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1.
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2.
Margot Darragh Ho Seok Ahn Bruce MacDonald Amy Liang Kathryn Peri Ngaire Kerse Elizabeth Broadbent 《Journal of the American Medical Directors Association》2017,18(12):1099.e1-1099.e4
Objectives
This scoping study is the first step of a multiphase, international project aimed at designing a homecare robot that can provide functional support, track physical and psychological well-being, and deliver therapeutic intervention specifically for individuals with mild cognitive impairment.Design
Observational requirements gathering study.Participants and settings
Semistructured interviews were conducted with 3 participant groups: (1) individuals with memory challenges, mild cognitive impairment (MCI), or mild dementia (patients; n = 9); (2) carers of those with MCI or dementia (carers; n = 8); and (3) those with expertise in MCI or dementia research, clinical care, or management (experts; n = 16). Interviews took place at the university, at dementia care facilities or other workplaces, at participant's homes, or via skype (experts only).Measurements
Semistructured interviews were conducted, transcribed, and reviewed.Results
Several key themes were identified within the 4 topics of: (1) daily challenges, (2) safety and security, (3) monitoring health and well-being, and (4) therapeutic intervention.Conclusions
A homecare robot could provide both practical and therapeutic benefit for the mildly cognitively impaired with 2 broad programs providing routine and reassurance; and tracking health and well-being. The next phase of the project aims to program homecare robots with scenarios developed from these results, integrate components from project partners, and then test the feasibility, utility, and acceptability of the homecare robot. 相似文献3.
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4.
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5.
Veerle Decalf Anja Huion Marie-Astrid Denys Candy Kumps Mirko Petrovic Karel Everaert 《Journal of the American Medical Directors Association》2017,18(5):433-437
Background
Despite the conflicting evidence about postvoid residual (PVR) and its variation in time and corresponding voided volume (VV), studies with urinary diaries and systematic measurements of PVR after each void have never been conducted in nursing home (NH) residents.Objective
To describe the circadian rhythm of PVR and residual fraction (RF, the net quantity of PVR) and to identify the time window with the highest PVR and RF.Design, setting, and participants
A multicentre prospective study conducted between 2014 and 2015 in 5 Belgian NHs. A convenience sample of cognitively intact residents completed a 24-hour frequency volume chart with PVR.Results
Participants (n = 73) had a median age of 84 years (interquartile range 82-89) and moderate impairment of activities of daily living; 69% were women.In residents with nocturia, mean PVR was higher during the night [45 mL (26–80)] than during the day [36 mL (18–61)]. In residents without nocturia no difference was detected.In spite of the variation between diurnal and nocturnal VV and PVR in residents with nocturia, all residents emptied their bladder as effectively during daytime as during nighttime [mean RF = 20% (12–32)].Maximum PVR and RF in residents with nocturia (n = 57) showed a circadian variation. The highest PVR and RF were found during the day. The PVR and RF of the first morning void were an indicator of the maximum nocturnal PVR and RF.Conclusions
PVR and VV should be measured in NH residents during the waking hours (first morning void excepted) to detect the clinically relevant maximum PVR and RF. 相似文献6.
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7.
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8.
Anto P. Rajkumar Clive Ballard Jane Fossey Martin Orrell Esme Moniz-Cook Robert T. Woods Joanna Murray Rhiannon Whitaker Jane Stafford Martin Knapp Renee Romeo Barbara Woodward-Carlton Zunera Khan Ingelin Testad Anne Corbett 《Journal of the American Medical Directors Association》2017,18(5):453.e1-453.e6
9.
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10.
Carlos Ayán-Pérez R. Iván Martínez-Lemos José M. Cancela-Carral 《Disability and health journal》2017,10(1):105-113
Background
There is limited evidence about the psychometric properties of field tests to measure cardiorespiratory fitness in people with Down syndrome.Objective
This study aimed at analyzing the reliability and convergent validity of the 6-min run test when performed by young adults with Down syndrome (DS).Methods
In a cross-sectional design fifty-one young adults with DS (mean age 26.20 ± 7.14 years; 54% women) performed the 6-min run test and the 16-min shuttle run test twice with a one week-interval between test and retest.Results
The 6-min run test offered high reliability for the distances covered (ICC: 0.974; 95% CI: 0.955–0.985) and good reliability when comparing peak heart rate values obtained in the test and retest (ICC: 0.870; 95% CI: 0.772–0.926). A significant correlation between the 6-min run test and the 16-min shuttle run test was observed for the test (r = 0.705; Sig = 0.001), and retest phases (r = 0.651; Sig = 0.001). The relationship between the estimated maximal oxygen consumption (VO2 max) peak after the performance of the 16-min shuttle run test and the distance covered by the 6-min run test was statistically significant (r > 0.7). No significant differences were found between the equations that estimate VO2 peak for both tests.Conclusions
These findings suggest that the 6-min run test shows high test/retest reliability and moderate to moderately high convergent validity when performed by adults with DS. 相似文献11.
