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1.
Vincenzo Solfrizzi Emanuele Scafato Davide Seripa Madia Lozupone Bruno P. Imbimbo Angela D&#x;Amato Rosanna Tortelli Andrea Schilardi Lucia Galluzzo Claudia Gandin Marzia Baldereschi Antonio Di Carlo Domenico Inzitari Antonio Daniele Carlo Sabbà Giancarlo Logroscino Francesco Panza 《Journal of the American Medical Directors Association》2017,18(1):89.e1-89.e8
Objectives
Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a “reversible” cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role.Design
Longitudinal population-based study with 3.5- and 7-year of median follow-up.Setting
Eight Italian municipalities included in the Italian Longitudinal Study on Aging.Participants
In 2150 older individuals from the Italian Longitudinal Study on Aging, we operationalized reversible cognitive frailty with the presence of physical frailty and pre-mild cognitive impairment subjective cognitive decline, diagnosed with a self-report measure based on item 14 of the Geriatric Depression Scale.Measurements
Incidence of dementia, its subtypes, and all-cause mortality.Results
Over a 3.5-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.02–5.18], particularly vascular dementia (VaD), and all-cause mortality (HR 1.74, 95% CI 1.07–2.83). Over a 7-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia (HR 2.12, 95% CI 1.12–4.03), particularly VaD, and all-cause mortality (HR 1.39, 95% CI 1.03–2.00). Vascular risk factors and depressive symptoms did not have any effect modifier on the relationship between reversible cognitive frailty and incident dementia and all-cause mortality.Conclusions
A model of reversible cognitive frailty was a short- and long-term predictor of all-cause mortality and overall dementia, particularly VaD. The absence of vascular risk factors and depressive symptoms did not modify the predictive role of reversible cognitive frailty on these outcomes. 相似文献2.
Verena R. Cimarolli Joann P. Reinhardt Jillian Minahan Orah Burack Channing Thomas Regina Melly 《Journal of the American Medical Directors Association》2017,18(11):991.e1-991.e4
Objectives
Use of exercise technologies has benefits for community-dwelling older adults in terms of improved gait and balance. But research on the feasibility of use of exercise technologies in various geriatric health care settings is lacking. Hence, the current study examined the feasibility of implementing an exercise technology intended to augment rehabilitation in patients receiving post-acute care (PAC) in a skilled nursing facility (SNF). We focused on 3 indicators of feasibility: extent of usage (including predictors of more intense use), patients' acceptability of the technology, and limited efficacy.Design
Cross-sectional study with data from patients' electronic medical records (EMR), exercise technology portal, and patient interviews.Setting
SNF.Participants
A sample of post-acute patients (n = 237).Measurements
Sociodemographic and health-related variables, time spent using the technology, and 8 items of the Physical Activity Enjoyment Scale (PACES).Results
Average time spent using the technology varied greatly (range, 1–460 minutes). A regression analysis showed that patients who had a longer length of stay (β = .01, P < .05) and were younger (β = ?0.01, P < .05) spent significantly more time using the technology. Acceptability of technology was high among patients. Finally, patients who used the technology had lower 30-day rehospitalization rates.Conclusion
Exercise technology is feasible to use in supporting rehabilitation in patients receiving PAC in a SNF and seems to have beneficial effects. 相似文献3.
Fiona A.H.M. Cleutjens Martijn A. Spruit Rudolf W.H.M. Ponds Lowie E.G.W. Vanfleteren Frits M.E. Franssen Jeanette B. Dijkstra Candy Gijsen Emiel F.M. Wouters Daisy J.A. Janssen 《Journal of the American Medical Directors Association》2017,18(5):420-426
Objectives
To compare changes in pulmonary rehabilitation (PR) dropout and outcomes between chronic obstructive pulmonary disease (COPD) patients with and without cognitive impairment.Design
A cross-sectional observational study.Setting
Patients with COPD were recruited from a PR centre in the Netherlands.Participants
The study population consisted of 157 patients with clinically stable COPD who were referred for and completed PR.Measurements
A comprehensive neuropsychological examination before start of PR was administered. Changes from baseline to PR completion in functional exercise capacity [6-minute walk test (6MWT)], disease-specific health status [COPD Assessment Test (CAT) and St George's Respiratory Questionnaire-COPD specific (SGRQ-C)], psychological well-being [Hospital Anxiety and Depression Scale (HADS)], COPD-related knowledge, and their need for information [Lung Information Needs Questionnaire (LINQ)] were compared between patients with and without cognitive impairment using independent samples t tests or Mann-Whitney U tests.Results
Out of 157 patients with COPD [mean age 62.9 (9.4) years, forced expiratory volume in the first second 54.6% (22.9%) predicted], 24 patients (15.3%) did not complete PR. The dropout rate was worse in patients with cognitive impairment compared to those without cognitive impairment (23.3% and 10.3%, P = .03). Mean changes in PR outcomes after PR did not differ between completers with and without cognitive impairment. The proportion of patients with a clinically relevant improvement in 6MWT, CAT, SGRQ-C, HADS, and LINQ scores was comparable for patients with and without cognitive impairment.Conclusion
PR is an effective treatment for patients with COPD and cognitive impairment. Yet patients with cognitive impairment are at increased risk for not completing the PR program. 相似文献4.
