The Adjuvanted Recombinant Zoster Vaccine Confers Long-Term Protection Against Herpes Zoster: Interim Results of an Extension Study of the Pivotal Phase 3 Clinical Trials ZOE-50 and ZOE-70.

BACKGROUND: This ongoing follow-up study evaluated the persistence of efficacy and immune responses for 6 additional years in adults vaccinated with the glycoprotein E (gE)-based adjuvanted recombinant zoster vaccine (RZV) at age ≥50 years in 2 pivotal efficacy trials (ZOE-50 and ZOE-70). The present interim analysis was performed after ≥2 additional years of follow-up (between 5.1 and 7.1 years [mean] post-vaccination) and includes partial data for year (Y) 8 post-vaccination. METHODS: Annual assessments were performed for efficacy against herpes zoster (HZ) from Y6 post-vaccination and for anti-gE antibody concentrations and gE-specific CD4[2+] T-cell (expressing ≥2 of 4 assessed activation markers) frequencies from Y5 post-vaccination. RESULTS: Of 7413 participants enrolled for the long-term efficacy assessment, 7277 (mean age at vaccination, 67.2 years), 813, and 108 were included in the cohorts evaluating efficacy, humoral immune responses, and cell-mediated immune responses, respectively. Efficacy of RZV against HZ through this interim analysis was 84.0% (95% confidence interval [CI], 75.9-89.8) from the start of this follow-up study and 90.9% (95% CI, 88.2-93.2) from vaccination in ZOE-50/70. Annual vaccine efficacy estimates were >84% for each year since vaccination and remained stable through this interim analysis. Anti-gE antibody geometric mean concentrations and median frequencies of gE-specific CD4[2+] T cells reached a plateau at approximately 6-fold above pre-vaccination levels. CONCLUSIONS: Efficacy against HZ and immune responses to RZV remained high, suggesting that the clinical benefit of RZV in older adults is sustained for at least 7 years post-vaccination. Clinical Trials Registration. NCT02723773.

Trajectories of social support are associated with health outcomes and depressive symptoms among older Taiwanese adults with diabetes following hip-fracture surgery.

OBJECTIVE: This study examined trajectories of social support and their relationships with health outcomes over 2 years post hip-fracture surgery for older adults with diabetes mellitus (DM). METHODS: This was a secondary analysis of data derived from a clinical trial, which included 158 hip fractured older adults with DM who had completed the Medical Outcomes Study Social Support Survey at 1-, 12-, 18-, and 24-months following hospital discharge. Health outcomes for self-care, physical and nutritional status, mental health, and depression were assessed at 3-month intervals up to 24-months after hospital discharge. Trajectories of social support were derived with latent class analysis while hierarchical linear models were employed to assess the associations of social-support trajectory with health outcomes. RESULTS: Four social-support trajectories were derived for persons with DM following hip-fracture surgery: poor and declining (n = 18, 11.4%), moderate and stable (n = 29, 18.4%), high but declining (n = 34, 21.5%), and high and stable (n = 77, 48.7%). Relative to those in the poor and declining group, participants in the high and stable trajectory group performed better in Activities of Daily Living and quadriceps muscle power, had better mental Health-Related Quality of Life and nutritional status, and had fewer depressive symptoms. These differences persisted over the 2 years following hospital discharge. CONCLUSIONS: These results suggest social support for persons with DM should be continually assessed following hip-fracture surgery.

Better nutrition trajectory improves recovery following a hip fracture surgery for older persons with diabetes mellitus.

BACKGROUND: Influences of nutritional status on hip fractured persons with diabetes mellitus (DM) following surgery have not been reported. AIMS: To explore the trajectory groups of nutritional status and their influences on post-operative recovery for older persons with hip fracture and DM. METHODS: A total of 169 patients with DM and hip fracture from a clinical trial were included in this analysis. Mini Nutritional Assessment was used to assess the nutritional status of the participants. Outcome variables included self-care ability, muscle strength, depressive symptoms, health related quality of life, and cognitive function, which were collected before discharge and 1-, 3-, 6-, 12-, 18-, and 24-months following hospital discharge. RESULTS: Among hip fractured older persons with DM, within two years following surgery there were three nutritional trajectory groups: malnourished (28.3%), at-risk of malnutrition (41.9%) and well-nourished (29.8%). A decline in nutritional status, especially for the malnourished group, was seen in the second year. A better nutritional trajectory was associated with better recovery outcomes, including self-care ability, health related quality of life, cognitive function and less depressive symptoms. DISCUSSION: Close to 30% of hip fractured persons with DM were considered to have a malnourished trajectory over 2 years following surgery. A poor nutritional trajectory was associated with poor mental health and physical recovery. CONCLUSIONS: Continuous nutrition assessment during the first 2 years following hip fracture surgery for older persons with DM is important. Development and implementation of interventions targeting the malnourished trajectory group are suggested.

