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BACKGROUND: Vertebral and pelvic fractures are associated with a significant burden of negative health and psychosocial outcomes. The number of vertebral and pelvic fractures is increasing in an aging society. Vertebral and pelvic fractures are increasingly significant injuries for individuals and society. However, few epidemiological studies have examined the clinical course of vertebral and pelvic fractures. This is the protocol for a study that observes patients who have been admitted to the hospital with an incident vertebral or pelvic fracture for a period of 12 months. METHODS: The observational cohort study is conducted at three study sites in Germany. Patients affected by vertebral or pelvic fractures are recruited within the first few days of hospital admission. Data collection takes place at four-time points: baseline, before discharge, after 4 months, and after 12 months after admission to the hospital. Particular emphasis is laid on the assessment of the fall mechanisms, physical function, physical activity, life space, mobility, treatment approach, and quality of life. The hospital stay involves the collection of biomaterials (blood and urine). DISCUSSION: The study aims to enhance understanding of the clinical progression and outcomes in patients with fractures in the vertebrae or pelvis.
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Huesos Pélvicos , Calidad de Vida , Fracturas de la Columna Vertebral , Humanos , Fracturas de la Columna Vertebral/epidemiología , Huesos Pélvicos/lesiones , Anciano , Femenino , Masculino , Estudios de Cohortes , Alemania/epidemiología , Fracturas Óseas/epidemiología , Anciano de 80 o más Años , Accidentes por Caídas/estadística & datos numéricosRESUMEN
Falls are a significant health problem in older people, so preventing them is essential. Since falls are often a consequence of improper reaction to gait disturbances, such as slips and trips, their detection is gaining attention in research. However there are no studies to date that investigated perturbation detection, using everyday wearable devices like hearing aids or smartphones at different body positions. Sixty-six study participants were perturbed on a split-belt treadmill while recording data with hearing aids, smartphones, and professional inertial measurement units (IMUs) at various positions (left/right ear, jacket pocket, shoulder bag, pants pocket, left/right foot, left/right wrist, lumbar, sternum). The data were visually inspected and median maximum cross-correlations were calculated for whole trials and different perturbation conditions. The results show that the hearing aids and IMUs perform equally in measuring acceleration data (correlation coefficient of 0.93 for the left hearing aid and 0.99 for the right hearing aid), which emphasizes the potential of utilizing sensors in hearing aids for head acceleration measurements. Additionally, the data implicate that measurement with a single hearing aid is sufficient and a second hearing aid provides no added value. Furthermore, the acceleration patterns were similar for the ear position, the jacket pocket position, and the lumbar (correlation coefficient of about 0.8) or sternal position (correlation coefficient of about 0.9). The correlations were found to be more or less independent of the type of perturbation. Data obtained from everyday wearable devices appears to represent the movements of the human body during perturbations similar to that of professional devices. The results suggest that IMUs in hearing aids and smartphones, placed at the trunk, could be well suited for an automatic detection of gait perturbations.
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Falls in older individuals often result from unexpected balance disturbances during walking, necessitating the analysis of recovery strategies for effective falls prevention. This becomes particularly crucial for individuals with cognitive impairment, who face a higher fall risk compared to cognitively healthy adults. Hence, our study aimed to compare the recovery response to standardized walking perturbations on a treadmill between older adults with cognitive impairment and cognitively healthy older adults. 36 individuals with a recent history of a severe fall, leading to an emergency department visit without subsequent admission, were stratified into two groups (with and without probable cognitive impairment) based on scores of the Montreal Cognitive Assessment. Recovery performance was quantified using force plate data from a perturbation treadmill (M-Gait, Motek Medical B.V., Amsterdam, the Netherlands), specifically evaluating the number of steps needed to restore step length and width to pre perturbation baseline across two trials of nine different perturbations. Individuals with cognitive impairment (n = 18, mean age: 74.7) required significantly (p = 0.045, Cohen's d = 0.69) more steps to recover total steps after perturbations compared to cognitively healthy individuals (n = 18, mean age: 69.7). While step width recovery was similar between the groups, those with probable cognitive impairment required significantly more steps to recover their step length (p = 0.039, Cohen's d = 0.72). Thus, our findings indicate that older adults with probable cognitive impairment manifest inferior gait adaptability, especially in adapting step length, potentially underscoring a critical aspect for effective falls prevention in this population.
