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1.
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2.
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3.
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4.
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5.
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6.
Simone Reppermund Rachael C. Birch John D. Crawford Jacqueline Wesson Brian Draper Nicole A. Kochan Julian N. Trollor Katharina Luttenberger Henry Brodaty Perminder S. Sachdev 《Journal of the American Medical Directors Association》2017,18(2):117-122
Objectives
The distinction between dementia and mild cognitive impairment (MCI) relies upon the evaluation of independence in instrumental activities of daily living (IADL). Self- and informant reports are prone to bias. Clinician-based performance tests are limited by long administration times, restricted access, or inadequate validation. To close this gap, we developed and validated a performance-based measure of IADL, the Sydney Test of Activities of Daily Living in Memory Disorders (STAM).Design
Prospective cohort study (Sydney Memory and Ageing Study).Setting
Eastern Suburbs, Sydney, Australia.Participants
554 community-dwelling individuals (54% female) aged 76 and older with normal cognition, MCI, or dementia.Measurements
Activities of daily living were assessed with the STAM, administered by trained psychologists, and the informant-based Bayer-Activities of Daily Living Scale (B-ADL). Depressive symptoms were measured with the Geriatric Depression Scale (15-item version). Cognitive function was assessed with a comprehensive neuropsychological test battery. Consensus diagnoses of MCI and dementia were made independently of STAM scores.Results
The STAM showed high interrater reliability (r = 0.854) and test-retest reliability (r = 0.832). It discriminated significantly between the diagnostic groups of normal cognition, MCI, and dementia with areas under the curves ranging from 0.723 to 0.948. A score of 26.5 discriminated between dementia and nondementia with a sensitivity of 0.831 and a specificity of 0.864. Correlations were low with education (r = 0.230) and depressive symptoms (r = ?0.179), moderate with the B-ADL (r = ?0.332), and high with cognition (ranging from r = 0.511 to r = 0.594). The mean time to complete the STAM was 16 minutes.Conclusions
The STAM has good psychometric properties. It can be used to differentiate between normal cognition, MCI, and dementia and can be a helpful tool for diagnostic classification both in clinical practice and research. 相似文献7.
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8.
Ivan Aprahamian Sumika Mori Lin Claudia Kimie Suemoto Daniel Apolinario Natália Oiring de Castro Cezar Serpui Marie Elmadjian Wilson Jacob Filho Mônica Sanches Yassuda 《Journal of the American Medical Directors Association》2017,18(4):367.e11-367.e18
Objectives
The aim of the present study was to (1) evaluate a geriatric outpatient sample with the FRAIL scale; (2) investigate the psychometric properties of the scale; and (3) characterize different associations of the subdimensions of the scale with demographic and clinical data.Design
Cross-sectional observational study.Setting
Geriatric outpatient center a university-based hospital in São Paulo, Brazil.Participants
A total of 811 men and women aged 60 years or older evaluated between March 2015 and September 2015.Measurements
A translated version of the FRAIL scale was used to evaluate frailty. A review of sociodemographic data, medical records, medication, and laboratory data was conducted. A multivariate ordinal logistic regression model was used to investigate the association between frailty categories and clinical variables. Exploratory factor analysis and 2-parameter logistic item response theory was used to evaluate the psychometric properties of the FRAIL scale.Results
The sample was distributed as 13.6% robust, 48.7% prefrail, and 37.7% frail older adults. Most participants reported fatigue (72.3%). Frailty was associated with older age (P = .02), depression (P = .02), dementia (P < .001), and number of medications taken (P < .001). A 2-factor model of the FRAIL scale (“ambulation” and “resistance” namely physical performance; “fatigue,” “weight loss,” and “illnesses” namely health status) provided independent classifications of frailty status. Physical performance (ambulation and resistance) was strongly associated with higher age and dementia, whereas health status (fatigue, weight loss, and illnesses) was more associated with female sex and depression.Conclusions
Our results suggest the existence of 2 subdimensions of the scale, suggesting different pathways to frailty. Frailty was associated with older age, depression, dementia, and number of medications in this outpatient sample. 相似文献9.
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10.