The relationship between preoperative American Society of Anesthesiologists Physical Status Classification scores and functional recovery following hip-fracture surgery.

BACKGROUND: Little is known about the relationship of the American Society of Anesthesiologists Physical Status Classification scores (ASA scores) on patient outcomes following hip fracture surgery in Asian countries. Therefore, this study explored the association of patients' preoperative ASA scores on trajectories of recovery in physical functioning and health outcomes during the first year following postoperative discharge for older adults with hip-fracture surgery in Taiwan. METHODS: The data for this study was generated from three prior studies. Participants (N = 226) were older hip-fracture patients from an observational study (n = 86) and two clinical trials (n = 61 and n = 79). Participants were recruited from the trauma wards of one medical center in northern Taiwan and data was collected prior to discharge and at 1, 3, 6, and 12 months after hospital discharge. Participants were grouped as ASA class 1-2 (50.5%; ASA Class 1, n = 7; ASA Class 2, n = 107) and ASA class 3 (49.5%, n = 112). Measures for mortality, service utilization, activities of daily living (ADL), measured by the Chinese Barthel Index, and health related quality of life, measured by Medical Outcomes Study Short Form-36, were assessed for the two groups. Generalized estimating equations (GEE) were used to analyze the changes over time for the two groups. RESULTS: During the first year following hip-fracture surgery, ASA class 1-2 participants had significantly fewer rehospitalizations (6%, p = .02) and better scores for mental health (mean = 70.29, standard deviation = 19.03) at 6- and 12-months following discharge than those classified as ASA 3. In addition, recovery of walking ability (70%, p = .001) and general health (adjusted mean = 58.31, p = .003) was also significantly better than ASA 3 participants. CONCLUSIONS: There was a significant association of hip-fracture patients classified as ASA 1-2 with better recovery and service utilization during the first year following surgery. Interventions for hip fractured patients with high ASA scores should be developed to improve recovery and quality of life.

Effects of interventions on trajectories of health-related quality of life among older patients with hip fracture: a prospective randomized controlled trial.

BACKGROUND: Health-related quality of life (HRQoL) has been used to assess subjects' prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery. METHODS: For this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models. RESULTS: We identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24-1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53-1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS. CONCLUSIONS: The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects' odds for following a trajectory of good physical functioning after hospitalization. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01350557 ).

Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2-year follow-up.

OBJECTIVES: Few studies describe the trajectories of cognitive function for hip-fracture patients following hospital discharge and the treatment effects of interdisciplinary intervention on cognitive outcomes. The purpose of this study was to explore the 2-year postoperative trajectory for cognitive function of older hip-fracture patients and cognitive effects of an interdisciplinary intervention. METHODS: Of 160 subjects randomly assigned to groups, 29 (35.8%) in the control group (n = 81) and 30 (38.0%) in the intervention group (n = 79) were cognitively impaired at admission. The intervention group received geriatric consultation, continuous rehabilitation, and discharge planning. Subjects' cognitive function was measured using the mini mental state examination Taiwan version at admission, 6, 12, 18, and 24 months after discharge and analyzed using hierarchical generalized linear models. RESULTS: Patients who received the intervention program had 75% less likelihood of being cognitively impaired 6 months following discharge than those who received routine care (odds ratio = 0.25, p < 0.001). The difference between the control and intervention groups was small at admission, peaked at 18 months, and decreased from 18 to 24 months following discharge. CONCLUSIONS: Our interdisciplinary intervention improved the long-term postoperative cognitive functioning of older persons with hip fracture in Taiwan.

Functional recovery of older people with hip fracture: does malnutrition make a difference?