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Accidentes por Caídas , Disfunción Cognitiva , Equilibrio Postural , Humanos , Accidentes por Caídas/prevención & control , Anciano , Masculino , Femenino , Equilibrio Postural/fisiología , Disfunción Cognitiva/fisiopatología , Anciano de 80 o más Años , Marcha/fisiología , Caminata/fisiología , Adaptación Fisiológica/fisiología , Prueba de EsfuerzoRESUMEN
PURPOSE: Incident delirium is a frequent complication among hospitalized older people with COVID-19, associated with increased length of hospital stay, higher morbidity and mortality rates. Although delirium is preventable with early detection, systematic assessment methods and predictive models are not universally defined, thus delirium is often underrated. In this study, we tested the role of the Multidimensional Prognostic Index (MPI), a prognostic tool based on Comprehensive Geriatric Assessment, to predict the risk of incident delirium. METHODS: Hospitalized older patients (≥ 65 years) with COVID-19 infection were enrolled (n = 502) from ten centers across Europe. At hospital admission, the MPI was administered to all the patients and two already validated delirium prediction models were computed (AWOL delirium risk-stratification score and Martinez model). Delirium occurrence during hospitalization was ascertained using the 4A's Test (4AT). Accuracy of the MPI and the other delirium predictive models was assessed through logistic regression models and the area under the curve (AUC). RESULTS: We analyzed 293 patients without delirium at hospital admission. Of them 33 (11.3%) developed delirium during hospitalization. Higher MPI score at admission (higher multidimensional frailty) was associated with higher risk of incident delirium also adjusting for the other delirium predictive models and COVID-19 severity (OR = 12.72, 95% CI = 2.11-76.86 for MPI-2 vs MPI-1, and OR = 33.44, 95% CI = 4.55-146.61 for MPI-3 vs MPI-1). The MPI showed good accuracy in predicting incident delirium (AUC = 0.71) also superior to AWOL tool, (AUC = 0.63) and Martinez model (AUC = 0.61) (p < 0.0001 for both comparisons). CONCLUSIONS: The MPI is a sensitive tool for early identification of older patients with incident delirium.
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COVID-19 , Delirio , Evaluación Geriátrica , Hospitalización , Humanos , Delirio/diagnóstico , Delirio/epidemiología , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/diagnóstico , Anciano , Masculino , Femenino , Estudios Prospectivos , Pronóstico , Hospitalización/estadística & datos numéricos , Evaluación Geriátrica/métodos , Anciano de 80 o más Años , Europa (Continente)/epidemiología , Medición de Riesgo , SARS-CoV-2 , Incidencia , Factores de RiesgoRESUMEN
INTRODUCTION: Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge. METHODS: The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n = 69 OACH (72.0 ± 8.2 years) and n = 76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the "SeFallED" study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age. RESULTS: The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (
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Accidentes por Caídas , Disfunción Cognitiva , Marcha , Evaluación Geriátrica , Equilibrio Postural , Humanos , Equilibrio Postural/fisiología , Anciano , Masculino , Femenino , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/diagnóstico , Anciano de 80 o más Años , Marcha/fisiología , Evaluación Geriátrica/métodosRESUMEN
BACKGROUND: Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT). METHODS: Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system. RESULTS: Both the SPPB total score improved significantly (p = < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p = < 0.001), walk ratio (p = 0.011), step length (p = < 0.001), stride length (p = < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible. CONCLUSIONS: SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care. TRIAL REGISTRATION: DRKS00026191.
