–4114) steps 1 day postdischarge, and to 1997 (IQR 938–4098) steps 7 days postdischarge. Age [β = ?57.93; 95% confidence interval (CI) ?111.15 to ?4.71], physical performance (β = 224.95; 95% CI 117.79–332.11), and steps in hospital (β = 0.76; 95% CI 0.46–1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = ?1400; 95% CI –2380 to ?420; P = .005).Conclusions and ImplicationsAmong acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.     

Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data

ObjectivesThis study examined the association between intensive rehabilitation for subacute stroke patients and medical costs and readmission ratio during the year after discharge.DesignThis was a natural experiment study.Setting and ParticipantsWe identified individuals with a diagnosis of cerebrovascular disorder (ICD-10: I60-I69 cerebrovascular disease) in an insurance claims database in Japan from January 2005 to December 2017. From the database, 980 patients who were admitted to a convalescent rehabilitation unit with stroke were identified. After excluding 575 patients, 405 were eligible for the study.MethodsIn Japan, from April 2011, a new policy was established that allows special costs to be added as rehabilitation time increases. This policy provides an additional medical fee for inpatients in a convalescent rehabilitation unit who receive more than 120 minutes of rehabilitation therapy. We defined high-intensity rehabilitation as transfer from hospitalization to a convalescent rehabilitation unit after April 2011. Outcomes were total direct medical costs and readmission ratio during the year after discharge from the convalescent rehabilitation unit.ResultsDaily rehabilitation time, total rehabilitation time, and total medical costs of the high-intensity rehabilitation group were significantly higher than those of the low-intensity rehabilitation group (P < .001, P < .001, P = .011, respectively). However, there was no significant difference in the medical costs during the year after discharge (P = .653) or in the readmission ratio (hazard ratio: 1.09, 95% confidence interval: 0.55-2.18, P = .804).Conclusions and ImplicationsIntensive rehabilitation did not reduce medical costs or the readmission ratio during the first year after discharge. Future studies should consider the necessary rehabilitation intensity given the severity of the patient's condition, using large sample sizes.     

Effects of a Low-Volume,Nutrient- and Energy-Dense Oral Nutritional Supplement on Nutritional and Functional Status: A Randomized,Controlled Trial in Nursing Home Residents

ObjectivesAlthough oral nutritional supplements (ONS) are known to be effective to treat malnutrition in the elderly, evidence from nursing home populations, including individuals with dementia, is rare, especially with regard to functionality and well-being. A known barrier for ONS use among elderly is the volume that needs to be consumed, resulting in low compliance and thus reduced effectiveness. This study aimed to investigate the effects of a low-volume, energy- and nutrient-dense ONS on nutritional status, functionality, and quality of life (QoL) of nursing home residents.DesignRandomized controlled intervention trial.SettingSix nursing homes in Nürnberg and Fuerth, Germany.ParticipantsNursing home residents affected by malnutrition or at risk of malnutrition.InterventionRandom assignment to intervention (IG) and control group (CG), receiving 2 × 125 mL ONS (600 kcal, 24 g protein) per day and routine care, respectively, for 12 weeks.MeasurementsNutritional (weight, body mass index [BMI], upper arm and calf circumferences, MNA-SF) and functional parameters (handgrip strength, gait speed, depressive mood [GDS], cognition [MMSE], activities of daily living [Barthel ADL]) as well as QoL (QUALIDEM) were assessed at baseline (T1) and after 12 weeks (T2). ONS intake was registered daily and compliance calculated.ResultsA total of 77 residents (87 ± 6 y, 91% female) completed the study; 78% had dementia (MMSE <17) and 55% were fully dependent (ADL ≤30). Median compliance was 73% (IQR 23.5%–86.5%) with median intake of 438 (141–519) kcal per day. Body weight, BMI, and arm and calf circumferences increased in the IG (n = 42) and did not change in the CG (n = 35). Changes of all nutritional parameters except MNA-SF significantly differed between groups in favor of the IG (P < .05). GDS, handgrip strength, and gait speed could not be assessed in 46%, 38%, and 49% of participants at T1 and/or T2, because of immobility and cognitive impairment. In residents able to perform the test at both times, functionality remained stable in IG and CG, except for ADLs, deteriorating in both groups. From 10 QoL categories, “positive self-perception” increased in IG (78 [33–100] to 83 [56–100]; P < .05) and tended to decrease in CG (100 [78–100] to 89 [56–100]; P = .06), “being busy” significantly dropped in CG (33 [0–50] to 0 [0–50]; P < .05).ConclusionLow-volume, nutrient- and energy-dense ONS were well accepted among elderly nursing home residents with high functional impairment and resulted in significant improvements of nutritional status and, thus, were effective to support treatment of malnutrition. Assessment of function was hampered by dementia and immobility, limiting the assessment of functionality, and highlighting the need for better tools for elderly with functional impairments. ONS may positively affect QoL but this requires further research.     