AIM: To report a study of the effects of protein-energy malnutrition on the functional recovery of older people with hip fracture who participated in an interdisciplinary intervention. BACKGROUND: It is not clear whether protein-energy malnutrition is associated with worse functional outcomes or it affects the interdisciplinary intervention program on the functional recovery of older people with hip fracture. DESIGN: A randomized experimental design. METHODS: Data were collected between 2002-2006 from older people with hip fracture (N = 162) in Taiwan. The generalized estimating equations approach was used to evaluate the effect of malnutrition on the functional recovery of older people with hip fracture. RESULTS: The majority of older patients with hip fracture were malnourished (48/80, 60% in the experimental group vs. 55/82, 67% in the control group) prior to hospital discharge. The results of the generalized estimating equations analysis demonstrated that subjects suffering from protein-energy malnutrition prior to hospital discharge appeared to have significantly worse performance trajectories for their activities of daily living, instrumental activities of daily living, and recovery of walking ability compared with those without protein-energy malnutrition. In addition, it was found that the intervention is more effective on the performance of activities of daily living and recovery of walking ability in malnourished patients than in non-malnourished patients. CONCLUSION: Healthcare providers should develop a nutritional assessment/management system in their interdisciplinary intervention program to improve the functional recovery of older people with hip fracture.

Two-year effects of an interdisciplinary intervention on recovery following hip fracture in older Taiwanese with cognitive impairment.

OBJECTIVE: This article aims to evaluate the long-term effects of an interdisciplinary intervention program on cognitively impaired older persons after hip fracture in Taiwan. METHODS: Of 160 subjects randomly assigned to control (n = 81) and intervention (n = 79) groups, 24 (29.6%) and 27 (34.2%) were cognitively impaired in the control and intervention groups, respectively, and outcomes were followed for 2 years after discharge. RESULTS: Among cognitively impaired subjects, more in the intervention group recovered their previous walking ability (odds ratio [OR] =3.49; confidence interval [CI] = 1.64 to 7.42), activities of daily life performance (ß = 18.59; p = 0.0002), and more were readmitted to the hospital (OR = 4.44, CI = 1.53 to 12.89) than those in the control group during the first 2 years following discharge. Among subjects without cognitive impairment, more in the intervention group recovered their previous walking ability (OR = 2.6; CI = 1.33 to 5.07), had fewer falls (OR = 0.47; CI = 0.25 to 0.86), and made fewer emergency room visits (OR = 0.33; CI = 0.11 to 0.97) during the first 2 years following discharge than those in the control group. CONCLUSIONS: Cognitively impaired individuals benefited from our interdisciplinary intervention by improving their walking ability and physical function during the first 2 years following discharge. Specific strategies on fall prevention following hip fracture need to be further developed for cognitively impaired individuals.

A family care model for older persons with hip-fracture and cognitive impairment: A randomized controlled trial.

BACKGROUND: Dementia and hip fracture are both associated with substantial disability and mortality. However, few studies have explored the effects of intervention programs on post-operative recovery of older persons with hip fracture and cognitive impairment. OBJECTIVE: To examine the effects of a family-centered care model for older persons with hip fracture and cognitive impairment and their family caregivers. DESIGN: Single-blinded clinical trial. SETTING: A 3000-bed medical center in Taiwan. PARTICIPANTS: Older persons hip fracture and cognitive impairment (N = 152); 76 in the intervention group, and 76 in the usual-care control group. METHODS: A family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care. Outcomes were assessed 1-, 3-, 6- and 12-months following hospital discharge for older persons with hip fracture and cognitive impairment. Assessed outcomes were self-care ability (performance of activities of daily living and instrumental activities of daily living), nutritional status, self-rated health, health-related quality of life and self-efficacy, and competence of the family caregivers. RESULTS: Relative to patients who received usual care, those who received the family-centered care intervention had a greater rate of improvement in self-rated health (ß = 1.68, p < .05) and nutritional status (ß = 0.23, p < .05), especially during the first 6 months following hospital discharge. Relative to family caregivers who received usual care, those who received family-centered care had a higher level of competence (ß = 7.97, p < .01), a greater rate of improvement in competence (ß = 0.57, p < .01), and a greater rate of improvement in self-efficacy (ß = 0.74, p < .05) 3 months following hospital discharge. CONCLUSIONS: A family-centered care model enhanced family caregivers' self-efficacy and competence but did not improve the physical recovery of the participants with hip fracture and dementia. We suggest adding an educational component to include geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care and assessing family caregiver outcomes in interventions for older persons with hip fracture and cognitive impairment. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT03894709) Tweetable abstract: A family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care of older persons with hip fracture and cognitive impairment enhanced family caregivers' self-efficacy and competence.

