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Westlake M, Cowley A, Robinson K, Gordon AL. Towards a common definition of hospital-acquired deconditioning in adults: a scoping review. BMJ Open 2025; 15:e086976. [PMID: 39819903 PMCID: PMC11751929 DOI: 10.1136/bmjopen-2024-086976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 11/12/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND Hospital-acquired deconditioning is a term used in clinical practice, describing a loss of physical and/or cognitive function associated with hospitalisation. Previous reviews have addressed interventions, its prevalence in older adults and potential assessment tools. However, each review has reported a core limitation, the need for an agreed-upon definition and diagnostic criteria for hospital-acquired deconditioning. OBJECTIVE We aimed to identify key components used to define hospital-acquired deconditioning in adults. We sought to do this by identifying diagnostic criteria, describing how authors operationalised Hospital- Acquired Deconditioning (HAD), and describing differences between HAD and other immobility-linked syndromes. This article focuses on how hospital-acquired deconditioning is understood and operationalised. DESIGN A scoping review using the Joanna Briggs Institute methodology for evidence synthesis. ELIGIBILITY CRITERIA Published in English after 1 January 1990, investigating adults over 18, set in inpatient rehabilitation or acute care settings, and including either a definition or description of hospital-acquired deconditioning or an outline of strategies to assess, prevent or manage hospital-acquired deconditioning. SOURCES OF EVIDENCE Published and grey literature, no restriction was placed on study design. CHARTING METHODS Relevant data, where available, was extracted from each source using a proprietary data extraction template. RESULTS One hundred and three articles were included from 2403 retrieved results. Thirty-three were from rehabilitation or post-acute care settings, 53 from acute care, 15 from intensive care and two from other settings. The literature was diverse in methodology and research question addressed. Hospital-acquired deconditioning was poorly defined, no consistent patterns were identified in aetiology and sequelae; diagnostic criteria were not fully agreed on. CONCLUSIONS The literature on hospital-acquired deconditioning is large, diverse and incomplete. Further work is required to develop a shared definition of hospital-acquired deconditioning, enabling researchers to coalesce for better understanding of the phenomenon, and clinicians, in turn, to better treat and mitigate against it. REVIEW REGISTRATION OSF: https://osf.io/b5sgw/.
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Affiliation(s)
| | - Alison Cowley
- Research & Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Adam L Gordon
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research, London, UK
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Hinrichs-Kinney LA, Pisegna J, Pontiff ME, Beisheim-Ryan EH, Altic R, Coats H, Stevens-Lapsley JE. Mixed-Method Evaluation to Understand Clinician Perspectives of a Program to Implement High-Intensity Resistance Rehabilitation Into Skilled Nursing Facilities. Arch Phys Med Rehabil 2025; 106:61-73. [PMID: 39341442 DOI: 10.1016/j.apmr.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/03/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVE To assess rehabilitation clinicians' viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation. DESIGN Prospective convergent mixed-method design. SETTING Eight rural SNFs within the Department of Veterans Affairs. PARTICIPANTS Physical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38). INTERVENTIONS Clinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks). MAIN OUTCOME MEASURES Acceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience. RESULTS Questionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience. CONCLUSIONS According to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.
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Affiliation(s)
- Lauren A Hinrichs-Kinney
- VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Janell Pisegna
- VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Occupational Therapy Department, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
| | - Mattie E Pontiff
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Denver-Seattle Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO
| | - Emma H Beisheim-Ryan
- VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Research & Surveillance Division, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA; Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA
| | - Rebecca Altic
- VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Heather Coats
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer E Stevens-Lapsley
- VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
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Jo SJ, Lee SH, Min HJ, Kim HJ, Kong HH. Mortality Outcomes and Contributing Risk Factors in Patients with Hospital-Associated Disability. J Clin Med 2024; 13:4798. [PMID: 39200940 PMCID: PMC11355630 DOI: 10.3390/jcm13164798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/29/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Hospital-associated disability (HAD), a functional decline following acute hospitalization, is a common complication associated with mortality and unfavorable prognoses in patients admitted to acute care hospitals. However, few studies have investigated mortality and associated factors in patients with HAD and have been limited by inconsistent HAD assessment tools and criteria. This study investigated mortality and risk factors in patients with HAD using specific criteria. Methods: This retrospective study evaluated patients referred to the Department of Rehabilitation Medicine with suspected HAD between June 2022 and March 2023. The collected data included medical histories, diagnostic tests for HAD (including muscle strength, balance, and modified Barthel Index), and bioelectrical impedance analysis (BIA). Multivariate logistic regression analysis was conducted to identify factors associated with mortality. Kaplan-Meier survival curves were constructed for mortality at 3 and 7 months. Results: A total of 455 patients were identified, among which 206 patients diagnosed with HAD (73.1 ± 12.5 years) were included in the analysis. The 3-month mortality rate was 27.2%. In the multivariate analysis, male sex (odds ratio (OR), 3.23; p < 0.01), a history of cancer (OR, 2.18; p < 0.05), and a low phase angle (OR, 0.69; p < 0.05) were significantly associated with mortality. A phase angle < 2.9° on BIA was associated with a significant increase in 3-month (hazard ratio (HR), 1.85; 95% confidence interval (CI), 1.06-3.23) and 7-month (HR, 2.80; 95% CI, 1.75-4.98) mortality. Conclusions: Patients with HAD had a high mortality rate, with several factors, particularly low BIA phase angles, associated with increased mortality.
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Affiliation(s)
- Soo-Jeong Jo
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea; (S.-J.J.); (S.-H.L.)
| | - So-Hee Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea; (S.-J.J.); (S.-H.L.)
| | - Hyo-Jin Min
- Department of Clinical Pharmacology and Therapeutics, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea;
- Department of Medicine, Chungbuk National University Graduate School, Cheongju 28644, Republic of Korea
| | - Hee-Ji Kim
- Department of Nursing, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea;
| | - Hyun-Ho Kong
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea; (S.-J.J.); (S.-H.L.)
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju 28644, Republic of Korea
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Magrini MA, Hoffman R, Barnett T, Bruursema J, Siedlik J. Effectiveness of a multicomponent rehabilitation protocol on outcomes following post-acute care. Clin Biomech (Bristol, Avon) 2024; 111:106138. [PMID: 37948988 DOI: 10.1016/j.clinbiomech.2023.106138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/27/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The purpose of this study was to determine the effect of a multicomponent rehabilitation protocol on functional outcomes in a post-acute care facility. METHODS Eleven older, medically complex patients (80.3 ± 7.3 yrs) completed a multicomponent rehabilitation protocol during a stay at a post-acute care facility. Gait speed, Berg Balance scores, and sit-to-stand velocity were examined upon admission and discharge. Bayesian paired sample t-tests were used to determine changes from PRE to POST and linear regression analyses were used to determine the influence of length of stay. FINDINGS Gait speed increased by 0.26 m/s (49% increase) from PRE (0.65 ± 0.38 m/s) to POST (0.90 ± 0.42 m/s) exercise intervention (p = 0.013). Berg Balance Scores significantly increased by 26% from PRE (38.27 ± 8.33) to POST (45.73 ± 3.32) exercise intervention (p = 0.009). A 45% increase in STS velocity from PRE (0.37 ± 0.14 m/s) to POST (0.51 ± 0.13 m/s; p ≤ 0.001) was observed following the multicomponent rehabilitation protocol. Length of stay did not influence improvements in gait speed, Berg Balance Scores, nor Sit-to-stand velocity (p = 0.176-0.811). INTERPRETATIONS The multicomponent rehabilitation protocol with movement velocity biofeedback is feasible in a post-acute care facility in medically complex older patients and demonstrates improvements in clinical mobility and balance outcomes.
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Affiliation(s)
- Mitchel A Magrini
- Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha, NE, USA.
| | - Rashelle Hoffman
- Department of Physical Therapy, Creighton University, Omaha, NE, USA
| | - Taylor Barnett
- Department of Physical Therapy, Creighton University, Omaha, NE, USA
| | | | - Jacob Siedlik
- Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha, NE, USA
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Izaguirre P, Arakaki É, Boero JV, Zalazar Á, Ghirlanda M, Caruso D. Functional Status in Older Adults following Hospitalization for COVID-19: A Cohort Study. Ann Geriatr Med Res 2023; 27:286-292. [PMID: 37673690 PMCID: PMC10772336 DOI: 10.4235/agmr.23.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/01/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can cause multiple acute complications. This study evaluated the long-term functional status of older patients hospitalized for acute COVID-19. METHODS We analyzed data from a multicenter ambispective cohort study on patients aged >60 years who were hospitalized for COVID-19 at two tertiary care hospitals in Argentina. The participants were contacted by telephone between November 2021 and September 2022 to collect data on their functional status. Ordinal logistic regression was used to identify factors associated with functional limitations after discharge. RESULTS Among the 374 included patients, 205 (55%) showed functional limitations, including 58 (28%) who died during follow-up. The factors independently associated with functional limitations were low baseline functional status (odds ratio [OR]=9.19; 95% confidence interval [CI], 3.35-25.17) and admission to the intensive care unit (OR=4.41; 95% CI, 2.28-8.53). Men had lower odds of functional impairment (OR=0.55; 95% CI, 0.35-0.86). CONCLUSION Older patients had high mortality rates and poor functional status at 2 years post-discharge for COVID-19. Several factors at the time of discharge were associated with a higher risk of functional limitations and can be used to identify patients' long-term needs for support and rehabilitation services.