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12.
Darren M. Lipnicki John Crawford Nicole A. Kochan Julian N. Trollor Brian Draper Simone Reppermund Kate Maston Karen A. Mather Henry Brodaty Perminder S. Sachdev 《Journal of the American Medical Directors Association》2017,18(5):388-395
Background
The nature and commonality of late-life risk factors for mild cognitive impairment (MCI), dementia, and mortality remain unclear. Our aim was to investigate potential risk factors, simultaneously in a single cohort including many individuals initially with normal cognition and followed for 6 years.Methods
We classified 873 community-dwelling individuals (70–90 years old and without dementia at baseline) from the Sydney Memory and Ageing Study as cognitively normal (CN), having MCI or dementia, or deceased 6 years after baseline. Associations with baseline demographic, lifestyle, health, and medical factors were investigated, including apolipoprotein (APOE) genotype, MCI at baseline, and reversion from MCI to CN within 2 years of baseline.Results
Eighty-three (9.5%) participants developed dementia and 114 (13%) died within 6 years; nearly 33% had MCI at baseline, of whom 28% reverted to CN within 2 years. A core set of baseline factors was associated with MCI and dementia at 6 years, including older age (per year: odds ratios and 95% confidence intervals = 1.08, 1.01–1.14 for MCI; 1.19, 1.09–1.31 for dementia), MCI at baseline (5.75, 3.49–9.49; 8.23, 3.93–17.22), poorer smelling ability (per extra test point: 0.89, 0.79–1.02; 0.80, 0.68–0.94), slower walking speed (per second: 1.12, 1.00–1.25; 1.21, 1.05–1.39), and being an APOE ε4 carrier (1.84, 1.07–3.14; 3.63, 1.68–7.82). All except APOE genotype were also associated with mortality (age: 1.11, 1.03–1.20; MCI: 3.87, 1.97–7.59; smelling ability: 0.83, 0.70–0.97; walking speed: 1.18, 1.03–1.34). Compared with stable CN participants, individuals reverting from MCI to CN after 2 years were at greater risk of future MCI (3.06, 1.63–5.72). Those who reverted exhibited some different associations between baseline risk factors and 6-year outcomes than individuals with stable MCI.Conclusion
A core group of late-life risk factors indicative of physical and mental frailty are associated with each of dementia, MCI, and mortality after 6 years. Tests for slower walking speed and poorer smelling ability may help screen for cognitive decline. Individuals with normal cognition are at greater risk of future cognitive impairment if they have a history of MCI. 相似文献13.
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
Objectives
We aimed to (1) study factors that determine the use of invasive procedures in the management of acute myocardial infarction (AMI) in patients with dementia and (2) determine whether the use of invasive procedures was associated with their better survival.Design
Cohort study based on patients registered in the Swedish Dementia Registry (SveDem), 2007–2012. Median follow-up time was 228 days.Setting
Patients diagnosed with dementia in specialist memory clinics and primary care units in Sweden.Participants
A total of 525 patients with dementia who suffered AMI (mean age 89 years, 54% women).Measurements
Information on AMI and use of invasive procedures (coronary angiography and percutaneous coronary intervention) was obtained from Swedish national health registers. Binary logistic regression was applied to study associations of patients’ characteristics with the use of invasive procedures; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Survival was analyzed with Kaplan-Meier curves; log-rank test was used to compare survival of patients who received an invasive procedure versus those who did not receive it. Cox regression was applied to study association of the invasive procedures with all-cause mortality; hazard ratios (HRs) with 95% CIs were calculated.Results
One hundred ten patients (21%) with dementia received an invasive procedure in the management of AMI. After multivariate adjustment, lower age and higher global cognitive status were associated with the use of invasive procedures. The invasively managed patients survived longer (P = .001). The use of invasive procedures was associated with a lower risk of all-cause mortality, adjusting for type of AMI and dementia disorder, age, gender, registration unit, history of AMI and comorbidity score (HR 0.35, 95% CI 0.21–0.59), or total number of drugs (HR 0.34, 95% CI 0.20–0.58).Conclusion
Age and cognitive status determine the use of invasive procedures in patients with dementia. This study suggests that the invasive management of AMI has a benefit for survival of patients with dementia. 相似文献14.
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15.
