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1.
Rev Med Suisse ; 17(722): 136-139, 2021 Jan 20.
Artículo en Francés | MEDLINE | ID: mdl-33470570

RESUMEN

COGERIA, a cantonal program is the fruit of a close collaboration between the Geneva General Directorate of Health and the major health and social partners in the canton. The program aims to improve inter-professional care for the frail elderly and to adapt their care pathways in close collaboration with their primary care physicians and home healthcare providers. Launched in May 2019, the program includes more than 283 beneficiaries and 152 primary care physicians in collaboration with the home healthcare providers in the Servette and Meyrin areas. Preliminary results show a possible trend towards a decrease in hospitalizations, as well as major satisfaction from beneficiaries and the COGERIA partners.


Asunto(s)
Anciano Frágil , Hospitalización , Anciano , Humanos , Satisfacción Personal
2.
J Frailty Aging ; 10(1): 31-37, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33331619

RESUMEN

BACKGROUND: Given the important association between cardiovascular disease and cognitive decline, and their significant implications on frailty status, the contribution of neurocognitive frailty measure helping with the assessment of patient outcomes is dearly needed. OBJECTIVES: The present study examines the prognostic value of the Neurocognitive Frailty Index (NFI) in the elderly with cardiovascular disease. DESIGN: Secondary analysis of the Canadian Study of Health and Aging (CSHA) dataset was used for prediction of 5-year cognitive changes. SETTING: Community and institutional sample. PARTICIPANTS: Canadians aged 65 and over [Mean age: 80.4 years (SD=6.9; Range of 66-100)]. MEASUREMENT: Neurocognitive Frailty Index (NFI) and Modified Mini-Mental State (3MS) scores for cognitive functioning of all subjects at follow-up and mortality rate were measured. RESULTS: The NFI mean score was 9.63 (SD = 6.04) and ranged from 0 to 33. This study demonstrated that the NFI was significantly associated with cognitive changes for subjects with heart disease and this correlation was a stronger predictor than age. CONCLUSION: The clinical relevance of this study is that our result supports the prognostic utility of the NFI tool in treatment planning for those with modifiable cardiovascular disease risk factors in the development of dementia.


Asunto(s)
Envejecimiento/psicología , Enfermedades Cardiovasculares/mortalidad , Cognición/fisiología , Fragilidad/psicología , Evaluación Geriátrica/métodos , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Envejecimiento Cognitivo , Análisis de Datos , Anciano Frágil/psicología , Humanos , Tasa de Supervivencia
3.
J Frailty Aging ; 10(1): 44-48, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33331621

RESUMEN

BACKGROUND: While a multitude of definitions and operationalizations of frailty have been developed, rarely have these considered the perspective of the older adult themselves. This knowledge gap was addressed by examining older adults' self-rating of frailty. OBJECTIVES: To assess the validity of self-rated frailty and to determine whether self-rated frailty relates to mortality. DESIGN: The Manitoba Follow-up Study was initiated in 1948 as a prospective cohort study of 3,983 men. SETTING: Community dwelling older adult men. PARTICIPANTS: Survivors of the original cohort (231 men) were sent a quality of life survey in 2015. A response was received from 186 men, including 146 surveys completed by the participant himself and thus were eligible to include (completion rate of 78.4%). MEASUREMENTS: The quality of life survey is sent out annually to the study participants to ascertain information about mental, physical, and social functioning. In 2015, the Clinical Frailty Scale was adapted and added to the survey as a simple self-rating of frailty. RESULTS: The mean age of the 146 respondents in 2015 was 93.7 years (SD 2.7) Self-ratings of "moderate-severe" frailty, received from 132 men, were associated with worse measures of physical health and functional impairment, thus supporting the significance of self-rated frailty. Adjusted for age, the Hazard Ratio for mortality over the next 3 years was 3.3 (95% CI: 1.5, 7.1) for those who rated themselves as "mildly to severely frail" vs. "very fit or well, with no disease". CONCLUSION: The present study has illustrated that self-rated frailty is associated with other measures of health and that self-rated frailty predicts mortality over a three-year period. These findings support the utilization of older adult's self-ratings of frailty for new avenues of operationalizing frailty.


