Cost‐Effectiveness of Maintenance Hemodialysis in Japan

The cost‐effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were > 20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro‐QOL 5‐dimensions (EQ‐5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost‐effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9 ± 13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ‐5D score was 0.75 ± 0.21, and the estimated total medical cost for one year of MHD treatment was 4.52 ± 0.88 US$10 000. ICUR was 6.88 ± 4.47 US$10 000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17 ± 6.28 vs. 6.82 ± 4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P < 0.05, <65; P < 0.01, 65≤; not significant). MHD is a treatment that could improve the socioeconomic state of elderly patients with end‐stage kidney disease (ESKD), but the ICUR for diabetic nephropathy was higher than that for glomerulonephritis.     

Relationship between characteristics of skeletal muscle and oral function in community-dwelling older women

PurposeTo examine the relationship between oral function and sarcopenia staging, including dynapenia and presarcopenia, in community-dwelling older adults.MethodsA cross-sectional study was performed in community-dwelling older women aged 65 years and above. We measured oral muscle strength using maximum tongue pressure, oral muscle performance using oral diadochokinesis, and subjective swallowing difficulties using the Eating Assessment Tool. We measured skeletal muscle mass and function and other variables. All participants were divided into 4 groups (normal, presarcopenia, dynapenia, and sarcopenia) using an algorithm that operationally defines sarcopenia staging by skeletal muscle characteristics. A general linear model was used to analyze differences in oral function among the 4 groups.ResultsA total of 245 participants were enrolled (median age [IQR], 81.0 [75.0–85.0]). The proportion of normal participants and those with presarcopenia, dynapenia, and sarcopenia was 48.6% (n = 119), 9.4% (n = 23), 30.2% (n = 74), and 11.8% (n = 29), respectively. The sarcopenia and dynapenia groups had significantly lower maximum tongue pressure and oral diadochokinesis than the normal group. In the multivariate analysis, after adjusting for age, maximum tongue pressure and oral diadochokinesis were found to be significantly lower in the sarcopenia and dynapenia groups than in the normal group.ConclusionsIn this study, participants with sarcopenia and dynapenia showed low oral function, and similar trends were indicated for oral function and skeletal muscle according to progression of sarcopenia staging. Future research should clarify the characteristics of swallowing-related muscles, including muscle mass, strength, and performance at each sarcopenia stage.     

Effect of exercise on cognitive performance in community-dwelling older adults: review of intervention trials and recommendations for public health practice and research

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention-outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight-member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used.     

Components and determinants of quality of life in community-dwelling older adults

The objectives of this study are to detect the main components of global quality of life (QoL) of community-dwelling older adults from their own perspective and to identify determinants of health-related and global QoL in the same population. This is a cross-sectional study covering a representative sample of 1,106 community-dwelling adults aged 60 years and older residing in Spain. The survey collected information on QoL through a face-to-face interview asking for QoL components in free-format, as well as the completion of two QoL measures, the EQ-5D and the Personal Wellbeing Index. The most important QoL dimensions, according to the participants of this study, were health, family, and finances. Depression was the main determinant of both QoL indices, while functional independence and social support specifically influenced health-related and global QoL, respectively. Based on the perspective of the older adults as well as on statistical analysis, this work emphasizes the importance of health, family, and social support as areas of special interest in aging. There was a discrepancy when comparing findings related to the importance of financial status. Results also support that global and health-related QoL share some common determinants, but with different weights for functional independence and social support.     

Home care as an option in worsening chronic heart failure -- a pilot study to evaluate feasibility, quality adjusted life years and cost-effectiveness

BACKGROUND: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care. AIM: To evaluate the feasibility of home care (HC) versus conventional care (CC) in relation to health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. METHODS: Thirty-one patients seeking medical attention at hospital for worsening CHF were randomised to HC or CC. Following discharge within 48 hours from the hospital, patients in the HC group were followed-up in their homes by a specialist nurse. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. RESULTS: There was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months (p=0.05). CONCLUSION: Reduction in cost of care for selected patients with CHF eligible for hospital care might be achieved by early discharge from hospital followed by home visits. Due to the small number of patients, these results must be interpreted with caution.     

Improvement in quality of life among women and men aged 60 years and older following treatment for alcohol use disorder

Background

Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults.

Aims

In a clinical sample of older adults with DSM-5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow-ups. We also examined the effect of gender and explored interaction effects with gender on QoL.