Jana Hummel Cecilia Weisbrod Leila Boesch Katharina Himpler Klaus Hauer Martin Hautzinger Andrea Gaebel Tania Zieschang Andrea Fickelscherer Slawomira Diener Ilona Dutzi Bertram Krumm Peter Oster Daniel Kopf 《Journal of the American Medical Directors Association》2017,18(4):341-349
Background
Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression.Objectives
To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness.Design
Randomized controlled trial with waiting list control group.Setting
Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients’ homes.Participants
A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness.Intervention
Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group.Measurements
HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician.Results
The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures.Conclusions
CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients.5.
Nadège Costa Emiel O. Hoogendijk Michael Mounié Robert Bourrel Yves Rolland Bruno Vellas Laurent Molinier Matteo Cesari 《Journal of the American Medical Directors Association》2017,18(5):453.e7-453.e12
Objectives
Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period.Design
This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study.Setting
Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included.Participants
Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5.Measurements
Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded.Results
Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia.Conclusions
NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs. 相似文献6.
John E. Morley Hidenori Arai Li Cao Birong Dong Reshma A. Merchant Bruno Vellas Renuka Visvanathan Jean Woo 《Journal of the American Medical Directors Association》2017,18(6):489-494
Background
Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric syndromes (frailty, sarcopenia, anorexia of aging, and cognitive decline) will delay or avert the development of disability.Objectives
To identify simple screening programs available for primary health professionals to identify geriatric syndromes.Data sources
PubMed for the last 5 years and study authors.Results
A number of screening programs for early detection of geriatric syndromes have been developed for use by primary care health providers, for example, EasyCare, Gérontopôle Frailty Screening Tool, the Rapid Geriatric Assessment, the Kihon Checklist, and others.Limitations
This is an evolving area with limited information on the outcomes of intervention and possible harms.Conclusion
Validated screening programs exist but more work is required to determine their utility in improving outcomes of older persons. 相似文献7.
Lien Van Malderen Patricia De Vriendt Tony Mets Dominique Verté Ellen Gorus 《Journal of the American Medical Directors Association》2017,18(6):495-502
Objectives
This study aimed to examine the effects of introducing participatory action research (PAR) within the nursing home (NH) on residents’ quality of life (QoL) and NH experience and participation, and to explore their experiences with PAR.Design
A mixed methods design was chosen, including a clustered randomized controlled trial (RCT) and qualitative interviews.Setting
For the RCT, 3 NHs were randomly allocated to 3 conditions: an intervention (weekly PAR activity), an active control (weekly reminiscence-activity), or passive control (care as usual). The qualitative study took place in the intervention NH.Participants
Within the RCT, about 30 residents were recruited for assessments per NH, including 9 PAR participants and 10 reminiscence participants. Qualitative interviews were held with all PAR participants (residents and internal moderator).Intervention
PAR is a method to structurally involve residents in the NH operation. Weekly PAR sessions were held with 9 residents and 2 moderators. Here, residents critically analyzed and discussed the NH operation, identified possible problems, suggested improvements, which were further implemented by the NH and monitored by the PAR group.Measurements
Residents’ NH experience (NH Active Aging Survey), QoL (Anamnestic Comparison Self-Assessment), and experienced participation (Impact on Participation and Autonomy) were measured in the RCT at pre-test, post-test (6 months), and follow-up (12 months). The qualitative study took into account interviews with the PAR stakeholders after 6 months.Results
The RCT showed residents’ QoL improving more between pre-test and follow-up in the intervention and active control NH compared with the passive control NH. No other effects were observed. The qualitative data revealed a positive PAR experience. Participants enjoyed the activity and indicated various positive influences. Still, there was room for improvement, including communication toward other residents and between staff.Conclusions
Notwithstanding the modest quantitative effects, PAR led to positive experiences and can have a future in the NH when solving some limitations. 相似文献8.