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Ejercicio Físico , Pacientes Internos , Humanos , Anciano , Proyectos Piloto , Caminata , Terapia por Ejercicio/métodos , Marcha , Equilibrio PosturalRESUMEN
BACKGROUND: Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited. OBJECTIVE: Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study. METHODS: The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics. RESULTS: Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed. CONCLUSION: ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory. TRIAL REGISTRATION: DRKS00025949.
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Servicio de Urgencia en Hospital , Hospitalización , Anciano , Humanos , Selección de Paciente , Accidentes por Caídas/prevención & controlRESUMEN
BACKGROUND: Accidental falls are a major health issue in older people. One significant and potentially modifiable risk factor is reduced gait stability. Clinicians do not have sophisticated kinematic options to measure this risk factor with simple and affordable systems. Depth-imaging with AI-pose estimation can be used for gait analysis in young healthy adults. However, is it applicable for measuring gait in older adults at a risk of falling? METHODS: In this methodological comparison 59 older adults with and without a history of falls walked on a treadmill while their gait pattern was recorded with multiple inertial measurement units and with an Azure Kinect depth-camera. Spatiotemporal gait parameters of both systems were compared for convergent validity and with a Bland-Altman plot. RESULTS: Correlation between systems for stride length (r=.992, [Formula: see text]) and stride time (r=0.914, [Formula: see text]) was high. Bland-Altman plots revealed a moderate agreement in stride length (-0.74 ± 3.68 cm; [-7.96 cm to 6.47 cm]) and stride time (-3.7±54 ms; [-109 ms to 102 ms]). CONCLUSION: Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect cameras. Affordable and small depth-cameras agree with IMUs for gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact. Clinical Translation Statement- Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect. Affordable and small depth-cameras, developed for various purposes in research and industry, agree with IMUs in clinical gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy to assess function or monitor changes in gait is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact.
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Accidentes por Caídas , Análisis de la Marcha , Humanos , Anciano , Accidentes por Caídas/prevención & control , Marcha , Caminata , Prueba de Esfuerzo/métodosRESUMEN
The closure of all sports facilities during the two lockdowns in Germany favoured a reduction of leisure time physical activity during the COVID-19 pandemic. The aim of this study was to compare leisure time physical activity during the 1st and 2nd lockdown and to examine exercise performance before and after resumption of exercise. Leisure time physical activity was measured by the Longitudinal Urban Cohort Ageing Study (LUCAS) functional ability index and energy expenditure in the Minnesota Leisure Time Physical Activity Questionnaire. Participants' exercise performance was extracted from a chip-controlled fitness circuit. Differences were tested for statistical significance using Friedman tests. 35 participants above 60 years were included from the Oldenburg area (20 women, 15 men, mean age and standard deviation 71±6 years). The decline in energy expenditure was higher during the 2nd lockdown (1st lockdown: Median -55.7 kcal.day-1, Q0.25-121.3 kcal.day-1, Q0.75 132.9 kcal.day-1; 2nd lockdown: Median -119.7 kcal.day-1, Q0.25-255.6 kcal.day-1, Q0.75-65.1 kcal.day-1; Friedman test: p<0.001, n = 35, W = 0.262). The time spent in the fitness circuit decreased from lockdown to lockdown as well as the number of participants exercising there. Intense activities were performed during the two lockdowns by only 7 and 3 participants, respectively, and were not resumed by two-thirds of the participants after the 2nd lockdown. During the 1st lockdown, exercise performance on resistance exercise devices increased in most of them, while it decreased by 1 to 7% during the 2nd lockdown. The lockdowns limited leisure time physical activity in older adults. This was more pronounced during the lockdown in winter 2020/2021, when participants engaged less in outdoor activities. Therefore, measures should be taken to maintain physical activity and muscle strength, especially during winter months, with a home-based training, if visiting gyms is not possible.