Asunto(s)
Anciano Frágil/estadística & datos numéricos , Fragilidad/diagnóstico , Mortalidad/tendencias , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Fragilidad/psicología , Humanos , Vida Independiente , Masculino , Manitoba/epidemiología , Debilidad Muscular , Estudios Prospectivos , Calidad de Vida
4.
J Frailty Aging ; 10(1): 56-62, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33331623

RESUMEN

BACKGROUND: In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty. OBJECTIVE: This study explored associations between oral health and two frailty measures in community-dwelling older people. DESIGN: A cross-sectional study. SETTING: The study was carried out in a Primary Healthcare Center (PHC) in The Netherlands. PARTICIPANTS: Of the 5,816 persons registered in the PHC, 1,814 persons were eligible for participation at the start of the study. MEASUREMENTS: Two frailty measures were used: 1. Being at risk for frailty, using Electronical Medical Record (EMR) data, and: 2. Survey-based frailty using 'The Groningen Frailty Indicator' (GFI). For oral health measures, dental-record data (dental care utilization, dental status, and oral health information) and self-reported oral problems were recorded. Univariate regression analyses were applied to determine the association between oral health and frailty, followed by age- and sex-adjusted multivariate logistic regressions. RESULTS: In total 1,202 community-dwelling older people were included in the study, 45% were male and the mean age was 73 years (SD=8). Of all participants, 53% was at risk for frailty (638/1,202), and 19% was frail based on the GFI (222/1,202). A dental emergency visit (Odds Ratio (OR)= 2.0, 95% Confidence Interval (CI)=1.33;3.02 and OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07;3.99), and making dietary adaptations (OR=2.66, 95% CI=1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01) were associated with being at risk for frailty and survey-based frailty respectively. CONCLUSIONS: A dental emergency visit and self-reported oral health problems are associated with frailty irrespective of the approach to its measurement. Healthcare professionals should be aware of the associations of oral health and frailty in daily practice.


Asunto(s)
Anciano Frágil , Fragilidad/epidemiología , Salud Bucal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Fragilidad/diagnóstico , Evaluación Geriátrica , Humanos , Vida Independiente , Masculino , Países Bajos/epidemiología
5.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(6): 317-325, nov.-dic. 2020. tab
Artículo en Español | IBECS | ID: ibc-192480

RESUMEN

ANTECEDENTES Y OBJETIVO: La pandemia por SARS-CoV-2 condiciona elevadas tasas de mortalidad en pacientes mayores hospitalizados. Actualmente, pocos estudios incluyen pacientes octogenarios y ninguno analiza el impacto del estado funcional sobre este resultado de salud. Nuestro objetivo es describir las características de los pacientes mayores de 80 años hospitalizados por coronavirus disease 2019 (COVID-19), determinar la tasa de mortalidad e identificar factores asociados. MATERIALES Y MÉTODOS: Estudio observacional prospectivo realizado en mayores de 80 años ingresados por COVID-19 en un Servicio de Geriatría. Se recogieron variables sociodemográficas, clínicas, funcionales, mentales, analíticas, radiológicas, terapéuticas y asistenciales. Se analizaron mediante análisis bivariante los factores asociados a mortalidad intrahospitalaria. RESULTADOS: Fueron incluidos 58 casos con COVID-19 confirmado por laboratorio, edad media 88,3 ± 5,4 años, 69% mujeres, 65,5% deterioro cognitivo moderado-severo e índice de Barthel previo 40,6 ± 36. Los principales síntomas fueron fiebre (60,3%), disnea (53,4%) y deterioro del estado funcional (50%). Las comorbilidades más frecuentes fueron enfermedad cardiovascular (75,9%), hipertensión arterial (HTA) (74,1%) y enfermedad renal crónica (ERC) (50%). Se detectó una tasa de mortalidad del 41,4%, siendo los factores asociados: dependencia funcional severa (OR = 3,8 [1,2-12,2]), ERC (OR = 3,2 [1,1-9,7]), deterioro cognitivo moderado-severo (OR = 4,9 [1 a 25,4]). CONCLUSIONES: Se objetivan altas tasas de mortalidad en pacientes mayores hospitalizados por COVID-19, con mayor riesgo de fallecer en aquellos con dependencia funcional severa o deterioro cognitivo. Estos hallazgos refuerzan la importancia de la Valoración Geriátrica para elaborar estrategias que permitan adecuar la toma de decisiones diagnósticas y terapéuticas y optimizar la atención al paciente anciano ante un nuevo brote epidémico