An interdisciplinary intervention for older Taiwanese patients after surgery for hip fracture improves health-related quality of life.

BACKGROUND: The effects of intervention programs on health-related quality of life (HRQOL) of patients with hip fracture have not been well studied. We hypothesized that older patients with hip fracture who received our interdisciplinary intervention program would have better HRQOL than those who did not. METHODS: A randomized experimental design was used. Older patients with hip fracture (N = 162), 60 to 98 years old, from a medical center in northern Taiwan were randomly assigned to an experimental (n = 80) or control (n = 82) group. HRQOL was measured by the SF-36 Taiwan version at 1, 3, 6, and 12 months after discharge. RESULTS: The experimental group had significantly better overall outcomes in bodily pain (ß = 9.38, p = 0.002), vitality (ß = 9.40, p < 0.001), mental health (ß = 8.16, p = 0.004), physical function (ß = 16.01, p < 0.001), and role physical (ß = 22.66, p < 0.001) than the control group at any time point during the first year after discharge. Physical-related health outcomes (physical functioning, role physical, and vitality) had larger treatment effects than emotional/mental- and social functioning-related health outcomes. CONCLUSIONS: This interdisciplinary intervention program may improve health outcomes of elders with hip fracture. Our results may provide a reference for health care providers in countries using similar programs with Chinese/Taiwanese immigrant populations. TRIAL REGISTRATION: NCT01052636.

Family caregivers' needs predict functional recovery of older care recipients after hip fracture.

AIM: This paper is a report of a study of the effect of family caregivers' needs on the functional recovery of elders with a hip fracture during the first 6 months after discharge. BACKGROUND: Family members are closely involved in the postdischarge care of older Chinese patients. However, the influence of family caregiving-related variables, such as caregiver's needs, on recovery after hip fracture has not been explored. METHODS: Data were collected between 2002 and 2005 with elders with hip fracture and their family caregivers at a medical centre in Taiwan. Data were collected at 1, 3 and 6 months after discharge, and 120 people completed all follow-ups. The effect of caregiver needs on elders' recovery was analysed using the generalized estimating equations approach. FINDINGS: Elders whose caregivers reported a need for information on caregiving and related health care were more likely (odds ratio = 1·93, confidence interval = 1·08-3·46) to recover their walking ability than those whose caregivers did not report such need. However, elders whose caregivers reported a need for social services were less likely to recover their walking ability (odds ratio = 0·38, confidence interval = 0·18-0·78), and activities of daily living (odds ratio = 0·40, confidence interval = 0·17-0·94) than those whose caregivers did not report such need. CONCLUSION: Healthcare providers should include caregivers' needs in their clinical assessment of Chinese elders after surgery for hip fracture. Given the rapidly increasing population of Asian elders in Western countries, the results of this study may be applicable to other countries with Chinese populations.

Increased oxidative damage in peripheral blood correlates with severity of Parkinson's disease.

Increased oxidative stress contributes to neuronal dysfunction in Parkinson's disease (PD). We investigated whether the pathological changes in PD brains may also be present in peripheral tissues. Leukocyte 8-hydroxydeoxyguanosine (8-OHdG), plasma malondialdehyde (MDA), erythrocyte glutathione peroxidase (GPx) and plasma vitamin E (Vit E) were measured for 211 PD patients and 135 healthy controls. Leukocyte 8-OHdG and plasma MDA were elevated, whereas erythrocyte GPx and plasma Vit E were reduced in PD patients when compared to the controls. After adjusting for environmental factors, logistic regression analysis showed that PD severity was independently correlated with 8-OHdG and MDA level, and inversely correlated with GPx activity and Vit E level. Leucocyte 8-OHdG level was continuously increased with advanced PD Hoehn-Yahr stages, while plasma MDA level peaked at early disease stages, among PD patients. These results suggest increased oxidative damage and decreased anti-oxidant capacity in peripheral blood, and a significant correlation between leucocyte 8-OHdG level and disease severity in PD.