A Delirium Risk Modification Program Is Associated With Hospital Outcomes

BackgroundDelirium has been associated with negative health consequences, which can potentially be improved by delirium risk modification. This study sought to determine if a quality improvement project to identify and modify delirium risk and discharge to rehabilitation is associated with improved outcomes for patients and health care systems.MethodsIn older veterans admitted to a tertiary VA hospital, delirium risk was assessed using cognitive impairment, vision impairment, and dehydration. Delirium risk was communicated to providers via electronic medical record. To modify delirium risk, interventions were provided in cognitive stimulation, sensory improvement, and sleep promotion. Primary outcomes included length of stay, restraint use, discharge to rehabilitation, and hospital variable direct costs. Outcomes were compared using a propensity-matched cohort of patients without intervention. Number of intervention categories was compared with primary outcomes.ResultsPatients (n = 1527) were older (78.2 ± 8.3 years) and male (98%). Propensity-matched patients (n = 566) were well matched for age, gender, cognitive deficits, vision impairment, and dehydration. Patients with interventions were discharged to rehabilitation similarly (mean difference [MD] 2.2%, 95% CI −2.5−6.9) and had lower lengths of stay (MD −0.7 day, 95% CI −1.3 to −0.1), lower restraint use (MD −4.0%, 95% CI −6.7 to −1.2) and trended toward lower variable direct costs (MD −$1390, 95% CI −3586−807). Increasing number of interventions was associated with shorter length of stay, lower rate of restraint use, and lower variable direct costs.ConclusionsThis delirium risk modification project was associated with patient outcomes and reduced costs. Serious consideration should be given to delirium risk identification and modification programs.     

Healthcare Utilization After Stroke: A 1-Year Prospective Study

ObjectivesThis study was undertaken to investigate the predictive value of disease-related factors, contextual factors, and functioning on the use of healthcare for 1 year after stroke.DesignA prospective study.Setting and ParticipantsIn total, 219 patients with stroke admitted to a hospital stroke unit were included.MethodsData were obtained through medical records, structured interviews, and assessments. Multivariable regression analyses were used to explore the association between the independent variables (stroke severity, comorbidity, age, sex, civil status, private financing, sense of coherence, cognitive function, walking ability, social everyday activities prestroke, and recent fall) and the use of inpatient or outpatient care 0 to 3, 3 to 6 and 6 to 12 months after stroke.ResultsMean age of the participants was 70 years, 43% were women, and 71% experienced mild stroke severity. All participants received inpatient care at 0 to 3 months, about one-fifth used inpatient care at 3 to 6 or 6 to 12 months, and all received outpatient care all 3 time periods. Moderate-severe stroke (P < .001), a lower age (P = .002), and walking disability (P < .001) were associated with a higher use of inpatient care 0 to 3 months after stroke. Living alone (P = .025) and recent fall (P = .05) were associated with a higher use of inpatient care 3 to 6 months after stroke. None of the independent variables were associated with use of inpatient care 6 to 12 months. Moderate-severe stroke (0–3; 3–6 months: P < .001, 6–12 months: P = .004), a lower age (0–3 months: P = .002, 3–6 months: P = .001, 6–12 months: P = .006), and walking disability (P < .001) were associated with a higher use of outpatient care in all 3 time periods.Conclusions and ImplicationsModerate-severe stroke, lower age, and walking disability are important predictors of healthcare utilization after stroke. The findings inform efforts to identify and support people with stroke who have the potential for high healthcare utilization in the year post stroke.     