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Affiliation(s)
- Pía Izaguirre
- Department of Internal Medicine, Hospital Dr. César Milstein, Buenos Aires, Argentina
| | - Érica Arakaki
- Department of Internal Medicine, Hospital Dr. César Milstein, Buenos Aires, Argentina
| | - Jorge Vogt Boero
- Department of Internal Medicine, Hospital Dr. César Milstein, Buenos Aires, Argentina
| | - Ángeles Zalazar
- Department of Internal Medicine, Hospital Dr. Víctor Sanguinetti, Chubut, Argentina
| | - Mariano Ghirlanda
- Department of Internal Medicine, Hospital Dr. César Milstein, Buenos Aires, Argentina
| | - Diego Caruso
- Department of Clinical Research, Hospital Dr. César Milstein, Buenos Aires, Argentina
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Beisheim-Ryan EH, Butera KA, Hinrichs LA, Derlein DL, Malone DJ, Holtrop JS, Forster JE, Diedrich D, Gustavson AM, Stevens-Lapsley JE. Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities: An Effectiveness-Implementation Hybrid Type 1 Clinical Trial Protocol. Phys Ther 2023; 103:pzad053. [PMID: 37255325 PMCID: PMC10506848 DOI: 10.1093/ptj/pzad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/16/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Skilled nursing facility rehabilitation is commonly required to address hospital-associated deconditioning among older adults with medical complexity. In skilled nursing facilities, standard-of-care rehabilitation focuses on low-intensity interventions, which are not designed to sufficiently challenge skeletal muscle and impart functional improvements. In contrast, a high-intensity resistance training approach (IntenSive Therapeutic Rehabilitation for Older NursinG homE Residents; i-STRONGER) in a single-site pilot study resulted in better physical function among patients in skilled nursing facilities. To extend this work, an effectiveness-implementation hybrid type 1 design, cluster-randomized trial will be conducted to compare patient outcomes between 16 skilled nursing facilities utilizing i-STRONGER principles and 16 Usual Care sites. METHODS Clinicians at i-STRONGER sites will be trained to deliver i-STRONGER as a standard of care using an implementation package that includes a clinician training program. Clinicians at Usual Care sites will continue to provide usual care. Posttraining, changes in physical performance (eg, gait speed, Short Physical Performance Battery scores) from patients' admission to discharge will be collected over a period of 12 months. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework will be used to evaluate i-STRONGER effectiveness and factors underlying successful i-STRONGER implementation. Effectiveness will be evaluated by comparing changes in physical function between study arms. Reach (proportion of patients treated with i-STRONGER), adoption (proportion of clinicians utilizing i-STRONGER), implementation (i-STRONGER fidelity), and maintenance (i-STRONGER sustainment) will be concurrently quantified and informed by clinician surveys and focus groups. IMPACT This effectiveness-implementation hybrid type 1 cluster-randomized trial has the potential to shift rehabilitation care paradigms in a nationwide network of skilled nursing facilities, resulting in improved patient outcomes and functional independence. Furthermore, evaluation of the facilitators of, and barriers to, implementation of i-STRONGER in real-world clinical settings will critically inform future work evaluating and implementing best rehabilitation practices in skilled nursing facilities.
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Affiliation(s)
- Emma H Beisheim-Ryan
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Katie A Butera
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Lauren A Hinrichs
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Danielle L Derlein
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Daniel J Malone
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Jodi S Holtrop
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
- Adult and Child Center for Outcomes Research and Delivery (ACCORDS), University of Colorado, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
| | | | - Allison M Gustavson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
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Extremely Low Activity of Serum Alanine Aminotransferase Is Associated with Long-Term Overall-Cause Mortality in the Elderly Patients Undergoing Percutaneous Coronary Intervention after Acute Coronary Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020415. [PMID: 36837617 PMCID: PMC9964269 DOI: 10.3390/medicina59020415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Background and Objectives: Recent studies revealed that the extremely low activity of serum alanine aminotransferase (ALT) is associated with frailty and contributes to increased mortality after acute physical stress. We aimed to investigate whether the extremely low activity of serum ALT (<10 U/L) at the time of diagnosis can be used to predict overall-cause mortality in elderly patients that underwent percutaneous coronary intervention (PCI) after acute coronary syndrome (ACS) diagnosis. Materials and Methods: A retrospective medical record review was performed on 1597 patients diagnosed with ACS who underwent PCI at a single university hospital from February 2014 to March 2020. The associations between the extremely low activity of serum ALT and mortality were assessed using a stepwise Cox regression (forward: conditional). Results: A total of 210 elderly patients were analyzed in this study. The number of deaths was 64 (30.5%), the mean survival time was 25.0 ± 18.9 months, and the mean age was 76.9 ± 7.6 years. The mean door-to-PCI time was 74.0 ± 20.9 min. The results of stepwise Cox regression analysis showed that the extremely low activity of serum ALT (adjusted hazard ratio: 5.157, 95% confidence interval: 3.001-8.862, p < 0.001) was the independent risk factor for long-term overall-cause mortality in the elderly who underwent PCI after ACS diagnosis. Conclusions: The extremely low activity of serum ALT at ACS diagnosis is a significant risk factor for increased long-term overall-cause mortality in the elderly who underwent PCI after ACS diagnosis. It is noteworthy that a simple laboratory test at the time of diagnosis was found to be a significant risk factor for mortality.
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Muscat F, Camilleri L, Attard C, Lungaro Mifsud S. Assessment Tools for the Admission of Older Adults to Inpatient Rehabilitation: A Scoping Review. J Clin Med 2023; 12:919. [PMID: 36769567 PMCID: PMC9918169 DOI: 10.3390/jcm12030919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
(1) Objective: To identify the assessment tools and outcome measures used to assess older adults for inpatient rehabilitation. (2) Design: Scoping review. (3) Data sources: ProQuest, PEDro, PubMed, CINAHL Plus with full text (EBSCO), Cochrane Library and reference lists from included studies. (4) Review method: The inclusion of studies covering patients aged >60, focusing on rehabilitation assessments delivered in hospitals in community settings. Studies reporting on rehabilitation specifically designed for older adults-testing for at least one domain that affects rehabilitation or assessments for admission to inpatient rehabilitation-were also included. Results were described both quantitatively and narratively. (5) Results: 1404 articles were identified through selected databases and registers, and these articles underwent a filtering process intended to identify and remove any duplicates. This process reduced the number to 1186 articles. These, in turn, were screened for inclusion criteria, as a result of which 37 articles were included in the final review. The majority of assessments for geriatric rehabilitation were carried out by a multidisciplinary team. Multiple studies considered more than one domain during assessment, with a high percentage evaluating a specific outcome measure used in geriatric rehabilitation. The most common domains assessed were function, cognition and medical status-with communication, vision and pain being the least common. A total of 172 outcome measures were identified in this review, with MMSE, BI, FIM and CCI being the most frequent. (6) Conclusions: This review highlights the lack of standardised approaches in existing assessment processes. Generally, older-adult-rehabilitation assessments struggle to capture rehabilitation potential in a holistic manner. Hence, a predictive model of rehabilitation for assessing patients at the initial stages would be useful in planning a patient-specific programme aimed at maximising functional independence and, thus, quality of life.