Ryan McGrath Brenda M. Vincent Soham Al Snih Kyriakos S. Markides Mark D. Peterson 《Journal of the American Medical Directors Association》2017,18(5):452.e7-452.e12
Objectives
A natural decline of muscle strength occurs during the aging process; however, preserving muscle strength may lower the rate of many preventable diseases such as diabetes, especially in higher risk populations. The purpose of this study was to examine the sex-specific association between muscle weakness and incident diabetes in older Mexican Americans.Design
Observational, longitudinal study.Setting
Urban and rural households in the Southwestern United States.Participants
A subsample of 1903 Mexican Americans aged at least 65 years without diabetes at baseline were followed for 19 years.Measurements
Muscle weakness was assessed with a hand-held dynamometer and was normalized to body weight (normalized grip strength). Male and female participants were categorized as weak if their normalized grip strength was ≤0.46 and ≤0.30, respectively. Sex-stratified Cox proportional hazard regression models were used to determine the association between muscle weakness and incident diabetes (self-reported) when using age as an entry variable and after adjusting for education, employment status, instrumental activities of daily living disability, interview language, marital status, and obesity. A sensitivity analysis was performed to account for influential outliers for the outcome variable (incident diabetes) and the model was re-run.Results
The hazard ratio for incident diabetes was 1.05 (95% confidence interval: 1.02–1.09; P < .001) in weak vs not-weak male participants and 1.38 (95% confidence interval: 1.35–1.41; P < .001) in weak vs not-weak female participants, after adjusting for relevant covariates.Conclusions
Muscle weakness was associated with an increased rate of diabetes in older male and female Mexican Americans. Health professionals should encourage activities that preserve muscle strength, thereby preventing the incidence of diabetes in older Mexican Americans. 相似文献11.
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.12.
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13.
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14.
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15.
Susanne C. de Ruiter Jos F.M. de Jonghe Tjeerd Germans Jaap H. Ruiter René W.M.M. Jansen 《Journal of the American Medical Directors Association》2017,18(5):409-413
Objectives
To evaluate the prevalence of cognitive impairment (CI), including mild CI and dementia, in elderly patients with syncope and unexplained falls. In this population, we compared the use of the Mini-Mental State Examination (MMSE) with a cognitive screening test that assesses executive dysfunction typical of subcortical (vascular) CI, that is, the Montreal Cognitive Assessment (MoCA).Design
Observational cohort study.Setting
Outpatient fall and syncope clinic.Participants
Consecutive patients aged ≥65 years with syncope and unexplained falls without loss of consciousness.Measurements
Baseline characteristics, functional status, MMSE, MoCA, and magnetic resonance imaging scans of the brain. Main outcome: prevalence of CI, comparing the MMSE with the MoCA. CI was defined as an MMSE/MoCA score <26. Secondary outcomes: MMSE/MoCA overall and subdomain scores, Fazekas and medial temporal lobe atrophy scores.Results
We included 200 patients, mean age 79.5 (standard deviation 6.6) years (Syncope Group: n = 101; Fall Group: n = 99). Prevalence of CI was 16.8% (MMSE) versus 60.4% (MoCA) in the Syncope Group (P < .001) and 16.8% (MMSE) versus 56.6% (MoCA) in the Fall Group (P < .001). Prevalence of CI did not differ between the Syncope Group and Fall Group with either method. Executive dysfunction was present in both groups.Conclusion
CI is as common in elderly patients with syncope as it is in patients with unexplained falls, with an overall prevalence of 58%. The MMSE fails as a screening instrument for CI in these patients, because it does not assess executive function. Therefore, we recommend the MoCA for cognitive screening in older patients with syncope and unexplained falls. 相似文献16.
