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1.
Background
While obesity can be an antecedent of disability and the prevalence of disabilities in increased in individuals with obesity, it has been highly debated whether obesity itself should be considered a disability. The European Court of justice has set a precedent in 2014, ruling that severe forms of obesity qualify for protection under the disability protection legislation. However, attitudes and opinions of those affected have not been investigated yet.Objective
To study attitudes of people with obesity regarding the acknowledgment of obesity as a disability.Methods
Cross-sectional analysis of a population-based study from Germany, conducted in 2015, in n = 1000 individuals with obesity.Results
We find that 38.2% of all respondents agreed that obesity ought to be considered a disability. In logistic regression analyses, heavier participants expressed a higher support of obesity seen as a disability, regardless of perceived discrimination experiences (ΔOR = 1.54, p = 0.427). Experiences of perceived discrimination were associated with a higher approval of obesity as a disability in individuals with class II obesity (OR = 2.07, p = 0.002) compared to respondents with less severe obesity.Conclusion
These findings go in line with the European Court of Justice's ruling, where it is stated that only severe forms of obesity qualify for protection under the disability legislation. The results underline the importance of considering adding weight to anti-discrimination legislation. 相似文献2.
Iván De-Rosende Celeiro Sergio Santos-del-Riego Javier Muñiz García 《Disability and health journal》2017,10(1):145-151
Background
Homebound status is associated with poor health, comorbidity, and mortality and represents a major challenge for health systems. However, its prevalence among people with disabilities in the basic activities of daily living (ADLs) is unknown.Objectives
The objectives were to: (1) examine the prevalence of the homebound status among middle-aged and older adults with disabilities in ADLs, and (2) identify its clinical, functional, and environmental determinants.Methods
This study included 221 community-dwelling subjects, aged ≥50 years, who applied for long-term care services at the Office for Legal Certification of Long-term Care Need of Coruña (Spain). Each subject had a disability in ADLs and was interviewed by a trained examiner in the subject's home. The participants were considered homebound if they remained inside their home during the previous week.Measures
Demographic, clinical, functional, and environmental factors. Multiple logistic regression was used to determine the factors associated with homebound status.Results
The prevalence of homebound status was 39.8%. A multivariate analysis revealed that the presence of architectural barriers at the home entrance (stairs [OR: 6.67, p < 0.001] or a heavy door [OR: 2.83, p = 0.023]), walking ability limitations (OR: 3.26, p = 0.006), and higher age (OR: 1.05, p = 0.04) were associated with homebound status.Conclusions
Homebound status is a highly prevalent problem among middle-aged and older adults with disabilities in ADLs. Architectural factors in the home and walking ability limitations seem to be important predictors, suggesting that health care interventions should target home adaptations and mobility skills as a means to preventing or decreasing homebound status. 相似文献3.
Background
Previous literature suggests that individuals with disabilities have increased rates of obesity and decreased participation in physical activity contributing to overall higher incidence of secondary health conditions compared to the general population without disabilities.Objective/hypothesis
The purpose of this research study was to examine the differences in physical activity rates for college students with Attention Deficit Hyperactivity Disorder (ADHD) and Learning Disabilities (LD).Methods
A secondary analysis was utilized to examine differences in physical activity rates based on disability, gender, and factors influencing participation in physical activity. The 2011 Fall National College Health Assessment was used as the reference group with a sample of 27,774 students. Multiple independent samples t-tests were utilized in this research.Results
The results of this study indicated that physical activity for college students with disabilities does not have significant variations compared to those without disabilities. However, gender influences participation in physical activity for this population.Conclusions
This research helps in narrowing the research gap in this topic through analysis of the college population with ADHD and LD. This paper concludes with implications that could benefit the health status of this population. 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.
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6.
Lucas Morin Davide L. Vetrano Giulia Grande Laura Fratiglioni Johan Fastbom Kristina Johnell 《Journal of the American Medical Directors Association》2017,18(6):551.e1-551.e7
Objectives
To investigate the prevalence and factors associated with the use of medications of questionable benefit throughout the final year of life of older adults who died with dementia.Design
Register-based, longitudinal cohort study.Setting
Entire Sweden.Participants
All older adults (≥75 years) who died with dementia between 2007 and 2013 (n = 120,067).Measurements
Exposure to medications of questionable benefit was calculated for each of the last 12 months before death, based on longitudinal data from the Swedish Prescribed Drug Register.Results
The proportion of older adults with dementia who received at least 1 medication of questionable benefit decreased from 38.6% 12 months before death to 34.7% during the final month before death (P < .001 for trend). Among older adults with dementia who used at least 1 medication of questionable benefit 12 months before death, 74.8% remained exposed until their last month of life. Living in an institution was independently associated with a 15% reduction of the likelihood to receive ≥1 medication of questionable benefit during the last month before death (odds ratio 0.85, 95% confidence interval 0.88–0.83). Antidementia drugs accounted for one-fifth of the total number of medications of questionable benefit. Lipid-lowering agents were used by 8.3% of individuals during their final month of life (10.2% of community-dwellers and 6.6% of institutionalized people, P < .001).Conclusion
Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of medications of questionable benefit near the end of life. 相似文献7.