Yue-Bin Lv Peng-Fei Zhu Zhao-Xue Yin Virginia Byers Kraus Diane Threapleton Choy-Lye Chei Melanie Sereny Brasher Juan Zhang Han-Zhu Qian Chen Mao David Bruce Matchar Jie-Si Luo Yi Zeng Xiao-Ming Shi 《Journal of the American Medical Directors Association》2017,18(2):193.e7-193.e13
Objectives
Higher or lower blood pressure may relate to cognitive impairment, whereas the relationship between blood pressure and cognitive impairment among the elderly is not well-studied. The study objective was to determine whether blood pressure is associated with cognitive impairment in the elderly, and, if so, to accurately describe the association.Design
Cross-sectional data from the sixth wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2011.Setting
Community-based setting in longevity areas in China.Participants
A total of 7144 Chinese elderly aged 65 years and older were included in the sample.Measures
Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured, pulse pressure (PP) was calculated as (SBP) ? (DBP) and mean arterial pressures (MAP) was calculated as 1/3(SBP) + 2/3(DBP). Cognitive function was assessed via a validated Mini-Mental State Examination (MMSE).Results
Based on the results of generalized additive models (GAMs), U-shaped associations were identified between cognitive impairment and SBP, DBP, PP, and MAP. The cutpoints at which risk for cognitive impairment (MMSE <24) was minimized were determined by quadratic models as 141 mm Hg, 85 mm Hg, 62 mm Hg, and 103 mm Hg, respectively. In the logistic models, U-shaped associations remained for SBP, DBP, and MAP but not PP. Below the identified cutpoints, each 1-mm Hg decrease in blood pressure corresponded to 0.7%, 1.1%, and 1.1% greater risk in the risk of cognitive impairment, respectively. Above the cutpoints, each 1-mm Hg increase in blood pressure corresponded to 1.2%, 1.8%, and 2.1% greater risk of cognitive impairment for SBP, DBP, and MAP, respectively.Conclusion
A U-shaped association between blood pressure and cognitive function in an elderly Chinese population was found. Recognition of these instances is important in identifying the high-risk population for cognitive impairment and to individualize blood pressure management for cognitive impairment prevention. 相似文献9.
Agnes A.M. Berendsen Jae H. Kang Ondine van de Rest Edith J.M. Feskens Lisette C.P.G.M. de Groot Francine Grodstein 《Journal of the American Medical Directors Association》2017,18(5):427-432
Objectives
To examine the association between long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women.Design
Prospective cohort study.Setting
The Nurses' Health Study, a cohort of registered nurses residing in 11 US states.Participants
A total of 16,144 women from the Nurses' Health Study, aged ≥70 years, who underwent cognitive testing a total of 4 times by telephone from 1995 to 2001 (baseline), with multiple dietary assessments between 1984 and the first cognitive examination. DASH adherence for each individual was based on scoring of intakes of 9 nutrient or food components.Measurements
Long-term DASH adherence was calculated as the average DASH adherence score from up to 5 repeated measures of diet. Primary outcomes were cognitive function calculated as the average scores of the 4 repeated measures, as well as cognitive change of the Telephone Interview for Cognitive Status score and composite scores of global cognition and verbal memory.Results
Greater adherence to long-term DASH score was associated with better average cognitive function, irrespective of apolipoprotein E ε4 allele status [multivariable-adjusted differences in mean z-scores between extreme DASH quintiles = 0.04 (95% confidence interval, CI 0.01–0.07), P trend = .009 for global cognition; 0.04 (95% CI 0.01–0.07), P trend = .002 for verbal memory and 0.16 (95% CI 0.03–0.29), and P trend = .03 for Telephone Interview for Cognitive Status, P interaction >0.24]. These differences were equivalent to being 1 year younger in age. Adherence to the DASH score was not associated with change in cognitive function over 6 years.Conclusions
Our findings in the largest cohort on dietary patterns and cognitive function to date indicate that long-term adherence to the DASH diet is important to maintain cognitive function at older ages. 相似文献10.
11.
