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1.
Tijdschr Gerontol Geriatr ; 44(2): 81-9, 2013 Apr.
Artículo en Holandés | MEDLINE | ID: mdl-23494688

RESUMEN

BACKGROUND: Currently, primary care for the older, vulnerable patient is reactive, fragmented and does not meet patients needs. Given the expected increase of home-dwelling frail elderly people a transition is needed to proactive and integrated care. METHODS: In the described study, we explore two innovative interventions in primary care. First we describe a newly developed screening and monitoring program for frail elderly patients based on routine care information in general practice. Second, we describe a multidisciplinary intervention program by trained nurses for frail elderly patients in general practice. The effectiveness of the interventions is examined in a three-armed, cluster randomized trial, taking place in 58 primary care practices in Utrecht, the Bilt and Maarsenbroek. RESULTS: Three thousand eight patients are included. Primary outcome measure is the impact of the interventions on the daily activities, measured with the Katz questionnaire. Secondary outcomes measures are the quality of life, mortality, recording in a care or nursing home, visit to an emergency room or outpatient unit, recording in the hospital and volunteer caregivers tax.


Asunto(s)
Servicios de Salud para Ancianos/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud , Atención Primaria de Salud/organización & administración , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Femenino , Anciano Frágil/psicología , Servicios de Salud para Ancianos/normas , Humanos , Masculino , Países Bajos , Vigilancia de la Población , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Calidad de la Atención de Salud , Calidad de Vida
2.
AJNR Am J Neuroradiol ; 27(4): 875-8, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16611781

RESUMEN

BACKGROUND AND PURPOSE: Detection of longitudinal changes in white matter hyperintensities (WMH) by using visual rating scales is problematic. We compared a widely used visual rating scale with a volumetric method to study longitudinal white matter changes. METHODS: WMH were assessed with the visual Scheltens scale and a volumetric method in 100 elderly subjects aged 70-81 years for whom repetitive MR images were available with an interval of 33 (SD, 1.4) months. Reliability was determined by intraclass correlation coefficients. To examine the sensitivity of both the visual and volumetric method, we calculated Spearman rank correlations of WMH ratings and volume measurements with age. RESULTS: Reliability of the visual rating scale was good, whereas reliability of the volumetric measurement was excellent. For baseline measurements of WMH, we found weaker associations between WMH and age when assessed with the visual scale (r = 0.20, P = .045) than with the volumetric method (r = 0.31, P = .002). Longitudinal evaluation of WMH assessments showed regression in 26% of the subjects when analyzed with the visual rating scale against 12% of the subjects when using volumetric measurements. Compared with the visual rating, the correlation between progression in WMH and age was twice as high when using the volumetric measurement (r = 0.19, P = .062 and r = 0.39, P < .001, respectively). CONCLUSION: Volumetric measurements of WMH offer a more reliable, sensitive, and objective alternative to visual rating scales in studying longitudinal white matter changes.


Asunto(s)
Encéfalo/patología , Imagen por Resonancia Magnética , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
3.
Ned Tijdschr Geneeskd ; 145(40): 1918-21, 2001 Oct 06.
Artículo en Holandés | MEDLINE | ID: mdl-11675972

RESUMEN

There is accumulating evidence that statins reduce stroke risk, even though total cholesterol is not a risk factor for stroke. The explanation for this discrepancy is subject to discussion. It should be realised that the beneficial effects of statins on stroke risk have only been demonstrated in a select population, i.e. middle-aged men with ischaemic heart disease. Several clinical trials are underway to examine the effects of statins on stroke risk in more characteristic groups of patients who are at increased risk of developing stroke. The results of these studies should be awaited before statins are recommended for the prevention of stroke. Recently it has been reported that statins lower the risk of developing dementia. These conclusions were drawn from two cross-sectional studies. Because of the nature of the studies, only an association between the use of statins and a lower risk of developing dementia was shown, and not a causal relationship. Experimentally-controlled studies have to be designed to investigate the effect of statins on dementia.