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Affiliation(s)
- Francesca Muscat
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2090 Msida, Malta
| | - Liberato Camilleri
- Statistics and Operations Research, Faculty of Science, University of Malta, MSD 2080 Msida, Malta
| | - Conrad Attard
- Computer Information Systems, Faculty of ICT, University of Malta, MSD 2080 Msida, Malta
| | - Stephen Lungaro Mifsud
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2090 Msida, Malta
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Lu SY, Otero TMN, Yeh DD, Canales C, Elsayes A, Belcher DM, Quraishi SA. The association of macronutrient deficit with functional status at discharge from the intensive care unit: a retrospective study from a single-center critical illness registry. Eur J Clin Nutr 2022; 76:551-556. [PMID: 34462556 DOI: 10.1038/s41430-021-01001-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nutrition is often thought to influence outcomes in critically ill patients. However, the relationship between macronutrient delivery and functional status is not well characterized. Our goal was to investigate whether caloric or protein deficit over the course of critical illness is associated with functional status at the time of intensive care unit (ICU) discharge. METHODS We performed a retrospective analysis of surgical ICU patients at a teaching hospital in Boston, MA. To investigate the association of caloric or protein deficit with Functional Status Score for the ICU (FSS-ICU), we constructed linear regression models, controlling for age, sex, race, body mass index, Nutritional Risk in the Critically Ill score, and ICU length of stay. We then dichotomized caloric as well as protein deficit, and performed logistic regressions to investigate their association with functional status, controlling for the same variables. RESULTS Linear regression models (n = 976) demonstrated a caloric deficit of 238 kcal (237.88; 95%CI 75.13-400.63) or a protein deficit of 14 g (14.23; 95%CI 4.46-24.00) was associated with each unit decrement in FSS-ICU. Logistic regression models demonstrated a 6% likelihood (1.06; 95%CI 1.01-1.14) of caloric deficit ≥6000 vs. <6000 kcal and an 8% likelihood (1.08; 95%CI 1.01-1.15) of protein deficit ≥300 vs. <300 g with each unit decrement in FSS-ICU. CONCLUSION In our cohort of patients, macronutrient deficit over the course of critical illness was associated with worse functional status at discharge. Future studies are needed to determine whether optimized macronutrient delivery can improve outcomes in ICU survivors.
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Affiliation(s)
- Shu Y Lu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Tiffany M N Otero
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Anesthesiology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA
| | - D Dante Yeh
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Cecilia Canales
- Department of Anesthesiology & Perioperative Medicine, University of California David Geffen School of Medicine, Los Angeles, CA, 90095, USA
| | - Ali Elsayes
- Department of Anesthesiology & Perioperative Medicine, Tufts Medical Center, Boston, MA, 02111, USA
| | - Donna M Belcher
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Sadeq A Quraishi
- Department of Anesthesiology & Perioperative Medicine, Tufts Medical Center, Boston, MA, 02111, USA.
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Gustavson AM, LeDoux CV, Himawan M, Stevens-Lapsley JE, Nearing KA. Implementation of a rehabilitation model in a Program of All-Inclusive Care for the Elderly (PACE): Preliminary data. J Am Geriatr Soc 2022; 70:880-890. [PMID: 35119693 DOI: 10.1111/jgs.17674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 12/14/2021] [Accepted: 01/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nursing home eligible participants in the Program of All-inclusive Care for the Elderly (PACE) are at high risk for falls. Physical function is a modifiable predictor of falls and an important target for prevention. We engaged a PACE site to explore feasibility of implementing progressive intensive rehabilitation to improve physical function and preliminary patient-level improvements. METHODS The research involved a mixed-methods, pre-post implementation study with longitudinal patient follow-up at one Denver PACE site. Older adults at risk for institutionalization (N = 28) took part in Screening and high-intensity interventions to Improve Falls risk and Transform expectations in age and aging (SHIFT) rehabilitation program over six weeks. Outcomes included the short physical performance battery (SPPB); 4-meter gait speed at baseline, discharge, and 6 and 12 months postdischarge from SHIFT. A focus group with staff explored facilitators and barriers to program implementation in the PACE setting and with complex patients and perceived effectiveness. RESULTS The rehabilitation team demonstrated high treatment fidelity to SHIFT (>80%). No treatment-specific adverse events were reported. SPPB scores and gait speeds improved significantly over time (p < 0.005). The average SPPB score at evaluation was 4.6 ± 0.24 compared to 7.7 ± 0.38 points at discharge. The average gait speed at evaluation was 0.58 ± 0.03 meters/second (m/s) compared to 0.79 ± 0.04 m/s at discharge. Common barriers to program completion included changes in health status and environmental factors (e.g., transportation). CONCLUSIONS Rehabilitation therapists incorporated a high-intensity resistance training program into routine care of complex older adults in PACE and improved pre-post physical function to levels above independence thresholds (SPPB ≥6; gait speed ≥0.65 m/s). Our pilot implementation study informed refinement of eligibility criteria, number of visits, and strategies to address long-term adherence to enhance scalability and optimize impact.
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Affiliation(s)
- Allison M Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.,Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Cherie V LeDoux
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Michael Himawan
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kathryn A Nearing
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Division of Geriatric Medicine and Multi-disciplinary Center on Aging, School of Medicine, University of Colorado, Aurora, Colorado, USA.,Office of Diversity, Equity, Inclusion and Community Engagement, University of Colorado, Aurora, Colorado, USA
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11
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An SJ, Yang YJ, Jeon NM, Hong YP, Kim YI, Kim DY. Significantly Reduced Alanine Aminotransferase Level Increases All-Cause Mortality Rate in the Elderly after Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094915. [PMID: 34063029 PMCID: PMC8125228 DOI: 10.3390/ijerph18094915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/02/2021] [Accepted: 05/02/2021] [Indexed: 01/02/2023]
Abstract
(1) Background: A significantly reduced alanine aminotransferase (ALT) level is being recognized as a risk factor of increasing mortality in the elderly in relation to frailty. In the elderly, both frailty and ischemic stroke are not only common, but are also associated with mortality. The aim of this research was to investigate whether a significantly reduced ALT level increases the all-cause mortality rate in the elderly with ischemic stroke. (2) Methods: Between February 2014 and April 2019, a retrospective study of 901 patients with ischemic stroke admitted to a university-affiliated hospital was conducted. Cox proportional hazard regression was used to determine whether a significantly reduced ALT level is an independent risk factor for mortality in elderly patients after an ischemic stroke. (3) Results: This study enrolled 323 older adults (age ≥ 65 years) who were first diagnosed with ischemic stroke. The mean age of the participants was 76.5 ± 6.6 years, the mean survival time was 37.1 ± 20.4 months, and the number of deaths was 96 (29.7%). Our results showed that reduced ALT level (less than 10 U/L) increased the risk of all-cause mortality in the elderly after ischemic stroke (adjusted HR: 3.24, 95% CI: 1.95–5.41; p < 0.001). (4) Conclusions: A significantly reduced ALT level at the time of diagnosis (less than 10 U/L) is an independent risk factor that increases the mortality rate in the elderly after ischemic stroke.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea; (S.J.A.); (Y.I.K.)
| | - Yun-Jung Yang
- Institute of Biomedical Science, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Korea;
| | - Na-mo Jeon
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea;
| | - Yeon-Pyo Hong
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Korea;
| | - Yeong In Kim
- Department of Neurology, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea; (S.J.A.); (Y.I.K.)
| | - Doo-Young Kim
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary’s Hospital, Incheon 22711, Korea;
- Correspondence: ; Tel.: +82-32-290-3112; Fax: +82-32-290-3879
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12
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Physical Therapy and Discharge Disposition Following Acute Hospitalization for UTI in Community-Dwelling Older Adults. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2021. [DOI: 10.1097/jat.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Kim DY, Cho KC. Extremely Low Serum Alanine Transaminase Level Is Associated with All-Cause Mortality in the Elderly after Intracranial Hemorrhage. J Korean Neurosurg Soc 2021; 64:460-468. [PMID: 33626855 PMCID: PMC8128522 DOI: 10.3340/jkns.2020.0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Extremely low alanine transaminase (ALT) levels are associated with all-cause mortality in frail elderly individuals; the clinical significance of ALT as a reliable biomarker is now being considered. Predicting mortality with routine tests at the time of diagnosis is important for managing patients after intracranial hemorrhage. We aimed to investigate whether an extremely low ALT level is associated with mortality in the elderly after intracranial hemorrhage. METHODS A retrospective review was performed on 455 patients with intracranial hemorrhage admitted to a university-affiliated tertiary care hospital from February 2014 to May 2019. Multivariate Cox regression analysis was performed for all ages and for each age group to determine whether an extremely low ALT level is an independent predictor of mortality only in the elderly. RESULTS Overall, 294 patients were enrolled, and the mean age of the subjects was 59.1 years, with 99 (33.8%) aged ≥65 years. The variables associated with all-cause mortality in all subjects were age, C-reactive protein (CRP) levels, hemoglobin (Hb) levels (<11 g/dL), and initial Glasgow coma scale (GCS) scores. In young patients, CRP, low Hb levels, and initial GCS scores were significantly associated with all-cause mortality. However, in the elderly (≥65 years), the variables significantly associated with allcause mortality were extremely low levels of ALT (<10 U/L) (adjusted hazard ratio, 3.313; 95% confidence interval, 1.232-8.909; p=0.018) and initial GCS scores. CONCLUSION Extremely low ALT level (<10 U/L) at the time of diagnosis is a significant risk factor for all-cause mortality in the elderly after intracranial hemorrhage.