Sophie Pilleron Soufiane Ajana Marthe-Aline Jutand Catherine Helmer Jean-François Dartigues Cécilia Samieri Catherine Féart 《Journal of the American Medical Directors Association》2017,18(2):169-175
Objective
To analyze the association between dietary patterns and the 12-year risk of frailty and its components in community-dwelling elderly French adults.Design
A prospective cohort study.Setting
The Bordeaux sample of the Three-City Study.Participants
A total of 972 initially nonfrail nondemented participants (336 men and 636 women) aged 73 years on average, re-examined at least once over 12 years.Measurements
Five sex-specific dietary clusters were previously derived at baseline. Frailty incident to the baseline visit was defined as having at least three out of the following 5 criteria: unintentional weight loss, exhaustion, low energy expenditure, slowness, and muscle weakness. Multivariate Cox proportional hazard models were used to assess the association between dietary clusters and the risk of frailty and its components.Results
In total, 78 men for 3719 person-years and 221 women for 7027 person-years became frail over the follow-up. In multivariate analyses, men in the “pasta” pattern and women in the “biscuits and snacking” pattern had a significantly higher risk of frailty compared with those in the “healthy” pattern [hazard ratio (HR) 2.2; 95% confidence interval (CI) 1.1–4.4 and HR 1.8; 95% CI 1.2–2.8, respectively; P = .09 and P = .13 for the global test of significance of risk difference across clusters, respectively]. In men, “biscuits and snacking” and “pasta” patterns were significantly associated with higher risk for muscle weakness (HR 3.3; 95% CI 1.6–7.0 and HR 2.1; 95% CI 1.2–3.7, respectively; P = .003 for global test).Conclusions
This 12-year prospective population-based study suggests that some particular unhealthy dietary patterns may increase the risk of frailty in older adults. 相似文献12.
Kimberly J. Rask Jennifer Hodge Linda Kluge 《Journal of the American Medical Directors Association》2017,18(11):991.e11-991.e15
Objectives
Identify contextual and implementation factors impacting the effectiveness of an organizational-level intervention to reduce preventable hospital readmissions from affiliated skilled nursing facilities (SNFs).Design
Observational study of the implementation of Interventions to Reduce Acute Care Transfers tools in 3 different cohorts.Setting
SNFs.Participants
SNFs belonging to 1 of 2 corporate entities and a group of independent SNFs that volunteered to participate in a Quality Improvement Organization (QIO) training program.Intervention
Two groups of SNFs received INTERACT II training and technical assistance from corporate staff, and 1 group of SNFs received training from QIO staff.Measurements
Thirty-day acute care hospital readmissions from Medicare fee-for-service claims, contextual factors using the Model for Understanding Success in Quality framework.Results
All 3 cohorts were able to deliver the INTERACT training program to their constituent facilities through regional events as well as onsite technical assistance, but the impact on readmission rates varied. Facilities supported by the QIO and corporation A were able to achieve statistically significant reductions in 30-day readmission rates. A review of contextual factors found that although all cohorts were challenged by staff turnover and workload, corporation B facilities struggled with a less mature quality improvement (QI) culture and infrastructure.Conclusions
Both corporations demonstrated a strong corporate commitment to implementing INTERACT II, but differences in training strategies, QI culture, capacity, and competing pressures may have impacted the effectiveness of the training. Proactively addressing these factors may help long-term care organizations interested in reducing acute care readmission rates increase the likelihood of QI success. 相似文献13.
Gilles Allali Cyrille P. Launay Helena M. Blumen Michele L. Callisaya Anne-Marie De Cock Reto W. Kressig Velandai Srikanth Jean-Paul Steinmetz Joe Verghese Olivier Beauchet 《Journal of the American Medical Directors Association》2017,18(4):335-340
Objectives
Falls are highly prevalent in individuals with cognitive decline. The complex relationship between falls and cognitive decline (including both subtype and severity of dementia) and the influence of gait disorders have not been studied. This study aimed to examine the association between the subtype (Alzheimer disease [AD] versus non-AD) and the severity (from preclinical to moderate dementia) of cognitive impairment and falls, and to establish an association between falls and gait parameters during the course of dementia.Design
Multicenter cross-sectional study.Setting
“Gait, cOgnitiOn & Decline” (GOOD) initiative.Participants
A total of 2496 older adults (76.6 ± 7.6 years; 55.0% women) were included in this study (1161 cognitively healthy individuals [CHI], 529 patients with mild cognitive impairment [MCI], 456 patients with mild dementia, and 350 with moderate dementia) from 7 countries.Measurements
Falls history was collected retrospectively at baseline in each study. Gait speed and stride time variability were recorded at usual walking pace with the GAITRite system.Results
The prevalence of individuals who fall was 50% in AD and 64% in non-AD; whereas it was 25% in CHIs. Only mild and moderate non-AD dementia were associated with an increased risk for falls in comparison with CHI. Higher stride time variability was associated with falls in older adults without dementia (CHI and each MCI subgroup) and mild non-AD dementia, whereas lower gait speed was associated with falls in all participant groups, except in mild AD dementia. When gait speed was adjusted for, higher stride time variability was associated with falls only in CHIs (odds ratio 1.14; P = .012), but not in MCI or in patients with dementia.Conclusions
These findings suggest that non-AD, but not AD dementia, is associated with increased falls in comparison with CHIs. The association between gait parameters and falls also differs across cognitive status, suggesting different mechanisms leading to falls in older individuals with dementia in comparison with CHIs who fall. 相似文献14.