Older people with hip fracture: depression in the postoperative first year.

AIM: This paper is a report of a study conducted to describe changes in risk of depressive symptoms and their predictors for older people with hip fracture during the first year following hospital discharge. BACKGROUND: The prevalence of depression in older people with hip fracture has been reported as 9-47%. However, the longitudinal changes in prevalence rate following hip fracture have not been well-studied, particularly in Asian countries. METHODS: The study was conducted in Taiwan in 2001-2003. A sample of 147 older people with hip fracture was assessed for depressive symptoms before discharge, and at 1, 3, 6 and 12 months after discharge using the Chinese version of the Geriatric Depression Scale. Longitudinal data were analysed by the generalized estimating equation approach. Findings. The majority of participants were at risk for depressive symptoms before discharge (n = 147, 57.8%) and 35.6% (n = 118) 12 months after discharge. These numbers decreased statistically significantly from before discharge to the 1st month after discharge (57.8% vs. 42.6%, P = 0.008), and from the 1st to the 6th month (42.6% vs. 31.3%, P = 0.03), and then remained stable until the 12th month after discharge. Lower emotional-social support predicted persistent depressive symptoms after discharge (P < 0.01). CONCLUSION: Timely psychological interventions are suggested within the first 6 months after discharge, especially the first 3 months. Healthcare professionals need to pay attention to older patients with hip fracture who are female, with poorer prefracture functioning and particularly those with lower emotional-social support.

Effects of a diabetes-specific care model for hip fractured older patients with diabetes: A randomized controlled trial.

OBJECTIVES: To examine the effects of a diabetes-specific care model for hip fractured elderly with diabetes mellitus (DM). METHODS: A randomized controlled trial was implemented in a 3000-bed medical center in northern Taiwan. Older adults (age ≥ 60) with DM who had hip-fracture surgery (N = 176) were recruited and randomly assigned to diabetes-specific care (n = 88) and usual care (n = 88). Usual care entailed one or two in-hospital rehabilitation sessions. Diabetes-specific care comprised an interdisciplinary care (including geriatric consultation, discharge planning, and in-home rehabilitation) and diabetes-specific care (including dietary and diabetes education, blood pressure control, dyslipidemia management, a glycemic treatment regimen, and rehabilitation exercises). Outcomes including heart rate variability; rehabilitation outcomes; activities of daily living and instrumental activities of daily living were assessed before discharge and 1, 3, 6, 12, 18, 24 months afterwards. RESULTS: Patients who received diabetes-specific care had significantly higher hip-flexion range of motion (b = 5.24, p < .01), peak-force quadriceps strength of the affected limb (b = 2.13, p < .05), higher total heart rate variability in terms of the time-domain parameter for the mean squared difference between two adjacent normal R-R intervals (b = 11.35, p < .05), and frequency-domain parameters, such as low frequency (b = 42.17, p < .05), and the high frequency-to-low frequency ratio (b = 0.11, p < .01). CONCLUSIONS: Our diabetes-specific care model enhanced hip-flexion range of motion, peak quadriceps strength of the affected limb, and overall heart rate variability, indicating dynamic responses to environmental changes during the 24 months following hospital discharge, above and beyond the effects of usual care.

Diabetic neuropathies influence recovery from hip-fracture surgery in older persons with diabetes.

BACKGROUND/OBJECTIVES: To explore the impact of diabetic peripheral neuropathy (DPN) on the recovery of older persons with diabetes mellitus (DM) after hip-fracture surgery. DESIGN, SETTING, PARTICIPANTS: Secondary data for this study came from a clinical trial on the effectiveness of a DM-specific care model for 176 older persons (age ≥ 60) with DM over 2 years following hip-fracture surgery at a medical center in Taiwan. In the original trial, the experimental group (n = 88) received DM-specific care comprising diabetes care plus subacute care, and the control group (n = 88) received only usual care. MEASUREMENTS: DPN was assessed using the Michigan Neuropathy Screening Instrument. Outcomes of self-care ability in activities of daily living (ADL), health-related quality of life (HRQoL), and depressive symptoms were assessed 1, 3, 6, 12, 18, 24 months following hospital discharge using the Chinese Barthel Index and Chinese-version instrumental ADL (IADL) scale; the SF-36 Taiwan version; and the Chinese-version Geriatric Depression Scale, short form, respectively. RESULTS: After controlling for covariates, participants with DPN had 8.38 fewer points in ADL performance, 0.49 fewer points in IADL performance, and 2.33 fewer points in the physical component summary (PCS) of HRQoL than participants without DPN at 3 months following discharge. During the first year following discharge, the rate of improvement increased less for PCS (ß = -0.45, p < 0.05), but more for the mental component summary (ß = 0.49, p < 0.05) for those with DPN than for those without. During the second year, the rate of decline in physical function-related HRQoL increased slightly more for those with DPN than for those without (ß = 0.03, p < 0.05). CONCLUSION: DPN adversely affected ADL performance, IADL performance, and physical function-related health outcomes for older persons recovering from hip-fracture surgery. These results suggest that older patients with DM recovering from hip-fracture surgery should be assessed and managed for DPN.

Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year.

BACKGROUND: Little is known about the effects of interventions for elderly patients with hip fracture in Asian countries, particularly beyond the short term. METHODS: Outcomes (service utilization, clinical outcomes, self-care ability, and depressive symptoms) were assessed at 1, 3, 6, and 12 months after discharge. Self-care ability (ability to perform activities of daily living [ADLs]), was measured by the Chinese Barthel Index. Depressive symptoms were measured by the Chinese Geriatric Depression Scale, short form. RESULTS: The experimental group (n = 80) had a significantly better ADL trajectory than the control group (n = 82) during the 1st year after discharge (p =.002). More participants in the experimental group than in the control group recovered their previous walking ability both at 6 months (81% vs 58%, respectively) and 12 months (84% vs 66%, respectively) after discharge. Overall, the odds ratio for the experimental group recovering their previous walking ability was 2.72 (p <.001) compared to the control group. The experimental group had significantly fewer depressive symptoms than the control group during the 1st year following discharge (p =.004). CONCLUSION: An interdisciplinary intervention for hip fracture with a discharge support component benefited elderly persons with hip fracture by improving both self-care ability and walking ability, and by decreasing depressive symptoms during the 1st year after hospital discharge.

Trajectories in postoperative recovery of elderly hip-fracture patients at risk for depression: A follow-up study.

OBJECTIVES: This secondary-analysis study aimed to identify distinct developmental depressive-symptom trajectories among elderly hip-fracture patients at risk for depression, examine the associations of trajectories with potential risk factors and care models, and explore the effect of trajectory membership on recovery outcomes. METHOD: Longitudinal data were obtained for 179 patients in a randomized controlled trial. These patients were included if their Geriatric Depression Scale short form scores were ≥ 5 before discharge or 1, 3, 6, or 12 months following discharge. Individuals who followed similar developmental depressive-symptom trajectories were identified by group-based trajectory modeling. Associations between trajectory-group membership and postoperative outcomes over the 12 months following discharge were evaluated by the generalized estimating equations method. RESULTS: We identified a progressively lower-risk group and a fluctuating higher-risk group. Patients' membership in the progressively lower-risk group was associated with receiving a comprehensive care model featuring psychological and physical interventions. Membership in this group was associated with better postoperative outcomes and fewer emergency department visits or hospital readmissions. Patients were more likely to belong to the fluctuating higher-risk group if they had more comorbidities or worse prefracture mobility. Patients in the fluctuating higher-risk group not only had higher levels of depressive symptoms, but also a greater likelihood of poor postoperative recovery outcomes. CONCLUSIONS: Depressive symptoms in elderly hip-fracture patients may be alleviated by postoperative comprehensive care that features both psychological and physical interventions. Patients with increasing depressive status should be targeted for early interventions. (PsycINFO Database Record

A randomized, placebo-controlled trial of varenicline, a selective alpha4beta2 nicotinic acetylcholine receptor partial agonist, as a new therapy for smoking cessation in Asian smokers.