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Affiliation(s)
- Doo Young Kim
- Department of Rehabilitation Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
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14
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High variability in hip fracture post-acute care and dementia patients having worse chances of receiving rehabilitation: an analysis of population-based data from Estonia. Eur Geriatr Med 2020; 11:581-601. [PMID: 32564341 DOI: 10.1007/s41999-020-00348-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/07/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Rehabilitation is a fundamental part of hip fracture (HF) care; however, the best strategies are unclear. This study maps index HF patients' post-acute care (PAC) in Estonia and compares the PAC of patients with and without a diagnosis of dementia. METHODS A retrospective cohort study was conducted using validated population-based data from the Estonian Health Insurance Fund using inclusion criteria: age ≥ 50 years, International Classification of Diseases code (S72.0-2) indicating HF between 1 January 2009 and 30 September 2017, and the survival of PAC. The presence of dementia diagnosis was based on the 10th revision of the International Classification of Diseases codes. RESULTS A total of 8729 patients were included in the study, 11% of whom had a dementia diagnosis. The PAC of HF patients varied from extensive to no care: 8.7% received combined inpatient and outpatient care; 59% received hospital care (13% had a length of stay (LOS) > 6 weeks; 33% had LOS between 2-4 weeks, 14% had LOS < 2 weeks); 4% received only community-based care; 28% received no PAC. Physical therapy (PT) was received by 56% of patients and by 35% of those with dementia diagnosis. Dementia patients had 1.5-fold higher odds of not receiving PT. CONCLUSION In Estonia, the PAC after index HF varies from extensive to no care, and the provision of PT is limited and unequal, affecting dementia patients in particular. Thus, there is an urgent need to standardise index HF PAC by reviewing the resources of PT and developing effective rehabilitation practices.
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15
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Gustavson AM, Falvey JR, Forster JE, Stevens-Lapsley JE. Predictors of Functional Change in a Skilled Nursing Facility Population. J Geriatr Phys Ther 2020. [PMID: 28650398 DOI: 10.1519/jpt.0000000000000137] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Inability to obtain sufficient gains in function during a skilled nursing facility (SNF) stay impacts patients' functional trajectories and susceptibility to adverse events. The purpose of this study was to identify predictors of functional change in patients temporarily residing in an SNF following hospitalization. METHODS One hundred forty patients admitted to a single SNF from the hospital who had both evaluation and discharge measures of physical function documented were included. Data from the Minimum Data Set 3.0 and electronic medical record were extracted to record clinical and demographic characteristics. The Short Physical Performance Battery (SPPB) was administered by rehabilitation therapists at evaluation and discharge. The SPPB consists of balance tests, gait speed, and a timed 5-time sit-to-stand test. RESULTS AND DISCUSSION The Patient Health Questionnaire (PHQ-9) Screening Tool for Depression was the only significant predictor of change in gait speed over an SNF stay. Eighty-seven percent of patients achieved a clinically meaningful change in the SPPB of 1 point or greater from evaluation to discharge, with 78% demonstrating a clinically meaningful change of 0.1 m/s or greater on gait speed. However, 69% of patients demonstrated SPPB scores of 6 points or less and 57% ambulated less than 0.65 m/s at the time of discharge from the SNF, which indicates severe disability. CONCLUSIONS Poor physical function following an SNF stay places older adult at significant risk for adverse events including rehospitalization, future disability, and institutionalization. Understanding the predictors of functional change from evaluation to discharge may direct efforts toward developing innovative and effective interventions to improve function trajectories for older adults following an acute hospitalization.
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Affiliation(s)
- Allison M Gustavson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora
| | - Jason R Falvey
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora.,Denver Veterans Affairs Medical Center, Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora
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16
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Cadore EL, Sáez de Asteasu ML, Izquierdo M. Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization. Exp Gerontol 2019; 122:10-14. [PMID: 30995516 DOI: 10.1016/j.exger.2019.04.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/10/2019] [Accepted: 04/13/2019] [Indexed: 10/27/2022]
Abstract
Frailty syndrome encompasses several physical hallmarks such as loss of muscle strength, power output and mass, which leads to poor gait ability, fatigue, falls and overall difficulty to perform activities of daily living. On the other hand, physical exercise interventions induce marked improvements in frailty physical hallmarks (e.g., gait ability, muscle strength, balance and falls). In addition, because cognitive impairment is closely related to frailty syndrome, exercise is an effective intervention to counteract the physical consequences of mild cognitive impairment and dementia. Moreover, exercise and early rehabilitation programs are among the interventions through which functional decline is prevented in older patients during acute hospitalization. This narrative review provides a summary of the effectiveness of different exercise interventions in the hallmarks of frailty. Furthermore, this review addresses special considerations on exercise in frail older with cognitive impairment. Also, we review the role of exercise interventions in acute hospitalized older patients. There is strong evidence that exercise training is an effective intervention for improving muscle strength, muscle mass, incidence of falls, and gait ability in frail older adults. In addition, it seems that multicomponent exercise intervention programs including resistance, gait and balance training is the best strategy for improving the frailty hallmarks, as well as for reducing the rate of falls in frail individuals, and so maintaining their functional capacity during aging. This training modality also proved to be safe and effective to revert the functional decline and cognitive impairment in acutely hospitalized older adults of advanced age. Based on the association between muscle power output and physical function, explosive resistance training should be included in the exercise intervention in order to optimize the functional outcomes in frail older adults.
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Affiliation(s)
- Eduardo Lusa Cadore
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mikel L Sáez de Asteasu
- Department of Health Sciences, Navarrabiomed, IdiSNA, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Public University of Navarra, Pamplona, Navarra, Spain
| | - Mikel Izquierdo
- Department of Health Sciences, Navarrabiomed, IdiSNA, CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Public University of Navarra, Pamplona, Navarra, Spain.
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17
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Timmer AJ, Unsworth CA, Browne M. A randomized controlled trial protocol investigating effectiveness of an activity-pacing program for deconditioned older adults. Can J Occup Ther 2019; 86:136-147. [DOI: 10.1177/0008417419830374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Acute hospitalization of older adults can lead to deconditioning and the need for rehabilitation to facilitate a return to home and previous lifestyle. An occupational therapy intervention to combat deconditioning is activity pacing, an active self-management strategy where individuals learn to modify how and when activities are completed with the aim of improving participation in occupation. Purpose. This study will examine the effectiveness of occupational therapy with activity pacing during rehabilitation for deconditioned older adults. Method. A randomized controlled trial is proposed with inclusion criteria of older adults, 65+ years old, living independently in the community prior to admission, with adequate cognition and language to participate in the intervention. Participation, health status, self-efficacy in daily activities, self-efficacy in activity pacing techniques, and symptom management (pain and fatigue) will be measured at admission, discharge, and 3 months postdischarge. Implications. Determining if an activity-pacing program is effective will provide occupational therapists with evidence to support service delivery.
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18
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Mazzola P, Floris P, Picone D, Anzuini A, Tsiantouli E, Haas J, Bellelli G, De Filippi F, Annoni G. Functional and clinical outcomes of patients aged younger and older than 85 years after rehabilitation post-hip fracture surgery in a co-managed orthogeriatric unit. Geriatr Gerontol Int 2018; 18:1194-1199. [DOI: 10.1111/ggi.13440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Paolo Mazzola
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Clinical Neurosciences Research Area; NeuroMI - Milan Center for Neuroscience; Milan Italy
| | - Patrizia Floris
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Acute Geriatrics Unit, Department of Medicine; Sondrio Hospital, ASST of Valtellina and Alto Lario; Sondrio Italy
| | - Domenico Picone
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
| | - Alessandra Anzuini
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
| | - Eleni Tsiantouli
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Department of Bone Diseases; Geneva University Hospital; Geneva Switzerland
| | - Justin Haas
- Neuroscience and Mental Health Institute, University of Alberta; Edmonton Canada
| | - Giuseppe Bellelli
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Clinical Neurosciences Research Area; NeuroMI - Milan Center for Neuroscience; Milan Italy
| | - Francesco De Filippi
- Acute Geriatrics Unit, Department of Medicine; Sondrio Hospital, ASST of Valtellina and Alto Lario; Sondrio Italy
| | - Giorgio Annoni
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Clinical Neurosciences Research Area; NeuroMI - Milan Center for Neuroscience; Milan Italy
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19
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Cammilletti V, Forino F, Palombi M, Donati D, Tartaglini D, Di Muzio M. BRASS score and complex discharge: a pilot study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:414-425. [PMID: 29350655 PMCID: PMC6166170 DOI: 10.23750/abm.v88i4.6191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 11/23/2022]
Abstract
Aims: A highly functional continuity of patient care, which is linked to the reduction of the risk of long-term hospitalization, above all for ‘at-risk’ patients. Research into an objective, reliable instrument for redirecting individual results to organizational aims to extend the entire country, is a fundamental step to move from a reactive assistance approach to a pro-active one. Methods: An observational and descriptive retrospective study was carried out July - November 2014 in two Italian state hospitals, completing the BRASS Index within 48/72 hours of admission. Results: The study group consisted of 122 inpatients. A correlation presented itself, albeit low (ρ=0.05191), between age and the number of ‘revolving door’ admissions; a medium correlation (ρ=0.485131) between age and risk band (according to BRASS). Conclusions: The BRASS Index is straightforward and swift, and can prove a valuable tool in directing nurses’ attention to those patients most at risk of prolonged hospitalization. (www.actabiomedica.it)
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Affiliation(s)
| | - Fortunata Forino
- Policlinico Umberto I of Rome, Sapienza University of Rome, Italy.
