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1.

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   

2.

Objectives

Pulmonary rehabilitation enhances health status and mood status in patients with chronic obstructive pulmonary disease (COPD). The aim was to determine the responsiveness of St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), COPD Clinical Questionnaire (CCQ), and Hospital Anxiety and Depression Scale (HADS) to pulmonary rehabilitation in patients with COPD, and estimate minimum clinically important differences (MCIDs) for CAT, CCQ, and HADS.

Design

A prospective analysis. MCIDs were estimated with anchor-based (anchor: SGRQ) and distribution-based methods. Newly estimated MCIDs were compared to known MCID estimates from a systematic literature search.

Setting

Newly estimated MCIDs were calculated in patients treated in pulmonary rehabilitation.

Participants

A subsample of 419 individuals with COPD (55.4% male, mean age 64.3 ± 8.8 years) were included from the Chance study.

Measurements

Health status was measured with SGRQ, CAT, and CCQ, before and after pulmonary rehabilitation. Mood status was assessed using HADS.

Results

419 patients with COPD (forced expiratory volume in the first second 37.3% ± 12.1% predicted) completed pulmonary rehabilitation. SGRQ (?9.1 ± 14.0 points), CAT (?3.0 ± 6.8 points), CCQ (?0.6 ± 0.9 points), HADS-Anxiety (?1.7 ± 3.7 points), and HADS-Depression (?2.1 ± 3.7 points) improved significantly. New MCIDs were estimated for CAT (range: ?3.8 to ?1.0 points), CCQ (range: ?0.8 to ?0.2 points), HADS-Anxiety (range: ?2.0 to ?1.1 points), and HADS-Depression (range: ?1.8 to ?1.4 points).

Conclusions

The SGRQ, CAT, CCQ, and HADS are responsive to pulmonary rehabilitation in patients with COPD. We propose MCID estimates ranging between ?3.0 and ?2.0 points for CAT; ?0.5 and ?0.3 points for CCQ, ?1.8 and ?1.3 points for HADS-Anxiety, and ?1.7 and ?1.5 points for HADS-Depression.  相似文献   

3.

Introduction

The burden of chronic obstructive pulmonary disease (COPD) in post-acute/long-term care (PA/LTC) settings is high, and many patients do not receive guideline-recommended care.

Methods

An interprofessional expert panel of PA/LTC professionals convened to discuss the unmet medical needs in patients with COPD in PA/LTC settings, and to make recommendations for the assessment of COPD patients to individualize the selection of maintenance treatment.

Results

Unmet needs observed in patients with COPD are described in addition to new tools for assessing individual patient abilities and appropriate device selection for maintenance treatment.

Conclusion

COPD management in PA/LTC settings needs to be reevaluated and updated to help reduce exacerbations, hospitalizations, and readmissions.  相似文献   

4.

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   

5.

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.

Clinical Trial Registration

www.germanctr.de German Trial Register DRKS 00004728  相似文献   

6.

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   

7.

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.

Objectives

Persons with osteoporotic fracture history are subject to an increased risk for subsequent fractures and mortality. The aim of this retrospective study was to investigate the impact of a previous osteoporotic low-impact (fragility) index fracture (eg, forearm, lower leg) on mortality of a subsequent femoral fracture.

Design

Retrospective cohort study.

Participants/measurements

Claims data of a German health insurance agency including >1.2 million insurants aged 65 years or older and observed between 2004 and 2009.

Methods

A multistate model was developed handling index fractures and care need as time-dependent exposures, while age was chosen as the underlying time scale. Excess risks were expressed as differences in cause-specific hazards. Nelson-Aalen estimates were used for their nonparametric estimation. Time-simultaneous statistical inference was based on confidence bands provided by wild bootstrap resampling.

Results

Excess femoral fracture risk increased with progressive age and was highest in persons with care need. It was observed starting from an age of 79 years in women and 85 years in men onward. A prior index fracture increased mortality after a femoral fracture by increasing femoral fracture risk, while leaving the hazard of death after a subsequent femoral fracture unchanged.

Conclusions

The results indicated that increased mortality of a subsequent femoral fracture is not triggered by an intrinsically increased mortality hazard but an increased femoral fracture incidence.  相似文献   

9.

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.

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   

11.

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   

12.

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   

13.

Objectives

To investigate the association between benzodiazepine and related drug (BZDR) use and hip fracture as well as postfracture mortality and duration of hospital stay in community-dwellers with and without Alzheimer disease (AD).

Design

Retrospective cohort study.

Setting

The register-based Medication Use and Alzheimer's disease (MEDALZ) study, including all community-dwelling persons diagnosed with AD in Finland during 2005–2011 (n = 70,718) and their matched comparison persons without AD.

Participants

Persons without BZDR use during the year preceding the AD diagnosis or the corresponding matching date as well as persons without history of hip fracture were included in this study.

Measurements

We investigated the risk of hip fracture associated with BZDR use compared with nonuse separately in persons with and without AD. Further, we investigated the association between BZDR use during hip fracture and 1-year mortality as well as longer than a 4-month hospital stay after hip fracture. Associations were reported as hazard ratios and odds ratios with 95% confidence intervals (CI).

Results

BZDR use was associated with an increased risk of hip fracture in persons with and without AD (adjusted hazard ratio 1.4 [95% CI 1.2–1.7] and 1.6 [95% CI 1.3–1.9], respectively). BZDR use during hip fracture was associated with longer than 4-month postfracture hospital stay in persons with AD [adjusted odds ratio 1.9 (95% CI 1.3–2.8)] but not in comparison persons. One-year mortality was not associated with BZDR use during hip fracture.

Conclusions

Higher threshold in prescribing BZDRs for neuropsychiatric symptoms might decrease the hip fracture rate and affect the length of hospital stay in persons with AD.  相似文献   

14.

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   

15.

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   

16.

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.

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   

18.

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   

19.

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   

20.

Background

Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.

Methods

After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.

Main outcomes

Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.

Findings

A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.

Conclusions

The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed.  相似文献   

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