Changes in Health and Well-Being of Nursing Home Managers from a Prepandemic Baseline in February 2020 to December 2021

ObjectiveTo evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada.DesignRepeated cross-sectional survey.Setting and ParticipantsA random sample of nursing homes (n = 35) in urban areas of Alberta was selected on 3 strata (region, size, ownership). Care managers were invited to participate if they (1) managed a unit, (2) worked there for at least 3 months, and (3) worked at least 6 shifts per month.MethodsWe measured various mental health and well-being outcomes, including job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale), burnout (Maslach Burnout Inventory—exhaustion, cynicism, efficacy), organizational citizenship behaviors (constructive efforts by individuals to implement changes to improve performance), mental and physical health (Short Form–8 Health Survey), burden of worry, and intention to leave. We use mixed effects regression to examine changes at the survey time points, controlling for staffing and resident acuity.ResultsThe final sample included 181 care managers (87 in the pre-COVID survey; 94 in the COVID survey). Response rates were 66.9% and 82.5% for the pre-COVID and COVID surveys, respectively. In the regression analysis, we found statistically significant negative changes in job satisfaction (mean difference ?0.26, 95% CI –0.47 to ?0.06; P = .011), cynicism (mean difference 0.43, 95% CI 0.02-0.84; P = .041), exhaustion (mean difference 0.84, 95% CI 0.41-1.27; P < .001), and SF-8 mental health (mean difference ?6.49, 95% CI –9.60 to ?3.39; P < .001).Conclusions and ImplicationsMental health and well-being of nursing home managers worsened during the pandemic, potentially placing them at risk for leaving their jobs and in need of improved support. These findings should be a major concern for policy makers, particularly given serious prepandemic workforce shortages. Ongoing assessment and support of this understudied group are needed.     

Effect of Aerobic and Resistant Exercise Intervention on Inflammaging of Type 2 Diabetes Mellitus in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

ObjectivesTo examine the effect of aerobic and resistant exercise intervention on inflammaging in middle-aged and older adults with type 2 diabetes mellitus (T2DM) using inflammatory cytokines, such as interleukin (IL)-1 β, IL-6, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) as biomarkers.DesignSystematic review and meta-analysis.Setting and ParticipantsMiddle-aged and older adults with T2DM in the community.MethodsArticles were searched from 8 electronic databases. Randomized control trials (RCTs) published in English, from inception to October 31, 2021, were included in this review. Two authors conducted data extraction and quality appraisal independently following guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted using Review Manager. Heterogeneity was investigated using subgroup and sensitivity analysis.ResultsThis review included 14 RCTs. The meta-analysis showed significant improvement in IL-6 [Z = 3.05; 95% confidence interval (CI): ?3.60 to ?0.79; P = .002], CRP (Z = 2.44; 95% CI: ?0.55 to ?0.06; P = .01) and TNF-α levels (Z = 2.96; 95% CI: ?2.21 to ?0.45; P = .003) post-exercise programs. Subgroup analysis revealed that combined aerobic and resistance exercises and long-term exercises have more significant improvement to the outcomes than usual care. Based on the Grades of Recommendation, Assessment, Development and Evaluation system, considerable risk of bias and low level of certainty were revealed in all biomarker outcomes.Conclusions and ImplicationsExercise intervention is effective in improving inflammatory, metabolic, and lipid markers in middle-aged and older adults with T2DM. By modifying the levels of these markers with exercise, inflammation and insulin resistance can be improved. Long-term, combined aerobic and resistance exercise interventions have more significant effect on biomarkers. The small sample size of this meta-analysis limited the generalizability of the results. Future studies can consider adopting a more optimized exercise regimen to achieve effective T2DM management in middle-aged and older adults. Similar studies should expand to other populations and larger sample sizes to explore replicability of these effects.     

Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients With a Primary Diagnosis of Heart Failure

ObjectiveSkilled nursing facilities (SNFs) are common destinations after hospitalization for patients with heart failure (HF). Our objective was to determine if patients in SNFs with a primary hospital discharge diagnosis of HF benefit from an HF disease management program (HF-DMP).DesignThis is a subgroup analysis of multisite, physician and practice blocked, cluster-randomized controlled trial of HF-DMP vs usual care for patients in SNF with an HF diagnosis. The HF-DMP standardized SNF HF care using HF practice guidelines and performance measures and was delivered by an HF nurse advocate.Setting and ParticipantsPatients with a primary hospital discharge diagnosis of HF discharged to SNF.MethodsComposite outcome of all-cause hospitalization, emergency department visits, and mortality were evaluated at 30 and 60 days post SNF admission. Linear mixed models accounted for patient clustering at the physician level.ResultsOf 671 individuals enrolled in the main study, 125 had a primary hospital discharge diagnosis of HF (50 HF-DMP; 75 usual care). Mean age was 79 ± 10 years, 53% women, and mean ejection fraction 46% ± 15%. At 60 days post SNF admission, the rate of the composite outcome was lower in the HF-DMP group (30%) compared with usual care (52%) (P = .02). The rate of the composite outcome at 30 days for the HF-DMP group was 18% vs 31% in the usual care group (P = .11).Conclusions and ImplicationsPatients with a primary hospital discharge diagnosis of HF who received HF-DMP while cared for in an SNF had lower rates of the composite outcome at 60 days. Standardized HF management during SNF stays may be important for patients with a primary discharge diagnosis of HF.     

Effects of Palliative Care for Progressive Neurologic Diseases: A Systematic Review and Meta-Analysis

ObjectivesTo determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes.DesignSystematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies.Setting and ParticipantsAdults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson’s disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers.MethodsMEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model.ResultsFifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), ?0.34 (95% Cl, ?0.59 to ?0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, ?0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, ?0.09 (95% Cl, ?0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, ?0.07 to 0.44)] were observed.Conclusions and ImplicationsPalliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals.     

Determinants of age at menarche and time to menstrual cycle regularity in the French E3N cohort

PurposeEarly menarche has been associated with a greater risk of several major chronic diseases. Although largely genetically determined, age at menarche also has been related to environmental and lifestyle factors.MethodsUsing linear regression models, we explored simultaneously several pre- and postnatal factors as potential determinants of age at menarche and time to menstrual cycle regularity in 96,493 women participating, since 1990, in the French E3N prospective cohort.ResultsYounger age at recruitment, greater father's income index, urban birth place, greater birth length, and larger body silhouette during childhood were associated with an earlier age at menarche (from ?1.3 to ?4.6 months, P_trend < .0001) whereas greater family size, food deprivation during childhood, and greater birth weight resulted in a delayed menarche (from +1.5 months to +5.3 months, P_trend < .0001). Father's income index, urban birth place, and prematurity predicted a shorter time to menstrual cycle regularity (from ?1.1 to ?1.9 months, P_trend < .04), whereas birth cohort, larger body silhouette at menarche, and childhood exposure to passive smoking were associated with a longer time to menstrual cycle regularity (from +1.1 months to +8.6 months, P_trend < .006).ConclusionsAge at menarche and menstrual cycle regularity are significantly influenced by several individual, environmental and lifestyle factors.     

Post-Acute Care for Older People Following Injury: A Randomized Controlled Trial

ObjectivesThe study sought to determine whether older people, on discharge from hospital and on referral to a supported discharge team (SDT), will have: (1) reduced length of stay in hospital; (2) reduced risk of hospital readmission; and (3) reduced healthcare costs.Design/InterventionRandomized controlled trial with follow-up at 4 and 12 months of post-acute home-based rehabilitation team (SDT). Programs were delivered by trained healthcare assistants, up to 4 times a day, 7 days a week, under the guidance of registered nurses, allied health, and geriatricians for up to 6 weeks.Participants/SettingA total of 303 older women and 100 older men (mean age 81) in hospital because of injury, were randomized to either SDT (n = 201) or usual care (n = 202). The intervention was operated from Waikato hospital, a regional hospital in New Zealand.MethodsDays spent in hospital in the year following randomization and healthcare costs were collected from hospital datasets, and functional status assessed using the interRAI Contact Assessment was gathered by health professional research associates.ResultsParticipants randomized to the SDT spent less time in hospital in the period immediately prior to discharge (mean 20.9 days) in comparison to usual care (mean 26.6 days) and spent less time in hospital in the 12 months following discharge home. Healthcare costs were lower in the SDT group in the 12 months following randomization.Conclusions/ImplicationsSDT can provide an important role in reducing hospital length of stay and readmissions of older people following an injury. Almost a million older people (65+ years of age) a year in the US are hospitalized as a consequence of falls-related injuries, most often fractured hip. Hospitals are not always the best location to provide care for older people. SDTs can help with the transition from hospital to home, while reducing hospital length-of-stay.     

Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis

ObjectivesPain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents.DesignA Cochrane-style systematic review and meta-analysis using PRISMA guidelines.Setting and ParticipantsRandomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60 years receiving interventions to reduce chronic pain.MethodsSix databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0.ResultsWe included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD ?0.80; 95% CI ?1.47 to ?0.12; P = .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD ?0.70; 95% CI ?0.95 to ?0.45; P < .001), combined interventions (SMD ?0.37; 95% CI ?0.60 to ?0.13; P = .002), and education interventions (SMD ?0.31; 95% CI ?0.48 to ?0.15; P < .001).Conclusions and ImplicationsOur findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.     

The Effect of COVID-19 Endemicity on the Mental Health of Health Workers

ObjectivesA major surge in COVID-19 cases despite Singapore's high vaccination has strained the health care system in October 2021. Our aim was to assess and compare Healthcare Worker (HCW) mental well-being in 2021 against a previously published cohort in 2020.DesignCross-sectional survey study.Setting and ParticipantsHCWs from 4 public hospitals and a primary health care system over a 4-week duration in 2021 coinciding with a major surge compared with a similar period in 2020.MethodsA survey comprising of the Oldenburg Burnout Inventory (OLBI), Hospital Anxiety and Depression Scale (HADS), and Safety Attitudes Questionnaire (SAQ) was distributed via email. Primary endpoints were the proportion meeting OLBI thresholds for both disengagement and exhaustion and being at risk for both Anxiety and Depression using HADS. Multivariate analysis identified significant predictors among demographic, workplace, and SAQ data. Subgroup analysis of overseas HCWs was performed.ResultsWe surveyed 1475 HCWs. Significantly more HCWs met primary outcomes using OLBI and HADS than in 2020 (84.1% and 39.6% vs 68.2% and 23.3%, respectively; P < .001). Burnout levels were uniformly high. A HADS score ≥8 in either subscale was significantly associated with meeting burnout thresholds (P < .001). Overseas HCWs (P = .002), South Asian ethnicity (P = .004), preuniversity educational qualifications (P = .026), and longer shift workhours of 8 to <12 (P = .015) and ≥12 (P = .001) were significantly associated with meeting HADS thresholds. Among overseas HCWs (n=407), seeing family more than a year ago was significantly associated with worse OLBI disengagement scores and a greater proportion meeting HADS thresholds vs seeing them within a year or being local HCWs (47.2% vs 37.2% and 35.6%, respectively; P = .001).Conclusions and ImplicationsHCW mental health has objectively worsened between 2020 and 2021 in the pandemic’s second year. Avoiding prolonged shifts, adopting preventive mental health strategies, improving patient safety, and attention to HCWs of minority ethnicity, from overseas, and with preuniversity education may help.     

COVID-19 and Proximal Femur Fracture in Older Adults—A Lethal Combination? An Analysis of the Registry for Geriatric Trauma (ATR-DGU)