| | - Marina Palombi
- Policlinico Umberto I of Rome, Sapienza University of Rome, Italy.
| | | | | | - Marco Di Muzio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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20
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Calle A, Onder G, Morandi A, Bellelli G, Ortolani E, Pérez LM, Mesas M, Sanniti A, Mazzanti P, Platto CN, Gentile S, Martinez N, Roquè M, Inzitari M. Frailty Related Factors as Predictors of Functional Recovery in Geriatric Rehabilitation: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) Multi-Centric study. J Nutr Health Aging 2018; 22:1099-1106. [PMID: 30379309 DOI: 10.1007/s12603-018-1060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation. OBJECTIVE The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults. DESIGN Multi-centric cohort study. Participanst and Settings: Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016. MEASUREMENTS The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission. RESULTS We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an ortho-pedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additionally, in both diagnostics groups, a better handgrip strength increased the chance of RFG. CONCLUSIONS Among frailty-related variables, physical, cognitive and muscular function at admission could be relevant for functional improvement during geriatric reha-bilitation. If confirmed, this data might orient targeted interventions.
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Affiliation(s)
- A Calle
- Alicia Calle, MD, Parc Sanitari Pere Virgili, Esteve Terradas Nº30, 08023 Barcelona, Spain, Tel: +34 932594102, E-mail:
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21
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Mas MÀ, Inzitari M, Sabaté S, Santaeugènia SJ, Miralles R. Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care. Age Ageing 2017; 46:925-931. [PMID: 28655169 DOI: 10.1093/ageing/afx099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/08/2017] [Indexed: 11/12/2022] Open
Abstract
Objective to analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care. Design quasi-experimental longitudinal study. Setting hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain. Participants we included older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation. Methods a CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain (functional gain/functional loss) ≥ 0.35; and (c) favourable crisis resolution (health + functional) = a + b. We compared between-groups outcomes using uni/multivariable logistic regression models. Results clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3-6.9) versus 11.2 (10.5-11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution 79.1% (versus 75.2%), OR 1.62 (1.09-2.41) and on favourable crisis resolution 73.8% (versus 69.6%), OR 1.54 (1.06-2.22), with shorter length of intervention, with a reduction of -5.72 (-9.75 and -1.69) days. Conclusions in our study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system.
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Affiliation(s)
- Miquel À Mas
- Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Marco Inzitari
- Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
- Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
| | - Sergi Sabaté
- Fundació Puigvert (IUNA), Barcelona, Catalonia, Spain
| | | | - Ramón Miralles
- Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
- Department of Geriatrics, Consorci Parc de Salut Mar, Barcelona, Catalonia, Spain
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22
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Forman DE, Arena R, Boxer R, Dolansky MA, Eng JJ, Fleg JL, Haykowsky M, Jahangir A, Kaminsky LA, Kitzman DW, Lewis EF, Myers J, Reeves GR, Shen WK. Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2017; 135:e894-e918. [PMID: 28336790 PMCID: PMC7252210 DOI: 10.1161/cir.0000000000000483] [Citation(s) in RCA: 203] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adults are living longer, and cardiovascular disease is endemic in the growing population of older adults who are surviving into old age. Functional capacity is a key metric in this population, both for the perspective it provides on aggregate health and as a vital goal of care. Whereas cardiorespiratory function has long been applied by cardiologists as a measure of function that depended primarily on cardiac physiology, multiple other factors also contribute, usually with increasing bearing as age advances. Comorbidity, inflammation, mitochondrial metabolism, cognition, balance, and sleep are among the constellation of factors that bear on cardiorespiratory function and that become intricately entwined with cardiovascular health in old age. This statement reviews the essential physiology underlying functional capacity on systemic, organ, and cellular levels, as well as critical clinical skills to measure multiple realms of function (eg, aerobic, strength, balance, and even cognition) that are particularly relevant for older patients. Clinical therapeutic perspectives and patient perspectives are enumerated to clarify challenges and opportunities across the caregiving spectrum, including patients who are hospitalized, those managed in routine office settings, and those in skilled nursing facilities. Overall, this scientific statement provides practical recommendations and vital conceptual insights.
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Thomazeau J, Huo Yung Kai S, Rolland Y, Sourdet S, Saffon N, Nourhashemi F. [Prognostic indices for older adults during the year following hospitalization in an acute medical ward: An update]. Presse Med 2017; 46:360-373. [PMID: 28325586 DOI: 10.1016/j.lpm.2016.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 11/15/2022] Open
Abstract
CONTEXT As population grow older, chronic diseases are more prevalent. It leads to an increase of hospitalization for acute decompensation, sometimes iterative. Management of these patients is not always clear, and care provided is not always proportional to life expectancy. Making decisions in acute situations is not easy. OBJECTIVE This review aims to list and describe mortality scores within a year following hospitalization of patients of 65 years or older. SOURCES Following keywords were searched in title and abstract of articles via an advanced search in PudMed, and by searching Mesh terms: "aged", "aged, 80 and over", "mortality", "prognosis", "hospitalized", "models, statistical", "acute geriatric ward", "frailty", "outcome". STUDIES SELECTION Studies published in English between 1985 and 2015 were selected. Last article was published in June 2015. Articles that described prognostic factors of mortality without a scoring system were excluded. Articles that focus either on patients in the Emergency Department and in Intensive Care Unit, or living in institution were excluded. RESULTS Twenty-two scores are described in 17 articles. These scores use items that refer to functional status, comorbidities, cognitive status and frailty. Scores of mortality 3 or 6 months after hospitalization are not discriminative. Few of the 1-year mortality prognostic score are discriminative with AUC≥0.7. LIMITS This review is not systematic. CONCLUSION Practical use of these scores might help management of these patients, in order to initiate appropriate reflexion and palliative care if necessary.
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Affiliation(s)
- Josephine Thomazeau
- CHU Purpan, unité résonance, douleur-soins de support, pavillon des médecines, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
| | - Samantha Huo Yung Kai
- Université Paul-Sabatier, faculté de médecine, département d'épidémiologie, économie de la santé et santé publique, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
| | - Yves Rolland
- Université Paul-Sabatier, UMR 1027 : épidémiologie et analyse en santé publique : risques, maladies chroniques et handicap, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
| | - Sandrine Sourdet
- Université Paul-Sabatier, UMR 1027 : épidémiologie et analyse en santé publique : risques, maladies chroniques et handicap, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
| | - Nicolas Saffon
- CHU Purpan, unité résonance, douleur-soins de support, pavillon des médecines, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Fati Nourhashemi
- Université Paul-Sabatier, UMR 1027 : épidémiologie et analyse en santé publique : risques, maladies chroniques et handicap, 37, allée Jules-Guesde, 31062 Toulouse cedex 9, France
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Pérez LM, Inzitari M, Quinn TJ, Montaner J, Gavaldà R, Duarte E, Coll-Planas L, Cerdà M, Santaeugenia S, Closa C, Gallofré M. Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study. PLoS One 2016; 11:e0166304. [PMID: 27829011 PMCID: PMC5102428 DOI: 10.1371/journal.pone.0166304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units. METHODS We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient's classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes). RESULTS Among 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54-8.63 and OR = 3.0, 95%CI = 1.52-5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81-10.75 and OR = 3.45, 95%CI = 1.31-9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65-17.03 and OR = 3.87, 95%CI = 1.69-8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23-0.75) and HCC (OR = 0.37, 95%CI = 0.19-0.73), for LOS lower Vs higher tertiles. CONCLUSION Our data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.