BACKGROUND: Rates of smoking in East Asian men range from >35% to >60%, and are increasing in women and the young. OBJECTIVE: This study evaluated the efficacy and tolerability of 1 mg BID varenicline, a novel alpha4beta2 nicotinic acetylcholine receptor partial agonist, for smoking cessation in smokers in Taiwan and Korea. METHODS: A randomized, double-blind, placebo-controlled, 12-week treatment, 12-week follow-up trial was conducted at 5 sites each in Korea and Taiwan. Eligible subjects, smoking >or=10 cigarettes/d, received brief smoking-cessation counseling and were randomly assigned in a 1:1 ratio to varenicline 1 mg BID (titrated during the first week) or placebo. Smoking status was established by self-report and confirmed at clinic visits by end-expiratory carbon monoxide or= 5% for varenicline were nausea (43.7% for varenicline vs 11.3% placebo), insomnia (15.1% vs 13.7%), increased appetite (7.9% vs 6.5%), constipation (7.1% vs 2.4%), anxiety (5.6% vs 2.4%), and abnormal dreams (5.6% vs 0.8%). Adverse events resulted in <10% treatment discontinuations overall. CONCLUSION: Varenicline was an efficacious and well-tolerated pharmacotherapy for smoking cessation in this group of Asian smokers over a 12-week treatment period, and its effects persisted for a further 12-week follow-up period.

Association between Physical Fitness and Successful Aging in Taiwanese Older Adults.

Population aging is escalating in numerous countries worldwide; among them is Taiwan, which will soon become an aged society. Thus, aging successfully is an increasing concern. One of the factors for achieving successful aging (SA) is maintaining high physical function. The purpose of this study was to determine the physical fitness factors associated with SA in Taiwanese older adults (OAs), because these factors are intervenable. Community-dwelling OAs aged more than 65 years and residing in Northern Taiwan were recruited in this study. They received a comprehensive geriatric assessment, which includes sociodemographic data, health conditions and behaviors, activities of daily living (ADL) and instrumental ADL (IADL) function, cognitive and depressive status, and quality of life. Physical fitness tests included the grip strength (GS), 30-second sit-to-stand (30s STS), timed up-and-go (TUG), functional reach (FR), one-leg standing, chair sit-and-reach, and reaction time (drop ruler) tests as well as the 6-minute walk test (6MWT). SA status was defined as follows: complete independence in performing ADL and IADL, satisfactory cognitive status (Mini-Mental State Examination ≥ 24), no depression (Geriatric Depression Scale < 5), and favorable social function (SF subscale ≥ 80 in SF-36). Adjusted multiple logistic regression analyses were performed. Among the total recruited OAs (n = 378), 100 (26.5%) met the aforementioned SA criteria. After adjustment for sociodemographic characteristics and health condition and behaviors, some physical fitness tests, namely GS, 30s STS, 6MWT, TUG, and FR tests, were significantly associated with SA individually, but not in the multivariate model. Among the physical fitness variables tested, cardiopulmonary endurance, mobility, muscle strength, and balance were significantly associated with SA in Taiwanese OAs. Early detection of deterioration in the identified functions and corresponding intervention is essential to ensuring SA.

Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial.

BACKGROUND: Little evidence is available on the longer-term effects (beyond 12 months) of intervention models consisting of hip fracture-specific care in conjunction with management of malnutrition, depression, and falls. OBJECTIVE: To compare the relative effects of an interdisciplinary care, and a comprehensive care programme with those of usual care for elderly patients with a hip fracture on self-care ability, health care use, and mortality. DESIGN: Randomised experimental trial. SETTING: A 3000-bed medical centre in northern Taiwan. PARTICIPANTS: Patients with hip fracture aged 60 years or older (N=299). METHOD: Patients were randomly assigned to three groups: comprehensive care (n=99), interdisciplinary care (n=101), and usual care (control) (n=99). Usual care entailed only one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month in-home rehabilitation. Building upon interdisciplinary care, comprehensive care extended in-home rehabilitation to 12 months and added management of malnutrition and depressive symptoms, and fall prevention. Patients' self-care ability was measured by activities of daily living and instrumental activities of daily living using the Chinese Barthel Index and Chinese version Instrumental Activities of Daily Living scale, respectively. Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip fracture. Hierarchical linear models were used to analyse health outcomes and health care utilisation, including emergency department visit and hospital re-admission. RESULTS: The comprehensive care group had better performance trajectories for both measures of activities of daily living and fewer emergency department visits than the usual care group, but no difference in hospital readmissions. The interdisciplinary care and usual care groups did not differ in trajectories of self-care ability and service utilisation. The three groups did not differ in mortality during the 2-year follow-up. CONCLUSION: Comprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care.