ObjectivesCOVID-19 can be a life-threatening illness, especially for older patients. The COVID-19 outbreak created a dramatic organizational challenge in treating infected patients requiring surgical treatment, like those suffering a proximal femur fracture, in a pandemic setting. We investigate the impact of a COVID-19 infection in patients with a proximal femur fracture not only on mortality but also on quality of life (QoL), length of stay, and discharge target.DesignRetrospective cohort analysis from July 1, 2020, to December 31, 2020. The Registry for Geriatric Trauma collected the data prospectively. Patient groups with and without COVID-19 infection were compared using linear and logistic regression models.Setting and ParticipantsRetrospective multicenter registry study including patients aged ≥70 years with proximal femur fracture requiring surgery from 107 certified Centers for Geriatric Trauma in Germany, Austria, and Switzerland.MeasuresThe occurrence and impact of COVID-19 infection in patients suffering a proximal femur fracture were measured regarding in-house mortality, length of stay, and discharge location. Moreover, QoL was measured by the validated EQ-5D-3L questionnaire.ResultsA total of 3733 patients were included in our study. Of them, 123 patients tested COVID-19 positive at admission. A COVID-19 infection resulted in a 5.95-fold higher mortality risk (odds ratio 5.95, P < .001], a length of stay prolonged by 4.21 days [regression coefficient (β) 4.21, P < .001], a reduced QoL (β ?0.13, P = .001), and a change in discharge target, more likely to their home instead of another inpatient facility like a rehabilitation clinic (P = .013).Conclusions and ImplicationsThe impact of a COVID-19 infection in patients suffering a proximal femur fracture is tremendous. The infected patients presented a dramatic rise in mortality rate, were significantly less likely to be discharged to a rehabilitation facility, had a longer in-hospital stay, and a reduced QoL.     

The impact of stroke on psychological and physical function outcomes in people with long-term physical disability

BackgroundAn increased number of people who have a long-term physical disability (LTPD) are aging. Similar to older adults without previous disability, individuals with LTPD may experience age-related comorbidities secondary to aging. A leading cause of disability in the United States among older adults is stroke. Limited evidence supports that individuals with LTPD are at higher risk of a stroke compared to those without disability. Stroke may negatively impact physical, cognitive, and/or psychosocial function. For those who have lived longer with LTPD, the impact of stroke may differ.ObjectiveTo determine the impact of stroke on health outcomes in people with LTPD.MethodsThirty-three individuals with both LTPD and self-reported stroke were identified in a national purposive sample of adults reporting physical disability associated with LTPD (Group A). Group A was compared to an age matched sample of 33 individuals with the same conditions but no stroke (Group B). Group A participants were also compared to national norms based on age cohort from a national sample of 182 stroke survivors (Group C).ResultsAge range of all participants = 65–74 years. Combine sample among three groups = 248. Group A did not differ from Group B. However, Group A reported significantly higher pain interference (p < .001), fatigue (p = .003), and decreased physical function (p < .001) than Group C.ConclusionsThe study informs how the impact of acquiring another condition after living with a LTPD differs among a general stroke population and those who are living with LTPD.     

Measuring Slowness in Old Age: Times to Perform Moberg Picking-Up and Walking Speed Tests

ObjectivesSlowness is a marker of frailty captured by the Fried phenotype by a walking speed test which, for health or logistical reasons, is sometimes difficult to perform. The Moberg picking-up test (MPUT) is another timed functional test. It measures hand motor activity and might represent an alternative to assess slowness when the walking speed cannot be evaluated. This study aimed to evaluate the relationship between MPUT and walking speed.DesignCross-sectional.Setting and ParticipantsIn total, 2748 individuals aged 66 to 83 years who participated in the latest examination (2015-2017) of the population-based Lausanne cohort 65+ and completed both tests.MethodsWalking speed (time to walk 20 meters at usual pace) and MPUT (time to pick up 12 objects) were compared using scatter graphs. Multivariate regression models further investigated the relationship between MPUT and walking times with adjustment for height, grip strength, body mass index, and Mini-Mental State Examination. All analyses were stratified by sex.ResultsMPUT and walking times were moderately, positively correlated in men (r = 0.38, P < .001) and in women (r = 0.38, P < .001). Higher grip strength and Mini-Mental State Examination performances were correlated to shorter MPUT and walking times. Men and women slower at the MPUT were also significantly slower at the walking speed test when adjusting for height (P < .001) as well as in fully adjusted models (P < .001).Conclusions and ImplicationsThese preliminary results point to a positive association between MPUT and walking speed independent of muscle strength and cognition. Further research is needed to investigate the capacity of MPUT to predict adverse health outcomes before considering this test as an alternative measure of slowness in the assessment of frailty.     