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Affiliation(s)
- Laura M. Pérez
- Convalescence and Rehabilitation Unit, Hospital Parc Sanitari Pere Virgili, Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Marco Inzitari
- Convalescence and Rehabilitation Unit, Hospital Parc Sanitari Pere Virgili, Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Joan Montaner
- Neurology Department, Neurovascular Research Laboratory (VHIR), Vall D´Hebrón Hospital, Barcelona, Spain
| | - Ricard Gavaldà
- Department of Computer Science, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar, Barcelona, Spain
| | - Laura Coll-Planas
- Fundació Salut i Envillement, Universitàt Autónoma de Barcelona, Barcelona, Spain
| | - Mercè Cerdà
- Catalan Healthcare Service, Government of Catalonia, Barcelona, Spain
| | - Sebastià Santaeugenia
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
- Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Spain
| | - Conxita Closa
- Rehabilitation Department, Corporación Fisiogestión, Barcelona, Spain
| | - Miquel Gallofré
- Pla Director Malaltia Vascular Cerebral, Department of Health, Government of Catalonia, Barcelona, Spain
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Hori T, Ogura Y, Onishi Y, Kamei H, Kurata N, Kainuma M, Takahashi H, Suzuki S, Ichikawa T, Mizuno S, Aoyama T, Ishida Y, Hirai T, Hayashi T, Hasegawa K, Takeichi H, Ota A, Kodera Y, Sugimoto H, Iida T, Yagi S, Taniguchi K, Uemoto S. Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation. World J Hepatol 2016; 8:1047-1060. [PMID: 27660671 PMCID: PMC5026996 DOI: 10.4254/wjh.v8.i25.1047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/16/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation (LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow (PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green (ICG) kinetics reflect the patient’s functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination constant (kICG) in the well-preserved allograft. The kICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.
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Stevens-Lapsley JE, Loyd BJ, Falvey JR, Figiel GJ, Kittelson AJ, Cumbler EU, Mangione KK. Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial. Clin Rehabil 2016; 30:776-85. [PMID: 26337626 PMCID: PMC8637964 DOI: 10.1177/0269215515603219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 07/29/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a progressive multicomponent physical therapy intervention in the home setting can improve functional mobility for deconditioned older adults following acute hospitalization. DESIGN Randomized controlled trial. SETTING Patient homes in the Denver, CO, metropolitan area. PARTICIPANTS A total of 22 homebound older adults age 65 and older (mean ± SD; 85.4 ±7.83); 12 were randomized to intervention group and 10 to the control group. INTERVENTION The progressive multicomponent intervention consisted of home-based progressive strength, mobility and activities of daily living training. The control group consisted of usual care rehabilitation. MEASUREMENTS A 4-meter walking speed, modified Physical Performance Test, Short Physical Performance Battery, 6-minute walk test. RESULTS At the 60-day time point, the progressive multicomponent intervention group had significantly greater improvements in walking speed (mean change: 0.36 m/s vs. 0.14 m/s, p = 0.04), modified physical performance test (mean change: 6.18 vs. 0.98, p = 0.02) and Short Physical Performance Battery scores (mean change: 2.94 vs. 0.38, p = 0.02) compared with the usual care group. The progressive multicomponent intervention group also had a trend towards significant improvement in the 6-minute walk test at 60 days (mean change: 119.65 m vs. 19.28 m; p = 0.07). No adverse events associated with intervention were recorded. CONCLUSIONS The progressive multicomponent intervention improved patient functional mobility following acute hospitalization more than usual care. Results from this study support the safety and feasibility of conducting a larger randomized controlled trial of progressive multicomponent intervention in this population. A more definitive study would require 150 patients to verify these conclusions given the effect sizes observed.
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Affiliation(s)
| | - Brian J Loyd
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Jason R Falvey
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Greg J Figiel
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | | | - Ethan U Cumbler
- Department of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Martínez-Velilla N, Cadore EL, Casas-Herrero Á, Idoate-Saralegui F, Izquierdo M. Physical Activity and Early Rehabilitation in Hospitalized Elderly Medical Patients: Systematic Review of Randomized Clinical Trials. J Nutr Health Aging 2016; 20:738-51. [PMID: 27499308 DOI: 10.1007/s12603-016-0683-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients. DESIGN Systematic review of the literature. METHODS A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described. RESULTS From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned. CONCLUSION The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.
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Affiliation(s)
- N Martínez-Velilla
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra (Navarra) Spain, Campus of Tudela, Av. de Tarazona s/n. 31500 Tudela (Navarra) Spain, Tel.: + 34 948 417876, E-mail:
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Huijberts S, Buurman BM, de Rooij SE. End-of-life care during and after an acute hospitalization in older patients with cancer, end-stage organ failure, or frailty: A sub-analysis of a prospective cohort study. Palliat Med 2016; 30:75-82. [PMID: 26376937 DOI: 10.1177/0269216315606010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many patients show deterioration in functioning and increased care needs in the last year of life. End-of-life care needs and health care utilization might differ between groups of acutely hospitalized older patients. AIM To investigate differences in geriatric conditions, advance care planning, and health care utilization in patients with cancer, organ failure, or frailty, who died within 1 year after acute hospitalization. DESIGN Prospective cohort study conducted between 2002 and 2008, with 1-year follow-up. SETTING University teaching hospital in the Netherlands. PARTICIPANTS Aged ⩾65 years, acutely hospitalized for ⩾48 h, and died within 1 year after hospitalization. At admission, all patients received a systematic comprehensive geriatric assessment. Hospital records were searched for advance care planning information and health care utilization. Differences between patient groups were calculated. RESULTS In total, 306 patients died within 1 year after acute admission (35%) and were included; 151 with cancer, 98 with end-stage organ failure, and 57 frail older persons. At hospital admission, 72% of the frail group had delirium and/or severe pre-existing cognitive impairment. The frail and organ failure group had many pre-existing disabilities. Three months post-discharge, 75% of the frail and organ failure group had died, 45% of these patients had an advance care plan in their hospital records. CONCLUSION Patients with frailty and organ failure had highest rates of geriatric conditions at hospital admission and often had missing information on advance care planning in the hospital records. There is a need to better identify end-of-life needs for these groups.
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Affiliation(s)
- Sanne Huijberts
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
In acute stroke, the major factor for recovery is the early use of thrombolysis aimed at arterial recanalization and reperfusion of ischemic brain tissue. Subsequently, neurorehabilitative training critically improves clinical recovery due to augmention of postlesional plasticity. Neuroimaging and electrophysiology studies have revealed that the location and volume of the stroke lesion, the affection of nerve fiber tracts, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks are relevant biomarkers of post-stroke recovery. However, associated disorders, such as mood disorders, epilepsy, and neurodegenerative diseases, may induce secondary cerebral changes or aggravate the functional deficits and, thereby, compromise the potential for recovery.
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Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, Centre of Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Biomedical Research Centre, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
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Abstract
Background Supporting older people’s choices to live safely and independently in the community (age-in-place) can maximize their quality of life and minimize unnecessary hospitalizations and residential care placement. Little is known of the views of older people about the aging-in-place process, and how they approach and prioritize the support they require to live in the community accommodation of their choice. Purpose To explore and synthesize the experiences and perspectives of older people planning for and experiencing aging-in-place. Methods Two purposively sampled groups of community-dwelling people aged 65+ years were recruited for individual interviews or focus groups. The interviews were semistructured, audio-recorded, and transcribed. Themes were identified by three researchers working independently, then in consort, using a qualitative thematic analysis approach. Results Forty-two participants provided a range of insights about, and strategies for, aging-in-place. Thematic saturation was reached before the final interviews. We identified personal characteristics (resilience, adaptability, and independence) and key elements of successful aging-in-place, summarized in the acronym HIPFACTS: health, information, practical assistance, finance, activity (physical and mental), company (family, friends, neighbors, pets), transport, and safety. Discussion This paper presents rich, and rarely heard, older people’s views about how they and their peers perceive, characterize, and address changes in their capacity to live independently and safely in the community. Participants identified relatively simple, low-cost, and effective supports to enable them to adapt to change, while retaining independence and resilience. The findings highlighted how successful aging-in-place requires integrated, responsive, and accessible primary health and community services.