Raphael Simon Peter Gabriele Nagel 《Journal of epidemiology / Japan Epidemiological Association》2017,27(6):294-297
Background
To date, the amount of heterogeneity among studies of the body mass index-mortality association attributable to differences in the age distribution and length of follow-up has not been quantified. Therefore, we wanted to quantify the amount of heterogeneity attributable to age and follow-up in results of studies on the body mass index-mortality relation.Methods
We used optima of the body mass index mortality association reported for 30 populations and performed meta-regression to estimate the amount of heterogeneity attributable to sex, ethnicity, mean age at baseline, percentage smokers, and length of follow-up.Results
Ethnicity as single factor accounted for 36% (95% CI, 11–56%) of heterogeneity. Mean age and length of follow-up had an interactive effect and together accounted for 56% (95% CI, 24–74%) of the remaining heterogeneity. Sex did not significantly contribute to the heterogeneity, after controlling for ethnicity, age, and length of follow-up.Conclusions
A considerable amount of heterogeneity in studies of the body mass index-mortality association is attributable to ethnicity, age, and length of follow-up. 相似文献15.
Tomotaka Ugai Keitaro Matsuo Norie Sawada Motoki Iwasaki Taiki Yamaji Taichi Shimazu Shizuka Sasazuki Manami Inoue Shoichiro Tsugane 《Journal of epidemiology / Japan Epidemiological Association》2017,27(7):305-310
Background
Cigarette smoking has been reported to be associated with an increased risk of leukemia. Most epidemiological evidence on the association between cigarette smoking and leukemia risk is from studies conducted in Western populations, however, and evidence from Asian populations is scarce.Methods
We conducted a large-scale population-based cohort study of 96,992 Japanese subjects (46,493 men and 50,499 women; age 40–69 years at baseline) with an average 18.3 years of follow-up, during which we identified 90 cases of acute myeloid leukemia (AML), 19 of acute lymphoblastic leukemia (ALL), and 28 of chronic myeloid leukemia (CML). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox regression model adjusted for potential confounders.Results
When we adjusted for age, sex, and study area, our findings showed no significant association or increasing dose–response relationship between risk of AML and cigarette smoking overall. However, after further adjustment for body mass index and occupation, current smokers with more than 30 pack-years of cigarette smoking had a significantly increased risk of AML compared to never smokers among men (HR 2.21; 95% CI, 1.01–4.83). This increased risk was not clear among women.Conclusions
Our results suggest that cigarette smoking increases the risk of AML in Japanese men. The associations of smoking with AML among women, and with CML and ALL among men and women, should be assessed in future studies. 相似文献16.
Abebaw Mengistu Yohannes Hana Mülerová Kim Lavoie Jorgen Vestbo Steve I. Rennard Emile Wouters Nicola A. Hanania 《Journal of the American Medical Directors Association》2017,18(11):955-959.e6
Background
Depression increases disability and health care utilization in older patients with chronic obstructive pulmonary disease (COPD).Objectives
To determine contribution of depressive symptoms to the incidence of moderate-severe and severe acute exacerbations of COPD (AECOPD) over 3 years.Design
We analyzed data collected from a prospective cohort of patients with COPD (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; ECLIPSE).Setting
Multicentered outpatient.Participants
A total of 2059 patients with COPD with complete data (63.7% men, mean age 63.4 + 7.1 years).Measurements
Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Moderate-severe AECOPDs were collected; a subset of very severe AECOPD was defined as requiring hospital admission.Results
A total of 540 (26%) patients with COPD reported high depressive symptoms (CES-D ≥16). High depressive symptoms at baseline related to an increased risk of moderate-severe and severe AECOPD during the follow-up (odds ratio [OR] 1.18; 95% confidence interval [CI] 1.07–1.30; for moderate-severe and OR 1.36; 95% CI 1.09–1.69 for severe events risk of hospitalizations) independent of key covariates of an AECOPD history before recruitment in the study, history of gastroesophageal reflux, baseline severity of airflow limitation, and white blood cell count that were also associated with an increased risk of moderate to severe exacerbations (all P < .001).Conclusion
Presence of high depressive symptoms at baseline were associated with subsequent moderate-severe exacerbations and hospital admissions in patients with COPD over 3 years, independent of a history of exacerbations and other demographic and clinical factors. Targeted personalized medicine that focuses both on AECOPD risk and depression may be a step forward to improving prognosis of patients with COPD. 相似文献17.
