Health status and health care utilization after discharge from geriatric in-hospital stay - description of a register-based study.

BACKGROUND: This study is the first part of a register-based research program with the overall aim to increase the knowledge of the health status among geriatric patients and to identify risk factors for readmission in this population. The aim of this study was two-fold: 1) to evaluate the validity of the study cohorts in terms of health care utilization in relation to regional cohorts; 2) to describe the study cohorts in terms of health status and health care utilization after discharge. METHODS: The project consist of two cohorts with data from patient records of geriatric in-hospital stays, health care utilization data from Stockholm Regional Healthcare Data Warehouse 6 months after discharge, socioeconomic data from Statistics Sweden. The 2012 cohort include 6710 patients and the 2016 cohort, 8091 patients; 64% are women, mean age is 84 (SD 8). RESULTS: Mean days to first visit in primary care was 12 (23) and 10 (19) in the 2012 and 2016 cohort, respectively. Readmissions to hospital was 38% in 2012 and 39% in 2016. The validity of the study cohorts was evaluated by comparing them with regional cohorts. The study cohorts were comparable in most cases but there were some significant differences between the study cohorts and the regional cohorts, especially regarding amount and type of primary care. CONCLUSION: The study cohorts seem valid in terms of health care utilization compared to the regional cohorts regarding hospital care, but less so regarding primary care. This will be considered in the analyses and when interpreting data in future studies based on these study cohorts. Future studies will explore factors associated with health status and re-admissions in a population with multi-morbidity and disability.

ReCOV: recovery and rehabilitation during and after COVID-19 - a study protocol of a longitudinal observational study on patients, next of kin and health care staff.

BACKGROUND: The knowledge of the long-term consequences of covid-19 is limited. In patients, symptoms such as fatigue, decreased physical, psychological, and cognitive function, and nutritional problems have been reported. How the disease has affected next of kin, as well as staff involved in the care of patients with covid-19, is also largely unknown. The overall aim of this study is therefore three-fold: (1) to describe and evaluate predictors of patient recovery, the type of rehabilitation received and patients' experiences of specialized rehabilitation following COVID-19 infection; (2) to study how next of kin experienced the hospital care of their relative and their experiences of the psychosocial support they received as well as their psychological wellbeing; (3) to describe experiences of caring for patients with COVID-19 and evaluate psychological wellbeing, coping mechanisms and predictors for development of psychological distress over time in health care staff. METHODS: This observational longitudinal study consists of three cohorts; patients, next of kin, and health care staff. The assessments for the patients consist of physical tests (lung function, muscle strength, physical capacity) and questionnaires (communication and swallowing, nutritional status, hearing, activities of daily living, physical activity, fatigue, cognition) longitudinally at 3, 6 and 12 months. Patient records auditing (care, rehabilitation) will be done retrospectively at 12 months. Patients (3, 6 and 12 months), next of kin (6 months) and health care staff (baseline, 3, 6, 9 and 12 months) will receive questionnaires regarding, health-related quality of life, depression, anxiety, sleeping disorders, and post-traumatic stress. Staff will also answer questionnaires about burnout and coping strategies. Interviews will be conducted in all three cohorts. DISCUSSION: This study will be able to answer different research questions from a quantitative and qualitative perspective, by describing and evaluating long-term consequences and their associations with recovery, as well as exploring patients', next of kins' and staffs' views and experiences of the disease and its consequences. This will form a base for a deeper and better understanding of the consequences of the disease from different perspectives as well as helping the society to better prepare for a future pandemic.

Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study.

OBJECTIVES: To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RMR) and body composition in the frail elderly. DESIGN: Open, randomised, controlled pilot treatment study. SETTING: Community-based research centre. PARTICIPANTS: Ninety-six community-dwelling frail elderly people aged 75 and older, 40% men. INTERVENTION: Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group. MEASUREMENTS: The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months' intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals). RESULTS: The training group showed a significantly increased RMR at 3 months. Otherwise, there were no observed differences within or between the four groups. There was no correlation over time between energy intake, RMR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study ('responders') had a statistically significantly lower BMI (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the 'non-responders'. The 'non-responders' showed a small but statistically significant decrease in body fat percentage at F1, and in body weight, BMI and FFM at 9 months (F3). CONCLUSION: Individual nutrition counselling and physical exercise had no effect on energy intake, RMR or fat free mass in community-dwelling frail elderly people aged 75 and older. Interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

Investigation into the reliability and validity of the measurement of elderly people's clinical walking speed: a systematic review.

The number of available walking tests has increased dramatically over the past decades. Therefore, it is highly important to help clinicians choose the most appropriate walking test for a specific setting. This systematic review aimed to critically evaluate the reliability, validity, and responsiveness of clinical walking speed in a broad population of elderly persons living in the community, sheltered housing, or institutions. Literature searches were performed in several different databases. Key words were based on the topic of the measurement properties of performance-based clinical tools for quantifying walking. The instrument selected for review was walking speed. The methods and results of all the evaluated measurement properties were rated by using a standard checklist for appraising the qualitative attributes and measurement properties of the instrument. A total number of 3,781 abstracts were reviewed, and 86 articles were chosen for inclusion. Habitual walking speed seems to be highly reliable in community-dwelling people and residents in mixed settings. There have not been any studies that accord with our inclusion and exclusion criteria that have evaluated the reliability of maximum walking speed in an aged population. Walking speed is a highly valid test, both at habitual and maximum speed. Few studies gave information about responsiveness for walking speed, which means that these results cannot be evaluated properly. Habitual walking speed is a reliable measure, but maximum walking speed needs further evaluation. Both habitual and maximum walking speeds are valid instruments, and they predict death, hospitalization/institutionalization, and decline in mobility.

Muscle strength testing with one repetition maximum in the arm/shoulder for people aged 75 + - test-retest reliability.

OBJECTIVE: To investigate the reliability of a muscle strength test of the arm/shoulder in elderly people, aged 75 and older, and to compare subjects with and without previous muscle strength training experience. DESIGN: Reliability study - test-retest. SETTING: Research centre for the elderly. MAIN MEASURES: One repetition maximum (1 RM) was measured using an arm/shoulder strength-training device (Pull Down, Norway). Two measurements were conducted, approximately one week apart. RESULTS: Forty people were included in the study and 34 completed both sessions. Eleven participants had previous muscle strength training experience on the indicated device. There was a high correlation between the test sessions, r = 0.97 for both groups. The analysis of 95% limits of agreement for the mean difference was -4.3/+6.9 kg for the group without and -3.0/+6.4 kg for the group with previous experience, respectively. CONCLUSION: One repetition maximum evaluated by the Pull Down device seems to be a reliable and safe method for dosing and evaluating a muscle strength training programme for elderly people. The observed variation of approximately -4/+7 kg cannot be interpreted as an effect of muscle training, but is more likely an effect of learning, fluctuations in daily condition and/or motivation.