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Affiliation(s)
- Karen Grimmer
- International Center for Allied Health Evidence, Sansom Institute, City East Campus, University of South Australia, Adelaide, SA, Australia
| | - Debra Kay
- International Center for Allied Health Evidence, Sansom Institute, City East Campus, University of South Australia, Adelaide, SA, Australia
| | - Jan Foot
- International Center for Allied Health Evidence, Sansom Institute, City East Campus, University of South Australia, Adelaide, SA, Australia
| | - Khushnum Pastakia
- International Center for Allied Health Evidence, Sansom Institute, City East Campus, University of South Australia, Adelaide, SA, Australia
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Sánchez-Rodríguez D, Miralles R, Muniesa JM, Mojal S, Abadía-Escartín A, Vázquez-Ibar O. Three measures of physical rehabilitation effectiveness in elderly patients: a prospective, longitudinal, comparative analysis. BMC Geriatr 2015; 15:142. [PMID: 26515028 PMCID: PMC4627405 DOI: 10.1186/s12877-015-0138-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rehabilitation success is measured by instruments that assess performance of activities of daily living. Guidelines on the use and choice of these instruments are lacking. The present study aimed to analyse prognostic indicators of physical rehabilitation effectiveness in elderly patients according to three rehabilitation impact indices. METHODS Prospective, longitudinal study in a post-acute care unit. The study included rehabilitation-eligible deconditioned elderly in-patients prospectively admitted to post-acute care (n = 685, aged 83.2 ± 8.3 years, mean length of stay 15 ± 9.2 days). DATA COLLECTION Premorbid health status variables (PHSV): age, sex, comorbidity (Charlson index), medical history (heart failure, pulmonary disease, cerebrovascular disease, dementia), previous living situation and pre-admission functional status (premorbid Lawton and Barthel indices). Admission health status variables (AHSV): main diagnoses, referral source, physical (Barthel-adm) and cognitive function (Pfeiffer test), undernutrition and dysphagia. OUTCOME MEASURES Absolute functional gain (AFG, admission-to-discharge Barthel change), relative functional gain (RFG, achieved percentage of potential gain) and rehabilitation efficiency index (REI, AFG over length of stay). Univariate analysis considered these parameters, along with PHSV and AHSV. Multivariate logistic regression analysis was performed for AFG ≥20, RFG ≥35 % and REI ≥ 0.50. RESULTS Greater AFG was associated with 14 variables, 8 PHSV (57.1 %) and 6 AHSV (42.8 %); greater RFG with 9 variables, 3 PHSV (33.3 %) and 6 AHSV (66.6 %); and REI with 9 variables, 4 PHSV (44.4 %) and 5 AHSV (55.5 %). Mean AFG value was 34.5 ± 15.8 in patients who achieved complete recovery (RFG 100 %, n = 189, 27.5 %) and 35.3 ± 15.0 (p = 0.593) in the remaining patients (n = 311, 45.4 %). In multivariate analysis, only Barthel-adm was related to all three rehabilitation impact indices. CONCLUSIONS Both premorbid and acute-process variables have a greater impact on AFG and REI, compared to RFG. Although AFG gives information about the degree of reduction in dependence, it does not provide clinical information about post-rehabilitation functional status (mean AFG values did not differ between patients with and without complete recovery). A future implication for evaluating rehabilitation effectiveness in elderly patients is to recommend RFG corrected by premorbid Barthel score, which is less affected by previous health conditions, as the optimum method to assess the degree to which maximum potential improvement was achieved.
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Affiliation(s)
- Dolores Sánchez-Rodríguez
- Geriatrics Department, Parc de Salut Mar Centre Fòrum Hospital del Mar (Llull, 410), Universitat Autònoma, Barcelona, (08019), Spain.
| | - Ramon Miralles
- Geriatrics Department, Parc de Salut Mar Centre Fòrum Hospital del Mar (Llull, 410), Universitat Autònoma, Barcelona, (08019), Spain.
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar Hospital de l´Esperança (Sant Josep de la Muntanya, 12), Universitat Autònoma, Barcelona, (08024), Spain.
| | - Sergio Mojal
- Biomedical Research Methods Consultant, Hospital del Mar Medical Research Institute (IMIM) (Doctor Aiguader 88), Barcelona, (08003), Spain.
| | - Anna Abadía-Escartín
- Geriatrics Department, Parc de Salut Mar Hospital de l´Esperança (Sant Josep de la Muntanya 12), Barcelona, (08024), Spain.
| | - Olga Vázquez-Ibar
- Geriatrics Department, Parc de Salut Mar Centre Fòrum Hospital del Mar (Llull, 410), Universitat Autònoma, Barcelona, (08019), Spain.
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Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Suárez N, Alonso-Renedo J, Contín KC, de Asteasu MLS, Echeverria NF, Lázaro MG, Izquierdo M. Functional and cognitive impairment prevention through early physical activity for geriatric hospitalized patients: study protocol for a randomized controlled trial. BMC Geriatr 2015; 15:112. [PMID: 26374430 PMCID: PMC4571136 DOI: 10.1186/s12877-015-0109-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older adults have reduced functional and physiological reserves, rendering them more vulnerable to the effects of hospitalization, which frequently results in failure to recover from the pre-hospitalization functional loss, new disability or even continued functional decline. Alternative care models with an emphasis on multidisciplinary and continuing care units are currently being developed. Their main objective, other than the recovery of the condition that caused admission, is the prevention of functional decline. Many studies on functional decline have discussed the available evidence regarding the effectiveness of acute geriatric units. Despite the theoretical support for the idea that mobility improvement in the hospitalized patient carries multiple benefits, this idea has not been fully translated into clinical practice. METHODS/DESIGN This study is a randomized clinical trial conducted in the Department of Geriatrics of a tertiary public hospital with 35 beds allocated. Hospitalized patients who meet the inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent exercise training programme, which will be composed of supervised progressive resistance exercise training, balance-training, and walking for 5-7 consecutive days. During the training period, patients will be trained in 20 min sessions twice a day (morning and evening). DISCUSSION Functional and cognitive impairment after and during acute hospitalization in older adults is a major determinant of the later need for health resources. If our hypothesis is correct and shows that a multicomponent, individualized and progressive exercise programme provides effective therapy for improving the functional capacity of acute elderly patients hospitalized for medical pathology versus conventional care, a change of the current system of hospitalization of elderly patients with medical conditions may be justified. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02300896 (Date of registration 19 November 2014).
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Affiliation(s)
- Nicolás Martínez-Velilla
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | - Alvaro Casas-Herrero
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | | | - Nacho Suárez
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
| | - Javier Alonso-Renedo
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | - Koldo Cambra Contín
- Navarrabiomed-Fundación Miguel Servet, Pamplona, Spain. .,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, Spain. .,IdiSNa. Navarra Institute for Health Research, Pamplona, Spain.
| | | | | | | | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
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Falvey JR, Mangione KK, Stevens-Lapsley JE. Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift. Phys Ther 2015; 95:1307-15. [PMID: 25908526 PMCID: PMC4556957 DOI: 10.2522/ptj.20140511] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/13/2015] [Indexed: 12/17/2022]
Abstract
Physical therapists often treat older adults with marked deficits in physical function secondary to an acute hospitalization. These deficits are often collectively defined as hospital-associated deconditioning (HAD). However, there is a paucity of evidence that objectively demonstrates the efficacy of physical therapy for older adults with HAD. Older adults with HAD represent a highly variable and complex population and thus may be difficult to study and develop effective interventions for using our current rehabilitation strategies. This perspective article outlines an innovative framework to operationalize and treat older adults with HAD. This framework may help therapists apply emerging exercise strategies to this population and facilitate additional research to support the total value of physical therapy for older adults in postacute care settings-with value measured not only by improvements in physical performance but perhaps also by reduced rates of disability development, rehospitalization, and institutionalization.
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Affiliation(s)
- Jason R Falvey
- J.R. Falvey, PT, DPT, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Mail Stop C244, 13121 East 17th Ave, Room 3116, Aurora, CO 80045 (USA).
| | - Kathleen K Mangione
- K.K. Mangione, PT, PhD, FAPTA, Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania
| | - Jennifer E Stevens-Lapsley
- J.E. Stevens-Lapsley, PT, PhD, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado
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Mitzner TL, Chen TL, Kemp CC, Rogers WA. Identifying the Potential for Robotics to Assist Older Adults in Different Living Environments. Int J Soc Robot 2014; 6:213-227. [PMID: 24729800 PMCID: PMC3979567 DOI: 10.1007/s12369-013-0218-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As the older adult population grows and becomes more diverse, so will their needs and preferences for living environments. Many adults over 65 years of age require some assistance [1, 2]; yet it is important for their feelings of well-being that the assistance not restrict their autonomy [3]. Not only is autonomy correlated with quality of life [4], autonomy enhancement may improve functionality [2, 5]. The goal of this paper is to provide guidance for the development of technology to enhance autonomy and quality of life for older adults. We explore the potential for robotics to meet these needs. We evaluated older adults' diverse living situations and the predictors of residential moves to higher levels of care in the United States. We also examined older adults' needs for assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and medical conditions when living independently or in a long-term care residence. By providing support for older adults, mobile manipulator robots may reduce need-driven, undesired moves from residences with lower levels of care (i.e., private homes, assisted living) to those with higher levels of care (i.e., skilled nursing).
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Appelboom G, Yang AH, Christophe BR, Bruce EM, Slomian J, Bruyère O, Bruce SS, Zacharia BE, Reginster JY, Connolly ES. The promise of wearable activity sensors to define patient recovery. J Clin Neurosci 2013; 21:1089-93. [PMID: 24534628 DOI: 10.1016/j.jocn.2013.12.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/02/2013] [Indexed: 12/30/2022]
Abstract
The recent emergence of mobile health--the use of mobile telecommunication and wireless devices to improve health outcomes, services, and research--has inspired a patient-centric approach to monitor health metrics. Sensors embedded in wearable devices are utilized to acquire greater self-knowledge by tracking basic parameters such as blood pressure, heart rate, and body temperature as well as data related to exercise, diet, and psychological state. To that end, recent studies on utilizing wireless fitness activity trackers to monitor and promote functional recovery in patients suggest that collecting up-to-date performance data could help patients regain functional independence and help hospitals determine the appropriate length of stay for a patient. This manuscript examines existing functional assessment scales, discusses the use of activity tracking sensors in evaluating functional independence, and explores the growing application of wireless technology in measuring and promoting functional recovery.