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COVID-19 , Pandemias , Masculino , Femenino , Humanos , Anciano , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles , Ejercicio Físico , Alemania/epidemiología , Actividades RecreativasRESUMEN
Introduction: Falls are one of the most common causes of emergency hospital visits in older people. Early recognition of an increased fall risk, which can be indicated by the occurrence of near-falls, is important to initiate interventions. Methods: In a study with 87 subjects we simulated near-fall events on a perturbation treadmill and recorded them with inertial measurement units (IMU) at seven different positions. We investigated different machine learning models for the near-fall detection including support vector machines, AdaBoost, convolutional neural networks, and bidirectional long short-term memory networks. Additionally, we analyzed the influence of the sensor position on the classification results. Results: The best results showed a DeepConvLSTM with an F1 score of 0.954 (precision 0.969, recall 0.942) at the sensor position "left wrist." Discussion: Since these results were obtained in the laboratory, the next step is to evaluate the suitability of the classifiers in the field.
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Due to demographic ageing and medical progress, the number and proportion of older organ donors and recipients is increasing. At the same time, the medical and ethical significance of ageing and old age for organ transplantation needs clarification. Advanced age is associated with the frailty syndrome that has a negative impact on the success of organ transplantation. However, there is emerging evidence that frailty can be modified by suitable prehabilitation measures. Against this backdrop, we argue that decision making about access to the transplant waiting list and the allocation of donor organs should integrate geriatric expertise in order to assess and manage frailty and impairments in functional capacity. Prehabilitation should be implemented as a new strategy for pre-operative conditioning of older risk patients' functional capacity. From an ethical point of view, advanced chronological age per se should not preclude the indication for organ transplantation and the allocation of donor organs.
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Fragilidad , Trasplante de Órganos , Obtención de Tejidos y Órganos , Humanos , Anciano , Ejercicio Preoperatorio , Evaluación Geriátrica , Anciano Frágil , Donantes de Tejidos , Listas de EsperaRESUMEN
BACKGROUND: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. OBJECTIVE: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. METHODS: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. RESULTS: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. CONCLUSIONS: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.
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COVID-19 , Fragilidad , Humanos , Femenino , Anciano , Anciano de 80 o más Años , Estudios Prospectivos , Fragilidad/tratamiento farmacológico , Pronóstico , Tratamiento Farmacológico de COVID-19 , Evaluación Geriátrica/métodosRESUMEN
INTRODUCTION: During the first wave of the COVID-19 pandemic in March 2020, worldwide restrictions in social life, including the closure of sport facilities, led to a reduction of physical activity and subjective well-being. The aim of this study is to describe physical training habits, and subjective well-being in relation to objective training data from a chip-controlled fitness circuit in the rural area of Oldenburg, Germany. MATERIALS AND METHODS: Overall, 35 older adults (20 women 71 ± 6 y/o and 15 men, 72 ± 7 y/o), regularly exercising in a chip-controlled fitness circuit before the lockdown in March 2020, were interviewed. The training data from February to August 2020 from six strength and two endurance exercise devices were extracted and compared to data before and up to three months after the lockdown. Additionally, participants' personal characteristics, physical activities and quality of life before, during, and after the first lockdown were assessed. RESULTS: The leg score (pre, postJune, postJuly, postAugust: 1207 ± 469 kg, 1248 ± 477 kg, 1254 ± 516 kg, 1283 ± 493 kg; p = 0.137) and endurance scores (ergometer: 0.93 ± 0.35 min- 1 · watt- 1, 0.86 ± 0.31 min- 1 · watt- 1, 0.86 ± 0.31 min- 1 · watt- 1, 0.85 ± 0.28 min- 1 · watt- 1 ; p = 0.442) were not significantly different, in contrast to the rowing score (1426 ± 582 kg, 1558 ± 704 kg, 1630 ± 757 kg, 1680 ± 837 kg; p < 0.001). A significant increase of total energy expenditure (p = 0.026), mainly through gardening, walking, and bike riding was observed. The greatest personal limitation reported, was the loss of social contacts. CONCLUSION: The presented data did not show a decrease in training performance, but a slight trend towards an increase. A compensatory increase in regular outdoor activities seems to have a protective effect against a loss of training performance and may have the potential to stabilize subjective well-being during lockdown periods.