Validation of handgrip strength and endurance as a measure of physical function and quality of life in healthy subjects and patients

ObjectiveHandgrip strength (HGS) is often used as a bedside measurement of muscle function in the hospital setting. The aim of this study was to investigate the extent to which HGS, endurance, and work (force during endurance × time) are related to physical function as measured by mobility and physical activity (PA) in young, healthy volunteers. Further, the relations between HGS, mobility, PA and quality of life (QoL) in patients were investigated.MethodsNinety-two healthy subjects (45% men, mean age 30 y) and 45 patients (56% men, mean age 55 y) were assessed for HGS, handgrip endurance, and handgrip work, mobility (timed up-and-go test), and PA (Baecke questionnaire or Bouchard activity diary). The patients were further assessed for QoL (SF-36).ResultsThere was a correlation between HGS and mobility in healthy subjects (r = ?0.31, P = 0.0028) and patients (r = ?0.59, P < 0.0001). Further, HGS and mobility were related to physical and mental component summary scores of QoL in patients. There was also a relation between HGS and PA in healthy female subjects and male patients.ConclusionHandgrip strength is a valid measurement of mobility and QoL in patients and of PA in healthy female subjects and male patients. Handgrip endurance and work were not found to be valid measurements of mobility and PA in healthy subjects or of QoL in patients.     

Stressful life events and habitual physical activity in older adults: 1-year accelerometer data from the Nakanojo Study

ObjectivesStressful life events may have an indirect effect on health by reducing a person's habitual physical activity. The literature supports a negative association between stressful life events and the self-reported physical activity of younger adults, but further evidence is needed for older individuals, using objective measurements of physical activity. We have therefore investigated this issue in a healthy sample of seniors.MethodsThe subjects were 83 men and 101 women, aged 65–85 years. An accelerometer measured their step counts and the intensity of physical activity in metabolic equivalents (METs) on a 24-h basis for an entire year. At the year's end, subjects reported stressful life events that had occurred during the year. Pearson's partial correlation coefficients between these events and physical activity were calculated after controlling for inter-individual differences in age.ResultsThe age-adjusted number of events was negatively correlated with both average daily step count and average daily duration of activity > 3 METs in males (r = ?0.27, p = 0.02; r = ?0.37, p = 0.001, respectively). The self-reported age-adjusted total severity of events showed significant negative correlations with both step count and duration of activity > 3 METs, both in males (r = ?0.29, p = 0.01; r = ?0.37, p = 0.001, respectively) and in females (r = ?0.21, p = 0.03; r = ?0.25, p = 0.01, respectively).ConclusionStressful life events in the elderly are associated with a low level of habitual physical activity (particularly in men who take little exercise of moderate intensity).     

Impacts of Chronic Obstructive Pulmonary Disease Care Pathway on Healthcare Utilization and Costs: A Matched Multiple Control Cohort Study in Saskatchewan,Canada

ObjectivesThis study aimed to evaluate the real-world impacts of a chronic obstructive pulmonary disease (COPD) care pathway program on healthcare utilization and costs in Saskatchewan, Canada.MethodsA difference-in-differences evaluation of a real-life deployment of a COPD care pathway, using patient-level administrative health data in Saskatchewan, was conducted. The intervention group (n = 759) included adults (35+ years) with spirometry-confirmed COPD diagnosis recruited into the care pathway program in Regina between April 1, 2018 and March 31, 2019. The 2 control groups comprised adults (35+ years) with COPD who lived in Saskatoon during the same period (n = 759) or Regina between April 1, 2015 and March 31, 2016 (n = 759) who did not participate in the care pathway.ResultsCompared with the individuals in the Saskatoon control groups, individuals in the COPD care pathway group had shorter inpatient hospital length of stay (average treatment effect on the treated [ATT] −0.46, 95% CI −0.88 to −0.04) but a higher number of general practitioner visits (ATT 1.46, 95% CI 1.14 to 1.79) and specialist physician visits (ATT 0.84, 95% CI 0.61 to 1.07). Regarding healthcare costs, individuals in the care pathway group had higher COPD-related specialist visit costs (ATT $81.70, 95% CI $59.45 to $103.96) but lower COPD-related outpatient drug dispensation costs (ATT −$4.81, 95% CI −$9.34 to −$0.27).ConclusionsThe care pathway reduced inpatient hospital length of stay, but increased general practitioner and specialist physician visits for COPD-related services within the first year of implementation.