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8.
9.
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10.
Kayoko Ichikawa Takeo Fujiwara Ichiro Kawachi 《Journal of epidemiology / Japan Epidemiological Association》2017,27(8):368-372
Background
Previous studies suggest that neighborhood social capital is associated with children's mental health. The purpose of this study was to examine the association between neighborhood collective efficacy and children's psychosocial development.Methods
We used data on children and their parents (n = 918) who were part of the Japanese study of Stratification, Health, Income, and Neighborhood (JSHINE) from 2010 to 2013 (wave 1 and wave 2). Households were recruited from the Tokyo metropolitan area through clustered random sampling. Changes in children's psychosocial development (assessed using a child behavioral checklist) between waves 1 and 2 were regressed on parents' perceptions of changes in neighborhood collective efficacy (social cohesion and informal social control).Results
Change in perception of neighborhood social cohesion was inversely associated with change in child total problems (β = ?0.22; 95% confidence interval [CI]: ?0.37 to ?0.001; effect size d = ?0.03). Change in perceptions of neighborhood informal social control was inversely associated with change in children's externalizing problems (β = ?0.16; 95% CI: ?0.30 to ?0.03; d = ?0.02).Conclusions
The results of these fixed-effects models suggest that strengthening neighborhood collective efficacy is related to improvements in child psychosocial development. 相似文献11.
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12.
Canan Ziylan Annemien Haveman-Nies Stefanie Kremer Lisette C.P.G.M. de Groot 《Journal of the American Medical Directors Association》2017,18(2):145-151
Objectives
Sufficient protein intake can decrease undernutrition risk among community-dwelling older adults. This study aimed to increase community-dwelling older adults' daily protein intake with acceptable and applicable protein-enriched bread and readymade meals at home.Design
Double-blind randomized controlled trial of 2 weeks.Setting
Senior residential center in the Netherlands.Participants
Forty-two community-dwelling elderly residents (≥65 years) participated, with a mean age of 74.0 ± 6.9 years and mean body mass index of 28.5 ± 3.45 kg/m2.Intervention
The intervention group (n = 22) received 5 protein-enriched readymade meals and plentiful protein-enriched bread during 2 weeks, whereas the control group (n = 20) received the regular equivalents during these 2 weeks.Measurements
Food intake was assessed by using dietary food record-assisted 24-hour recalls and by weighing meal leftovers. Acceptability of the enriched products was assessed with product evaluation questionnaires and in-depth interviews.Results
Mean intake of food products (g) and energy (kJ) did not differ significantly between the control and the intervention groups. Total daily protein intake in the intervention group was 14.6 g higher than in the control group (87.7 vs 73.1 g/d, P = .004). Expressed in g/kg body weight per day, protein intake was significantly higher in the intervention group than in the control group (1.25 vs 0.99 g/kg/d, P = .003). The enriched products were equally liked, scoring 7.7 of 10.0. The in-depth interviews with participants indicated high acceptability of the enriched products.Conclusion
This study showed that community-dwelling older adults' protein intake can be increased to recommended levels with highly acceptable and applicable protein-enriched products that fit into the normal eating pattern. Future studies should investigate whether this effect is maintained in the long-term among a frailer population. 相似文献13.