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COVID-19 , Calidad de Vida , Masculino , Humanos , Femenino , Anciano , Pandemias , COVID-19/epidemiología , Control de Enfermedades Transmisibles , Aptitud Física , Rendimiento Físico FuncionalRESUMEN
Introduction: In the context of the COVID-19 pandemic in Germany, governmental restrictions led to the closure of sports facilities for several months. To date, only subjective and fitness-tracking related data on physical activity during the pandemic are available. Using data of a chip-controlled fitness circuit, training data as a measure of physical performance before and after the lockdown during the first wave of the COVID-19 pandemic will show the impact of the training interruption on exercise performance in middle-aged and older adults. The re-training data are analyzed, to extract practical recommendations. Methods: Objective training data of 17,450 participants [11,097 middle-aged (45-64 yrs), 6,353 older (≥65 yrs)] were exported from chip-controlled milon® fitness circuit systems before and after the first COVID-19 related lockdown in Germany. The change in the product of training weight (sum of lifting and lowering the training weight) and repetitions on the leg extension resistance exercise device (leg score) between the last three training sessions before the lockdown and the first ten training sessions after individual training resumption as well as the last training session before the second lockdown in October 2020 was analyzed. Results: Participants who trained with high intensity before the lockdown, experienced deleterious effects of the training interruption (middle-aged group: -218 kg, older group: ~-230.8 kg; p < 0.001 for change in leg score from to post-lockdown) with no age effect. Participants training with a leg score of more than 3,000 kg did not resume their leg score until the second lockdown. Conclusion: The interruption of training in a fitness circuit with combined resistance and endurance training due to the lockdown affected mainly those participants who trained at high intensity. Apparently, high-intensity training could not be compensated by home-based training or outdoor activities. Concepts for high-intensity resistance training during closure of sports facilities are needed to be prepared for future periods of high incidence rates of infectious diseases, while especially vulnerable people feel uncomfortable to visit sports facilities. Trial registration: Identifier, DRKS00022433.
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COVID-19 , Pandemias , Persona de Mediana Edad , Humanos , Anciano , Pandemias/prevención & control , Distanciamiento Físico , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles , Aptitud Física , Ejercicio FísicoRESUMEN
OBJECTIVE: To investigate proportions of hospitalized nursing home residents during periods of increased vulnerability, ie, the first 6 months after institutionalization and the last 6 months before death, and comparing the figures between Germany and the Netherlands. DESIGN: Systematic review, registered in PROSPERO (CRD42022312506). SETTING AND PARTICIPANTS: Newly admitted or deceased residents. METHODS: We searched MEDLINE via PubMed, EMBASE, and CINAHL from inception through May 3, 2022. We included all observational studies that reported the proportions of all-cause hospitalizations among German or Dutch nursing home residents during these defined vulnerable periods. Study quality was assessed using the Joanna Briggs Institute's tool. We assessed study and resident characteristics and outcome information and descriptively reported them separately for both countries. RESULTS: We screened 1856 records for eligibility and included 9 studies published in 14 articles (Germany: 8; Netherlands: 6). One study for each country investigated the first 6 months after institutionalization. A total of 10.2% of the Dutch and 42.0% of the German nursing home residents were hospitalized during this time. Overall, 7 studies reported on in-hospital deaths, with proportions ranging from 28.9% to 29.5% for Germany and from 1.0% to 16.3% for the Netherlands. Proportions for hospitalization in the last 30 days of life ranged from 8.0% to 15.7% (Netherlands: n = 2) and from 48.6% to 58.0% (Germany: n = 3). Only German studies assessed the differences by age and sex. Although hospitalizations were less common at older ages, they were more frequent in male residents. CONCLUSIONS AND IMPLICATIONS: During the observed periods, the proportion of nursing homes residents being hospitalized differed greatly between Germany and the Netherlands. The higher figures for Germany can probably be explained by differences in the long-term care systems. There is a lack of research, especially for the first months after institutionalization, and future studies should examine the care processes of nursing home residents following acute events in more detail.