Bram de Boer Jan P.H. Hamers Sandra M.G. Zwakhalen Frans E.S. Tan Hanneke C. Beerens Hilde Verbeek 《Journal of the American Medical Directors Association》2017,18(1):40-46
Objectives
Innovative care environments are developed for people with dementia to encourage person-centered care. This study aims to investigate whether residents of green care farms that provide 24-hour nursing care participate more in (physical) activities and social interaction compared with residents of other nursing homes.Design
Longitudinal observation study.Setting
Nursing homes in the Netherlands (green care farms, traditional nursing homes, and regular small-scale living facilities).Participants
A total of 115 nursing home residents at baseline, 100 at follow-up.Measurements
Ecological momentary assessments (n = 16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool. Residents living at green care farms were compared with residents living in traditional nursing homes and regular small-scale living facilities. The following aspects were collected for this study: the activity performed by the participant or occurring in his or her vicinity, the engagement in the activity, the level of physical activity during the activity, the physical environment (location where the activity occurred), and the level of social interaction during the activity.Results
In total, 9660 baseline observations and 7200 follow-up observations were conducted. Analyses showed that residents of green care farms significantly more often participated in domestic activities (P = .004, SE = 1.6) and outdoor/nature-related activities (P = .003, SE = 0.9), and significantly less often engaged in passive/purposeless activities (P < .001, SE = 1.7) compared with residents of traditional nursing homes. Furthermore, residents of green care farms had significantly more active engagement (P = .014, SE = 0.9), more social interaction (P = .006, SE = 1.1), and came outside significantly more (P = .010, SE = 1.1) than residents of traditional nursing homes. Residents of green care farms were significantly more physically active (P = .013, SE = 0.8) than were residents of regular small-scale living facilities. No other significant differences were found.Conclusion
Green care farms can be a valuable alternative to traditional nursing homes. They provide an attractive, homelike environment and activities that positively influence engagement and social interaction. Research is needed to study how successful elements of green care farms can be implemented in existing nursing homes. 相似文献17.
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18.
Wei-Syun Hu Cheng-Li Lin 《Journal of epidemiology / Japan Epidemiological Association》2017,27(12):574-577
Background
This study was conducted to evaluate the association between hemorrhoid and risk of incident peripheral artery occlusive disease (PAOD).Methods
Using the Taiwanese Longitudinal Health Insurance Database 2000, we compared the incident PAOD risk between the hemorrhoid and the non-hemorrhoid cohorts. Both of these cohorts were followed up from the index date until the date of PAOD diagnosis, withdrawal from the National Health Insurance program, or the end of 2011.Results
The mean follow-up period was 6.82 (standard deviation [SD], 3.22) and 6.70 (SD, 3.23) years in the hemorrhoid and non-hemorrhoid cohorts, respectively. The plot of the Kaplan–Meier analysis showed that, by the end of the 12-year follow-up period, the cumulative incidence of PAOD was significantly higher for the hemorrhoid cohort than for the non-hemorrhoid cohort (log-rank test: P < 0.001).Conclusions
A significantly increased PAOD risk in patients with hemorrhoids was found in this nationwide cohort study. 相似文献19.
Amy Liang Isabell Piroth Hayley Robinson Bruce MacDonald Mark Fisher Urs M. Nater Nadine Skoluda Elizabeth Broadbent 《Journal of the American Medical Directors Association》2017,18(10):871-878
Objectives
To investigate the affective, social, behavioral, and physiological effects of the companion robot Paro for people with dementia in both a day care center and a home setting.Design
A pilot block randomized controlled trial over 12 weeks. Participants were randomized to the intervention (Paro) or control condition (standard care).Setting
Two dementia day care centers and participants’ homes in Auckland, New Zealand.Participants
Thirty dyads (consisting of a care recipient with dementia and their caregiver) took part in this study. All care recipients attended dementia day care centers at Selwyn Foundation and had a formal diagnosis of dementia.Intervention
Thirty-minute unstructured group sessions with Paro at the day care center were run 2 to 3 times a week for 6 weeks. Participants also had Paro at home for 6 weeks.Measurements
At the day care centers, observations of the care recipients’ behavior, affect, and social responses were recorded using a time sampling method. Observations of interactions with Paro for participants in the intervention were also recorded. Blood pressure and salivary cortisol were collected from care recipients before and after sessions at day care. In the home setting, level of cognition, depressive symptoms, neuropsychiatric symptoms, behavioral agitation, and blood pressure were measured at baseline, 6 weeks, and 12 weeks. Hair cortisol measures were collected at baseline and at 6 weeks.Results
Observations showed that Paro significantly improved facial expressions (affect) and communication with staff (social interaction) at the day care centers. Subanalyses showed that care recipients with less cognitive impairment responded significantly better to Paro. There were no significant differences in care recipient dementia symptoms, nor physiological measures between the intervention and control group.Conclusion
Paro shows promise in enhancing affective and social outcomes for certain individuals with dementia in a community context. Larger randomized controlled trials in community settings, with longer time frames, are needed to further specify the contexts and characteristics for which Paro is most beneficial. 相似文献20.
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