Jennifer L. Carnahan James E. Slaven Christopher M. Callahan Wanzhu Tu Alexia M. Torke 《Journal of the American Medical Directors Association》2017,18(10):853-859
Background
Many adults are discharged to skilled nursing facilities (SNFs) prior to returning home from the hospital. Patient characteristics and factors that can help to prevent postdischarge adverse outcomes are poorly understood.Objective
To identify whether early post–SNF discharge care reduces likelihood of 30-day hospital readmissions.Design
Secondary data analysis using the Electronic Medical Record, Medicare, Medicaid and the Minimum Data Set.Participants/setting
Older (age > 65 years), community-dwelling adults admitted to a safety net hospital in the Midwest for 3 or more nights and discharged home after an SNF stay (n = 1543).Measurements
The primary outcome was hospital readmission within 30 days of SNF discharge. The primary independent variables were either a home health visit or an outpatient provider visit within a week of SNF discharge.Results
Out of 8754 community-dwelling, hospitalized older adults, 3025 (34.6%) were discharged to an SNF, of whom 1543 (51.0%) returned home. Among the SNF to home group, a home health visit within a week of SNF discharge was associated with reduced hazard of 30-day hospital readmission [adjusted hazard ratio (aHR) 0.61, P < .001] but outpatient provider visits were not associated with reduced risk of hospital readmission (aHR = 0.67, P = .821).Conclusion
For patients discharged from an SNF to home, the finding that a home health visit within a week of discharge is associated with reduced hazard of 30-day hospital readmissions suggests a potential avenue for intervention. 相似文献14.
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15.
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16.
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17.
Claudia K.Y. Lai Xiaojuan Wan 《Journal of the American Medical Directors Association》2017,18(6):509-514
Objectives
Studies reporting prompted voiding (PV) interventions were of short duration and were delivered by research personnel rather than nursing home staff. This study examined the effectiveness of the use of PV by nursing home staff in managing urinary incontinence among residents over a 6-month period.Design
A randomized controlled trial.Setting
Five nursing homes in Hong Kong.Participants
Data were collected from 52 nursing home residents who had been admitted to the facility for at least 6 months prior to the initiation of the study and whose incontinence had been stable over the 6-month period.Intervention
The PV intervention was delivered by the staff for 6 months. All nursing home staff were trained to ensure that they would be able to correctly deliver the intervention before initiating the intervention. The control group received the usual care.Measurements
Outcomes were defined in terms of wet episodes per day, incontinence rate per day, self-initiated toileting per day, and total continent toileting per day. Data were collected at baseline, 3 months postintervention (T1), and 6 months postintervention (T2).Results
There were significant differences between the two groups in wet episodes per day, incontinence rate per day, and total continent toileting per day at 6 months post-intervention, with positive results found in the intervention group. A decrease of 9.1% was observed in the incontinence rate of the intervention group.Conclusions
PV was shown to have positive effects, although the effects in this study were not as powerful as those found in overseas studies. The intervention delivered by staff was sustainable for a 6-month period. Nursing home operators should promote better continence care through PV, as it is a sustainable noninvasive behavioral intervention that can be mastered by staff with training. 相似文献18.
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19.
Shosuke Satake Hiroshi Shimokata Kazuyoshi Senda Izumi Kondo Kenji Toba 《Journal of the American Medical Directors Association》2017,18(6):552.e1-552.e6
Objectives
To validate the ability of the total Kihon checklist (t-KCL) score to predict the incidence of dependency or death within 3 years in a community-dwelling older population.Design
Population-based longitudinal observational study.Setting
Town of Higashi-ura, Japan.Participants
A total of 5542 independent seniors who were residents in the town of Higashi-ura.Measurements
The KCL questionnaire was sent to independent older residents. Based on our previous report, those with a t-KCL score of 0-3 were classified as robust, 4-7 as pre-frail, and 8 + as frail. The incidence of dependency or death was observed over 3 years. Dependency was defined as a new certification for long-term care insurance (LTCI) service need. Information regarding LTCI certification or death was obtained from the municipal government.Results
Of 8091 independent older adults, 5542 seniors completed the KCL questionnaire. Based on the t-KCL score, they were classified into 3 groups: 2962 (53.4%) as robust, 1625 (29.3%) as pre-frail, and 955 (17.2%) as frail. Over the 3 years, 510 seniors (9.2%) had new LTCI certifications and 170 (3.1%) died. Cox regression analysis adjusted for age and sex showed that the classification of frailty status by t-KCL score was significantly associated with the incidence of dependency both in the pre-frail and the frail [hazard ratios (HRs): 2.027 and 4.768; 95% confidence intervals (CIs): 1.575-2.608 and 3.733-6.089, respectively]. On the other hand, the ability to predict death was significant, but only in the frail group (HR: 2.830; 95% CI: 1.952-4.104).Conclusion
The classification of frailty status by t-KCL score could be a significant tool to predict the incidences of dependency and mortality in older adults. 相似文献20.
Tobias Bluhmki Raphael Simon Peter Kilian Rapp Hans-Helmut König Clemens Becker Ivonne Lindlbauer Dietrich Rothenbacher Jan Beyersmann Gisela Büchele 《Journal of the American Medical Directors Association》2017,18(3):221-226