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Affiliation(s)
- Geoff Appelboom
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA.
| | - Annie H Yang
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Brandon R Christophe
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Eliza M Bruce
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Justine Slomian
- Support Unit in Epidemiology and Biostatistics, Department of Public Health Sciences, University of Liège, Liège, Belgium
| | - Olivier Bruyère
- Support Unit in Epidemiology and Biostatistics, Department of Public Health Sciences, University of Liège, Liège, Belgium
| | - Samuel S Bruce
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Jean-Yves Reginster
- Support Unit in Epidemiology and Biostatistics, Department of Public Health Sciences, University of Liège, Liège, Belgium
| | - E Sander Connolly
- Neurodigital Laboratory, Columbia University, Department of Neurological Surgery, 630 West 168th Street, New York, NY 10032, USA
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Abstract
Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI <92) and low (GNRI 92–98) nutritional risk were 36·1 and 30·6 %, respectively. At multivariable linear regression, functional status was independently associated with age (P=0·045), arm muscle area (P=0·048), the number of co-morbidities (P=0·027) and mainly with the GNRI (P<0·001). During a median follow-up of 4·7 years (25th–75th percentile 3·7–6·2), 230 (66·5 %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95% CI 1·32, 2·63; P<0·001) and low nutritional risk (HR 1·52, 95% CI 1·08, 2·14; P=0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI <92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95% CI 1·28, 2·91; P<0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly.
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Johansen I, Lindbak M, Stanghelle JK, Brekke M. Independence, institutionalization, death and treatment costs 18 months after rehabilitation of older people in two different primary health care settings. BMC Health Serv Res 2012; 12:400. [PMID: 23150906 PMCID: PMC3507889 DOI: 10.1186/1472-6963-12-400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 11/12/2012] [Indexed: 11/30/2022] Open
Abstract
Background The optimal setting and content of primary health care rehabilitation of older people is not known. Our aim was to study independence, institutionalization, death and treatment costs 18 months after primary care rehabilitation of older people in two different settings. Methods Eighteen months follow-up of an open, prospective study comparing the outcome of multi-disciplinary rehabilitation of older people, in a structured and intensive Primary care dedicated inpatient rehabilitation (PCDIR, n=202) versus a less structured and less intensive Primary care nursing home rehabilitation (PCNHR, n=100). Participants: 302 patients, disabled from stroke, hip-fracture, osteoarthritis and other chronic diseases, aged ≥65years, assessed to have a rehabilitation potential and being referred from general hospital or own residence. Outcome measures: Primary: Independence, assessed by Sunnaas ADL Index(SI). Secondary: Hospital and short-term nursing home length of stay (LOS); institutionalization, measured by institutional residence rate; death; and costs of rehabilitation and care. Statistical tests: T-tests, Correlation tests, Pearson’s χ2, ANCOVA, Regression and Kaplan-Meier analyses. Results Overall SI scores were 26.1 (SD 7.2) compared to 27.0 (SD 5.7) at the end of rehabilitation, a statistically, but not clinically significant reduction (p=0.003 95%CI(0.3-1.5)). The PCDIR patients scored 2.2points higher in SI than the PCNHR patients, adjusted for age, gender, baseline MMSE and SI scores (p=0.003, 95%CI(0.8-3.7)). Out of 49 patients staying >28 days in short-term nursing homes, PCNHR-patients stayed significantly longer than PCDIR-patients (mean difference 104.9 days, 95%CI(0.28-209.6), p=0.05). The institutionalization increased in PCNHR (from 12%-28%, p=0.001), but not in PCDIR (from 16.9%-19.3%, p= 0.45). The overall one year mortality rate was 9.6%. Average costs were substantially higher for PCNHR versus PCDIR. The difference per patient was 3528€ for rehabilitation (p<0.001, 95%CI(2455–4756)), and 10134€ for the at-home care (p=0.002, 95%CI(4066–16202)). The total costs of rehabilitation and care were 18702€ (=1.6 times) higher for PCNHR than for PCDIR. Conclusions At 18 months follow-up the PCDIR-patients maintained higher levels of independence, spent fewer days in short-term nursing homes, and did not increase the institutionalization compared to PCNHR. The costs of rehabilitation and care were substantially lower for PCDIR. More communities should consider adopting the PCDIR model. Trial registration Clinicaltrials.gov ID NCT01457300
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Affiliation(s)
- Inger Johansen
- Department of General Practice/General Practice Research Unit, Institute of Health and Society, University of Oslo, PO Box 1130, Oslo, Blindern, N-0318, Norway.
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Martin JL, Jouldjian S, Mitchell MN, Josephson KR, Alessi CA. A longitudinal study of poor sleep after inpatient post-acute rehabilitation: the role of depression and pre-illness sleep quality. Am J Geriatr Psychiatry 2012; 20:477-84. [PMID: 22617164 PMCID: PMC3377443 DOI: 10.1097/jgp.0b013e31824877c1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore the unique impact of poor sleep and symptoms of depression on sleep quality for up to 1 year after inpatient post-acute rehabilitation among older adults. DESIGN Prospective longitudinal cohort study. SETTING Two inpatient post-acute rehabilitation facilities. PARTICIPANTS A total of 245 individuals older than 65 years (mean age = 80 years, 38% women). INTERVENTIONS None. MEASUREMENTS Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) during the post-acute care stay twice to evaluate pre-illness sleep quality and sleep quality during the post-acute care stay, and again at 3-, 6-, 9-, and 12-month follow-up. Demographics, symptoms of depression, cognitive functioning, and comorbidities were also assessed. RESULTS Across time points, sleep was significantly disturbed for many individuals. Nested regression models predicting PSQI total score at 3, 6, 9, and 12 months showed that variables entered in Block 1 (age, gender, cognitive functioning, and comorbidities) were significant predictors of poor sleep at 6-month follow-up but not at 3-, 9-, or 12-month follow-up. Depression (Block 2) and pre-illness PSQI total score (Block 3) were significant predictors of PSQI total score at all follow-up time points. PSQI total score during post-acute care (Block 4) explained a significant proportion of variance only at the 3-month follow-up. CONCLUSIONS This study confirms that chronic poor sleep is common among older adults during post-acute rehabilitation and resolution of sleep disturbance after acute health events may be a lengthy process. Our findings expand understanding of the role of depressive symptoms and preexisting sleep complaints in predicting poor sleep over time among these vulnerable older adults.
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Affiliation(s)
- Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
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Martin JL, Fiorentino L, Jouldjian S, Mitchell M, Josephson KR, Alessi CA. Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults. Sleep 2011; 34:1715-21. [PMID: 22131610 DOI: 10.5665/sleep.1444] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To evaluate the association between self-reported sleep quality among older adults during inpatient post-acute rehabilitation and one-year survival. DESIGN Prospective, observational cohort study. SETTING Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration). PARTICIPANTS Older patients (aged ≥ 65 years, n = 245) admitted for inpatient post-acute rehabilitation. INTERVENTIONS None. MEASUREMENTS AND RESULTS Within one year of post-acute rehabilitation, 57 participants (23%) were deceased. Cox proportional hazards models showed that worse Pittsburgh Sleep Quality Index (PSQI) total scores during the post-acute care stay were associated with increased mortality risk when controlling for amount of rehabilitation therapy received, comorbidities, and cognitive functioning (Hazard ratio [95% CI] = 1.11 [1.02-1.20]). Actigraphically estimated sleep was unrelated to mortality risk. CONCLUSIONS Poorer self-reported sleep quality, but not objectively estimated sleep parameters, during post-acute rehabilitation was associated with shorter survival among older adults. This suggests self-reported poor sleep may be an important and potentially modifiable risk factor for negative outcomes in these vulnerable older adults. Studies of interventions to improve sleep quality during inpatient rehabilitation should therefore be undertaken, and the long-term health benefits of improved sleep should be explored.
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Affiliation(s)
- Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles, USA
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Bozzano C, Lancini I, Mei E, Lucarini M, Mastriforti R, Zuccone N, Vanni D, Pedace C. L’indice di Flugelman per individuare pazienti complessi e di difficile dimissione. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2010.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Seitz RJ, Donnan GA. Role of neuroimaging in promoting long-term recovery from ischemic stroke. J Magn Reson Imaging 2010; 32:756-72. [PMID: 20882606 DOI: 10.1002/jmri.22315] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, University Hospital Düsseldorf, and Biomedical Research Centre, Heinrich-Heine-University Düsseldorf, Germany.
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