Mary Adams 《Disability and health journal》2017,10(1):131-138
Background
Limited study has been done on proxy responses for non-respondents with subjective cognitive decline (SCD) on the Behavioral Risk Factor Surveillance System (BRFSS).Objective
To directly compare results for survey respondents with SCD with those for proxies provided for non-respondents with SCD.Methods
Publicly available 2011 BRFSS data from 120,485 households in 21 states were analyzed using Stata. Respondents ages 40 and older with SCD (n = 10,831) were compared with proxy responses for non-respondents ages 40 and older with SCD (n = 4296) living in households where the respondent did not have SCD. Outcome measures included functional difficulties associated with their SCD, needing help, receiving informal care, talking with a healthcare provider about their SCD, getting treatment, and having a dementia diagnosis. Logistic regression for each outcome controlled for age, household income, state of residence, and number of household adults.Results
Non-respondents were significantly more likely than respondents by Pearson chi square tests with alpha = 0.05 to report all 6 outcomes. Adjusted odds ratios comparing non-respondents with respondents ranged from 2.61 (95% confidence interval: 2.22–3.07) for needing help, to 8.99 (6.60–12.24) for a dementia diagnosis and confirmed unadjusted results.Conclusion
Respondent results only represent adults capable of answering a telephone survey. To represent all household adults and avoid nonresponse bias that may under-represent the true population parameters by as much as 70%, results must include both respondents and non-respondents. Other measures may be similarly affected if they inhibit one's ability to respond to a telephone survey (e.g. disability, stroke). 相似文献16.
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17.
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18.
Abebaw M. Yohannes W. Chen Ana M. Moga I. Leroi Martin J. Connolly 《Journal of the American Medical Directors Association》2017,18(5):451.e1-451.e11
Background
Cognitive impairment is common in people living with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF); however, accurate estimates of prevalence are lacking. To date, there are no meta-analyses that have specifically investigated prevalence of mild cognitive impairment (MCI) in this particular population. Our aim was to undertake a systematic review and apply meta-analytic methods to estimate the prevalence of MCI and any cognitive impairment (ACI) in people with COPD and CHF.Methods
We identified relevant studies for COPD and CHF by searching the published literature from inception to February 2016 using the MEDLINE and Web of Science databases. Studies were included if they documented the prevalence of MCI and/or cognitive impairment for COPD and CHF patients without dementia.Results
Seventeen studies including people with CHF (n = 29,456) and 14 studies including people with COPD (n = 23,116) were included. The pooled mean age for COPD was 66.3 years and for CHF, 75.6 years. The pooled prevalence of MCI in the COPD was 25% (95% CI: 23%, 42%) and ACI, 32% (95% CI: 18%, 38%). Correspondingly, the pooled prevalence of MCI in those with CHF was 32% (95% CI: 22%, 43%) and ACI, 31% (95% CI: 23%, 40%).Conclusions
One in 4 people with COPD and 1 in 3 people with CHF had MCI, respectively. The overall prevalence of ACI for COPD was 32% and for CHF, 31%. Future work should consider ways of detecting, managing, or improving cognitive function and other cognition-related outcomes in this group of people. 相似文献19.
Eyal Y. Kimchi Tammy T. Hshieh Ray Guo Bonnie Wong Margaret O&#x;Connor Edward R. Marcantonio Eran D. Metzger Jason Strauss Steven E. Arnold Sharon K. Inouye Tamara G. Fong 《Journal of the American Medical Directors Association》2017,18(12):1010-1018.e1
Objectives
To survey the current methods used to ascertain dementia and mild cognitive impairment (MCI) in longitudinal cohort studies, to categorize differences in approaches and to identify key components of expert panel methodology in current use.Methods
We searched PubMed for the past 10 years, from March 6, 2007 to March 6, 2017 using a combination of controlled vocabulary and keyword terms to identify expert panel consensus methods used to diagnose MCI or dementia in large cohort studies written in English. From these results, we identified a framework for reporting standards and describe as an exemplar the clinical consensus procedure used in an ongoing study of elective surgery patients (the Successful Aging after Elective Surgery study).Results
Thirty-one articles representing unique cohorts were included. Among published methods, membership of experts panel varied significantly. There was more similarity in what types of information was use to ascertain disease status. However, information describing the diagnostic decision process and resolution of disagreements was often lacking.Conclusions
Methods used for expert panel diagnosis of MCI and dementia in large cohort studies are widely variable, and there is a need for more standardized reporting of these approaches. By describing the procedure in which our expert panel achieved consensus diagnoses, we hope to encourage the development and publication of well-founded and reproducible methods for diagnosis of MCI and dementia in longitudinal studies. 相似文献20.
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