Jennifer S. Albrecht Lindsay Croft Daniel J. Morgan Mary-Claire Roghmann 《Journal of the American Medical Directors Association》2017,18(2):158-161
Objectives
To explore current use and perceptions of glove and gown use in nursing homes.Design
Qualitative study using focus groups and semi-structured interviews.Setting
Three community-based nursing homes in Maryland.Participants
Direct care staff, administrators, and residents.Methods
We conducted three focus groups among nursing home staff, one focus group among nursing home administrators, and five interviews with residents. Topic guides were created based on our recent study results and a review of the literature. Two investigators separately analyzed the transcribed recordings and identified recurrent themes.Results
Direct care staff reported using gowns and gloves primarily as self-protection against contact with bodily fluids, not to prevent MRSA transmission. Glove use was described as common and more acceptable to staff and residents than gown use. Administrators were surprised that MRSA transmission to health care worker hands and clothing occurred during activities when direct care staff perceives no contact with bodily fluids. Staff and administrators expressed willingness to use gowns and gloves for high-risk care activities, particularly if use is targeted toward specific types of residents such as those with pressure ulcers. There was a knowledge deficit about MRSA transmission and infection among direct care staff and residents.Conclusions
Results from this study will inform a strategy to reduce MRSA transmission in long-term care. 相似文献18.
Alain Queyroux Bernard Saricassapian Daniel Herzog Karin Müller Isabelle Herafa Dorothée Ducoux Benoît Marin Thierry Dantoine Pierre-Marie Preux Achille Tchalla 《Journal of the American Medical Directors Association》2017,18(6):528-532
Importance
Dental neglect and high levels of unmet dental needs are becoming increasingly prevalent among elderly residents of long-term care facilities, although frail, elderly, and dependent populations are the most in need of professional dental care. Little is known about the validity of teledentistry for diagnosing dental pathology in nursing home residents.Objectives
To evaluate the accuracy of teledentistry for diagnosing dental pathology, assessing the rehabilitation status of dental prostheses, and evaluating the chewing ability of older adults living in nursing homes (using direct examination as a gold standard).Design
Multicenter diagnostic accuracy study performed in France and Germany.Setting
Eight nursing homes in France and Germany.Participants
Nursing home residents with oral or dental complaints, self-reported or reported by caregivers, willing to receive oral or dental preventive care. In total, 235 patients were examined. The mean age was 84.4 ± 8.3 years, and 59.1% of the subjects were female.Intervention
The patients were examined twice. Each patient was his or her own control. First, the dental surgeon established a diagnosis by reviewing a video recorded in the nursing home and accessed remotely. Second, within a maximum of 7 days, patients were examined conventionally (face-to-face) by the same surgeon who established the initial diagnosis.Measurements
All residents received a comprehensive clinical examination in their home by a trained geriatrician and underwent a dental hygiene evaluation that used the Silness-Loe and Greene-Vermillion dental hygiene assessment indices. The diagnoses established via the video recording and in the face-to-face setting were compared. The main outcome measure was number of dental pathologies.Results
In total, 128 (55.4%) patients had a dental pathology. The sensitivity of teledentistry for diagnosing dental pathology was 93.8% (95% confidence interval [CI] 90.7–96.9), and the specificity was 94.2% (95% CI 91.2–97.2). Among the 128 cases of dental pathology identified by teledentistry, 6 (4.8%) were false positives. The teledentistry assessments were quicker than the face-to-to-face examinations (12 and 20 minutes, respectively).Conclusions
Teledentistry showed excellent accuracy for diagnosing dental pathology in older adults living in nursing homes; its use may allow more regular checkups to be carried out by dental professionals. 相似文献19.
Pavla Cermakova Karolina Szummer Kristina Johnell Johan Fastbom Bengt Winblad Maria Eriksdotter Dorota Religa 《Journal of the American Medical Directors Association》2017,18(1):19-23