Methods

We utilized data from the “Elderly Study,” a multi-national, single-blind, randomized, controlled trial of 693 adults aged 60+ with DSM-5 AUD. Alcohol use was assessed with the Form-90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4-, 12-, 26-, and 52-week follow-ups. Multilevel mixed-effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL.

Results

Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1-year follow-up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4–3.9), psychological health (β: 3.5, 95% CI: 3.3–3.8), social relationships (β: 4.0, 95% CI: 2.5–5.6), and environmental health (β: 1.4, 95% CI: 0.4–2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05).

Conclusions

Among 60+ year-old adults receiving treatment for DSM-5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender.     

Effect of physical activity at midlife on skeletal muscle mass in old age in community-dwelling older women: A cross-sectional study

Background/PurposeMeasures to prevent the development of muscle mass decline should be initiated from midlife. However, the impact of physical activity at midlife on muscle mass in old age remains uncertain. The aim of this cross-sectional study was to determine whether physical activity at midlife influences muscle mass and physical performance in old age.MethodsA total of 272 Japanese women aged 65 years and older were enrolled in the study. Information about physical activity levels at midlife and in old age were collected using a retrospective questionnaire. We calculated the skeletal muscle mass index in old age and recorded the participants' walking speed and hand grip strength in old age. We then classified the participants into four groups according to their physical activity levels at midlife and in old age and conducted multiple linear regression analysis to determine whether the physical activity levels at midlife and in old age were associated with skeletal muscle mass index and physical performance in old age.ResultsThe participants in the groups that were physically inactive at midlife had a significantly lower skeletal muscle mass index in old age than those who were physically active at midlife (p < 0.01). Participants in the groups that were physically inactive in old age also had significantly slower walking speeds at old age than those who were physically active (p < 0.01). These associations remained significant after adjustment for age and body mass index.ConclusionPhysical activity at midlife may be associated with a higher muscle mass in old age and physical activity in old age may be associated with higher walking speeds in old age.     

A population model evaluating the costs and benefits associated with different oral treatment strategies in people with type 2 diabetes

Aim: The attainment of near‐normal glycaemia is an important feature in reducing complications in people with type 2 diabetes. Current treatment pathways advocate a failure‐driven therapy algorithm for blood‐glucose lowering that leads to the sequential addition of therapies. The addition and combination of multiple blood‐glucose lowering agents may be associated with significant side effects, such as weight gain and hypoglycaemia, resulting in a detrimental quality of life. The objective of this study is to quantify the overall costs and quality‐adjusted life years (QALY) associated with therapy escalation via oral only treatment strategies with different adverse event profiles as a function of target HbA1c achievement. Methods: A previously published model was adapted to run as a non‐terminating simulation model. The model is designed to evaluate the cost utility of treatment strategies in a population of type 2 diabetes mellitus patients. Model outputs include incidence of micro‐ and macrovascular complications, hypoglycaemia and diabetes‐specific and all‐cause mortality. Results: The total number of vascular events predicted by the model varied little across the four treatment strategies because of the glycaemic profile associated with each therapy strategy being similar. The strategy with sequential addition of thiazolidinediones (TZDs) and sulphonylureas (SUs) to metformin (MF) was associated with greatest predicted hypoglycaemia burden. The addition of SU and dipeptidyl peptidase (DPP‐4) inhibitors to MF was associated with the highest estimated QALYs. Conclusions: A treatment strategy involving the sequential addition of SU and TZD to first‐line MF therapy is associated with the lowest cost and lowest gain across a population, whereas addition of TZD and SU sequentially to first‐line MF therapy resulted in the highest cost and incrementally less QALY gain when compared with treatment strategies involving the addition of a DPP‐4 inhibitor and SU to first‐line MF (irrespective of the treatment sequence) that were associated with both less cost and greatest QALY gain.     

Effects of Playback Theatre on cognitive function and quality of life in older adults in Singapore: A preliminary study

Objective

This study investigated the effects of Playback Theatre on older adults’ cognitive function and well‐being, specifically in the Singapore context.

Methods

Eighteen healthy older adults, older than 50 years of age, participated in the study. Due to practical limitations, a single‐group pre–post study design was adopted. Participants completed the outcome measures before and after the training program. There were six weekly sessions in total (about 1.5 hours, once weekly).

Results

Participants experienced a significant improvement in their emotional well‐being after training. However, there were no significant changes in participants’ cognitive function or health‐related quality of life.

Conclusion

Our results suggest that Playback Theatre as a community program has potential to improve the mental and emotional well‐being of older people.