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Cuidados a Largo Plazo , Casas de Salud , Humanos , Masculino , Hospitalización , Etnicidad , AlemaniaRESUMEN
The prevalence of dementia increases with age. In rare cases, people younger than 65 years old are also affected, with substantial consequences for the professional life. The symptoms depend on the form of dementia and can vary individually. Impairment of short-term memory is not always in the foreground and other neurocognitive domains, such as the disturbance of executive functions can have a significant impact on the ability to cope with everyday life. Pathophysiologically, neurodegenerative dementias with the major forms of Alzheimer's dementia, Lewy body dementia, and frontotemporal dementia are distinguished from vascular dementias. Mixed forms are common. There is no curative treatment, but progression can be slowed by nonpharmacological measures and, especially in Alzheimer's dementia, by pharmacological treatment. Appropriate measures can promote independence and autonomy for as long as possible; however, in the course of the disease restrictions in the extended activities of independent living will initially occur, such as banking transactions, use of means of transport and, in the further course, also in the basic activities of daily living. Legal capacity and the ability to consent to health interventions are restricted sooner or later; however, this must always be evaluated for the specific situation and is not generally the case with the diagnosis of dementia. Instruments such as living wills, identification of a health care proxy, and advanced care planning should be used at an early stage. To decrease family caregiver burden with the increased risk of developing depression, supportive, accompanying measures and education are of great importance.
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Enfermedad de Alzheimer , Demencia Frontotemporal , Enfermedad por Cuerpos de Lewy , Humanos , Anciano , Enfermedad de Alzheimer/diagnóstico , Actividades Cotidianas , Enfermedad por Cuerpos de Lewy/psicología , Cuidadores/psicología , Demencia Frontotemporal/diagnósticoRESUMEN
BACKGROUND: When older adults fall below the thresholds of functional geriatric assessment (FGA), they may already be at risk of mobility impairment. A reduction in (jumping) power could be an indication of functional decline, one of the main risk factors for falls. OBJECTIVE: This paper explores whether six-month delta (∆) values of muscle power can predict 24-month follow-up FGA in older adults. METHODS: This observational study of independent, healthy, high-performing community-dwelling adults aged 70 + years involved FGA (mobility, balance, and endurance tests) at baseline (t0), after 6 months (t1), and after 24 months (t2); maximum jumping power (max JP) was determined at t0 and t1. A predictive linear model was developed in which the percentage change of Δmax JP0,1 was transferred to all FGA (t0) values. The results were compared with measured FGA values at t2 via sensitivity and specificity in terms of the clinically meaningful change (CMC) or the minimal detectable change (MDC). RESULTS: In 176 individuals (60% female, mean age 75.3 years) the mean percentage (SD) between predicted and measured FGA ranged between 0.4 (51.3) and 18.11 (51.9). Sensitivity to identify the CMC or MDC of predicted FGA tests at t2 ranged between 17.6% (Timed up and go) and 75.0% (5-times-chair-rise) in a test-to-test comparison and increased to 97.6% considering clinically conspicuousness on global FGA. CONCLUSION: The potential of jumping power to predict single tests of FGA was low regarding sensitivity and specificity of CMC (or MDC). 6 months Δmax JP seem to be suitable for predicting physical function, if the measured and predicted tests were not compared at the test level, but globally, in the target group in the long term.