OBJECTIVE: The SARS-CoV-2 pandemic conditions high mortality rates in hospitalized elderly. Currently, a few studies include octogenarian patients and none of them analyze the impact of functional status on this health outcome. Our objective is to describe the characteristics of patients older than 80 years hospitalized for coronavirus disease 2019 (COVID-19), to determine the mortality rate and to identify associated factors. MATERIAL AND METHODS: Prospective observational study carried out on patients over 80 years admitted for COVID-19 in a Geriatrics Service. Sociodemographic, clinical, functional, mental, analytical, radiological, therapeutic and healthcare variables were collected. The factors associated with in-hospital lethality were analyzed by bivariate analysis. RESULTS: 58 cases with laboratory-confirmed COVID-19 were included, mean age 88.3 ± 5.4 years, 69% women, 65.5% moderate-severe cognitive impairment and previous Barthel index 40.66 ± 36. The main symptoms were fever (60,3%), dyspnea (53.4%) and deterioration of functional condition (50%). The most frequent comorbidities were cardiovascular disease (75.9%), hypertension (HT) (74.1%) and chronic kidney disease (CKD) (50%). A mortality rate of 41,4% was detected and the associated factors were: severe functional dependence (OR = 3.8 [1.2-12.2]), moderate-severe cognitive impairment (OR = 4.9 [1-25.4]) and CKD (OR = 3.2 [1.1-9.7]). CONCLUSION: High mortality rates are observed in older patients hospitalized for COVID-19, with a higher risk of dying in those with severe functional dependence or cognitive impairment. These findings reinforce the value of Geriatric Assessment to develop strategies to adapt diagnostic and therapeutic decision-making and to optimize care for elderly patients in the event of a new epidemic outbreak


Asunto(s)
Humanos , Masculino , Femenino , Anciano de 80 o más Años , Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria/tendencias , Virus del SRAS/aislamiento & purificación , Estudios Prospectivos , Indicadores de Morbimortalidad , Causas de Muerte/tendencias , Anciano Frágil/estadística & datos numéricos
8.
Rev Med Liege ; 75(12): 816-821, 2020 Dec.
Artículo en Francés | MEDLINE | ID: mdl-33331707

RESUMEN

The frailty syndrome is a dynamic and evolving geriatric concept, involving many dimensions of everyday life and leading to a risk of developing a loss of daily life and autonomy. Although there is no consensual definition, the consequences remain major : risk of functional decompensation, multiplication of hospitalizations, dependence in the activities of the daily life, institutionalization and increase of the mortality.


Asunto(s)
Fragilidad , Anciano , Anciano Frágil , Fragilidad/prevención & control , Evaluación Geriátrica , Hospitalización , Humanos , Síndrome
10.
J Immunol Res ; 2020: 8375096, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33354578

RESUMEN

Recently, the novel coronavirus epidemic occurred in China and spread worldwide to become a global pandemic. COVID-19 is a fatal viral infection causing death, particularly in aged individuals, due to impaired immunity. To date, no intervention is available to prevent COVID-19 and its manifestations. Physical exercise training generally has health benefits, and it assists in the prevention of several chronic diseases. Therefore, this review is aimed at exploring the role of physical exercise training in the face of COVID-19 in older adults and elderly individuals. From this point of view, this review suggests that physical exercise training plays a key role in promoting immune system regulation, delaying immunity dysfunction, reducing circulatory inflammation markers, and preventing sarcopenia and thus could prevent the risk of acquiring COVID-19 infection and reduce the complications of recommended self-isolation in older adults and elderly individuals. Additionally, immunity biomarkers were optimistically demonstrated in older adults following physical exercise training, thereby reducing mortality and morbidity rates. Finally, in accordance with recommendations to stay home and perform self-isolation to prevent the spread of COVID-19, all populations are strongly recommended to practice regular home exercise training at home to promote immune system functioning.