Asunto(s)
Demencia/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Accidente Cerebrovascular/prevención & control , Anticolesterolemiantes/uso terapéutico , Arteriosclerosis/prevención & control , Ensayos Clínicos como Asunto , Estudios Transversales , Demencia/metabolismo , Humanos , Riesgo , Accidente Cerebrovascular/metabolismo
4.
J Frailty Aging ; 3(3): 166-72, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-27050063

RESUMEN

BACKGROUND: Little is known regarding the complex care needs, level of frailty or quality of life of multi-morbid older patients. OBJECTIVES: The objective of this study was to determine the relationship between frailty, complexity of care and quality of life in multi-morbid older people. DESIGN: Cross-sectional study. SETTING: Thirteen primary care practices in the Netherlands. PARTICIPANTS: 1,150 multi-morbid older people living in the community. MEASUREMENTS: The level of frailty was assessed with the Groningen Frailty Indicator. Complexity of care needs was measured with the Intermed for the Elderly Self-Assessment. Quality of life (QoL) was measured with two items of the RAND-36. RESULTS: In total, 758 out of 1,150 (65.9%) patients were frail, 8.3% had complex care needs, and the mean QoL score was 7.1 (standard deviation 1.2). Correlations between frailty and complexity, frailty and QoL, and complexity of care and QoL were 0.67, -0.51 and -0.52 (all p<0.001) respectively. All patients with complex care needs were frail, but, only 12.5% of the frail patients had complex care needs. Problems at climbing up stairs was associated with higher levels of frailty and complexity of care but with a lower QoL. CONCLUSIONS: Higher levels of frailty and complexity of care are associated with a lower QoL in multi-morbid older people. The results of this study contribute to a better understanding these concepts and are valuable for the development of tailored interventions for older persons in the future.

5.
J Neurol Neurosurg Psychiatry ; 77(2): 149-53, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16421114

RESUMEN

OBJECTIVE: To investigate the influence of deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVWMH) on progression of cognitive decline in non-demented elderly people. METHODS: All data come from the nested MRI sub-study of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). We performed a 3 year follow up study on 554 subjects of the PROSPER study using both repeated magnetic resonance imaging and cognitive testing. Cognitive decline and its dependency on WMH severity was assessed using linear regression models adjusted for sex, age, education, treatment group, and test version when applicable. RESULTS: We found that the volume of PVWMH at baseline was longitudinally associated with reduced mental processing speed (p = 0.0075). In addition, we found that the progression in PVWMH volume paralleled the decline in mental processing speed (p = 0.024). In contrast, neither presence nor progression of DWMH was associated with change in performance on any of the cognitive tests. CONCLUSION: PVWMH should not be considered benign but probably underlie impairment in cognitive processing speed.


Asunto(s)
Ventrículos Cerebrales , Trastornos del Conocimiento/diagnóstico , Demencia Vascular/diagnóstico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Pruebas Neuropsicológicas , Pravastatina/uso terapéutico , Tiempo de Reacción/fisiología , Anciano , Anciano de 80 o más Años , Infarto Cerebral/diagnóstico , Infarto Cerebral/tratamiento farmacológico , Infarto Cerebral/patología , Ventrículos Cerebrales/patología , Trastornos del Conocimiento/psicología , Demencia Vascular/tratamiento farmacológico , Demencia Vascular/patología , Progresión de la Enfermedad , Método Doble Ciego , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Estudios Longitudinales , Masculino , Pravastatina/efectos adversos , Estudios Prospectivos , Estadística como Asunto
6.
Neurology ; 64(10): 1807-9, 2005 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-15911821
7.
Neurology ; 63(9): 1699-701, 2004 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-15534259

RESUMEN

The authors investigated the progression of white matter hyperintensities (WMHs) in a large population of elderly men and women. After 3 years of follow-up, women had accumulated approximately twice as much deep WMH (DWMH) as men. The progression of periventricular WMH was the same for men and women. Gender differences may affect the pathogenesis of DWMH, which in turn may result in different clinical consequences in women.


Asunto(s)
Leucoaraiosis/diagnóstico , Leucoaraiosis/etiología , Factores Sexuales , Anciano , Encéfalo/patología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino
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