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Evaluación Geriátrica , Vida Independiente , Femenino , Humanos , Anciano , Masculino , Estudios de Seguimiento , Estado de Salud , Estudios de CohortesRESUMEN
OBJECTIVE: Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. DESIGN: Longitudinal, multicenter study. SETTINGS AND PARTICIPANTS: 502 older people hospitalized for COVID-19 in 10 European hospitals. METHODS: MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). RESULTS: Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. CONCLUSIONS AND IMPLICATIONS: MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.
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COVID-19 , Anciano , Anciano de 80 o más Años , COVID-19/terapia , Evaluación Geriátrica/métodos , Humanos , Pronóstico , Estudios Prospectivos , Respiración ArtificialRESUMEN
BACKGROUND: Falls are a leading cause for emergency department (ED) visits in older adults. As a fall is associated with a high risk of functional decline and further falls and many falls do not receive medical attention, the ED is ideal to initiate secondary prevention, an opportunity generally not taken. Data on trajectories to identify patients, who would profit the most form early intervention and to examine the impact of a fall event, are lacking. To tailor interventions to the individual's needs and preferences, and to address the whole scope of fall risks, we developed this longitudinal study using an extensive assessment battery including dynamic balance and aerobic fitness, but also sensor-based data. Additionally, participative research will contribute valuable qualitative data, and machine learning will be used to identify trips, slips, and falls in sensor data during daily life. METHODS: This is a mixed-methods study consisting of four parts: (1) an observational prospective study, (2) a randomized controlled trial (RCT) to explore whether a diagnostic to measure reactive dynamic balance influences fall risk, (3) machine learning approaches and (4) a qualitative study to explore patients' and their caregivers' views. We will target a sample size of 450 adults of 60 years and older, who presented to the ED of the Klinikum Oldenburg after a fall and are not hospitalized. The participants will be followed up over 24 months (within four weeks after the ED, after 6, 12 and 24 months). We will assess functional abilities, fall risk factors, participation, quality of life, falls incidence, and physical activity using validated instruments, including sensor-data. Additionally, two thirds of the patients will undergo intensive testing in the gait laboratory and 72 participants will partake in focus group interviews. DISCUSSION: The results of the SeFallED study will be used to identify risk factors with high predictive value for functional outcome after a sentinel fall. This will help to (1) establish a protocol adapted to the situation in the ED to identify patients at risk and (2) to initiate an appropriate care pathway, which will be developed based on the results of this study. TRIAL REGISTRATION: DRKS (Deutsches Register für klinische Studien, DRKS00025949 ). Prospectively registered on 4th November, 2021.
Asunto(s)
Servicio de Urgencia en Hospital , Marcha , Anciano , Terapia por Ejercicio , Humanos , Estudios Observacionales como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVE: Restrictions in public life during the COVID-19 pandemic mainly addressed the safety of high-risk older multimorbid patients to protect them from infection. Nevertheless, detrimental aspects of the lockdown for older people are a reduction in physical activity and limited access to physiotherapy, which are likely to have a negative impact on the health status. This study examined the feasibility of video-based physiotherapy (VT) and the subjective rating of VT by patients and therapists. METHODS: From April to June 2020, 4 facilities with 9 patients (6 women, 64-82 years old) participated in the study and were provided with technical equipment. Semistructured telephone interviews were conducted in eight patients to assess physical activity, functional ability and participation before and during the restrictions. Both patients and therapists were asked about their subjective experiences with VT. RESULTS: A total of 92 VT sessions took place. Performance of the exercises and comprehension of instructions were rated as good to very good. The level of acceptance was high. Of the patients four described a perceived reduction in their physical activities due to the public restrictions; however, in the questionnaires no substantial differences in participation and physical activity were found. DISCUSSION: The use of VT is feasible in older patients. Only minor technical support is needed. In pandemic situations or in other contexts VT appears to be a promising supplement or alternative to normal physiotherapy. Further studies are needed to identify suitable patient groups, to prove efficacy and to develop further content-related aspects of VT.