Asunto(s)
Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Anciano , Anciano de 80 o más Años , Anciano Frágil/psicología , Humanos , Inmunidad Celular/inmunología , Aislamiento de Pacientes , Carencia Psicosocial , Sarcopenia/prevención & control
11.
Nutrients ; 13(1)2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33374341

RESUMEN

BACKGROUND: Vitamin K concentrations are inversely associated with the clinical severity of COVID-19. The objective of this cohort study was to determine whether the regular use of vitamin K antagonist (VKA) prior to COVID-19 was associated with short-term mortality in frail older adults hospitalized for COVID-19. METHODS: Eighty-two patients consecutively hospitalized for COVID-19 in a geriatric acute care unit were included. The association of the regular use of VKA prior to COVID-19 with survival after 7 days of COVID-19 was examined using a propensity-score-weighted Cox proportional-hazards model accounting for age, sex, severe undernutrition, diabetes mellitus, hypertension, prior myocardial infarction, congestive heart failure, prior stroke and/or transient ischemic attack, CHA2DS2-VASc score, HAS-BLED score, and eGFR. RESULTS: Among 82 patients (mean ± SD age 88.8 ± 4.5 years; 48% women), 73 survived COVID-19 at day 7 while 9 died. There was no between-group difference at baseline, despite a trend for more frequent use of VKA in those who did not survive on day 7 (33.3% versus 8.2%, p = 0.056). While considering "using no VKA" as the reference (hazard ratio (HR) = 1), the HR for 7-day mortality in those regularly using VKA was 5.68 [95% CI: 1.17; 27.53]. Consistently, COVID-19 patients using VKA on a regular basis had shorter survival times than the others (p = 0.031). CONCLUSIONS: Regular use of VKA was associated with increased mortality at day 7 in hospitalized frail elderly patients with COVID-19.


Asunto(s)
Anticoagulantes , Anciano Frágil , Vitamina K , Factores de Edad , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , /tratamiento farmacológico , Supervivencia sin Enfermedad , Femenino , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Tasa de Supervivencia , Vitamina K/antagonistas & inhibidores , Vitamina K/sangre
12.
Anesthesiology ; 133(1): 78-95, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-33377927

RESUMEN

BACKGROUND: A barrier to routine preoperative frailty assessment is the large number of frailty instruments described. Previous systematic reviews estimate the association of frailty with outcomes, but none have evaluated outcomes at the individual instrument level or specific to clinical assessment of frailty, which must combine accuracy with feasibility to support clinical practice. METHODS: The authors conducted a preregistered systematic review (CRD42019107551) of studies prospectively applying a frailty instrument in a clinical setting before surgery. Medline, Excerpta Medica Database, Cochrane Library and the Comprehensive Index to Nursing and Allied Health Literature, and Cochrane databases were searched using a peer-reviewed strategy. All stages of the review were completed in duplicate. The primary outcome was mortality and secondary outcomes reflected routinely collected and patient-centered measures; feasibility measures were also collected. Effect estimates were pooled using random-effects models or narratively synthesized. Risk of bias was assessed. RESULTS: Seventy studies were included; 45 contributed to meta-analyses. Frailty was defined using 35 different instruments; five were meta-analyzed, with the Fried Phenotype having the largest number of studies. Most strongly associated with: mortality and nonfavorable discharge was the Clinical Frailty Scale (odds ratio, 4.89; 95% CI, 1.83 to 13.05 and odds ratio, 6.31; 95% CI, 4.00 to 9.94, respectively); complications was associated with the Edmonton Frail Scale (odds ratio, 2.93; 95% CI, 1.52 to 5.65); and delirium was associated with the Frailty Phenotype (odds ratio, 3.79; 95% CI, 1.75 to 8.22). The Clinical Frailty Scale had the highest reported measures of feasibility. CONCLUSIONS: Clinicians should consider accuracy and feasibility when choosing a frailty instrument. Strong evidence in both domains support the Clinical Frailty Scale, while the Fried Phenotype may require a trade-off of accuracy with lower feasibility.


Asunto(s)
Fragilidad/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Cuidados Preoperatorios/métodos , Anciano , Anciano de 80 o más Años , Delirio del Despertar/diagnóstico , Delirio del Despertar/epidemiología , Anciano Frágil , Evaluación Geriátrica , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas
13.
Minerva Chir ; 75(5): 320-327, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33210528

RESUMEN

BACKGROUND: During Coronavirus disease (COVID-19) pandemic entire countries rapidly ran out of intensive care beds, occupied by critically ill infected patients. Elective surgery was initially halted and acute non-deferrable surgical care drastically limited. The presence of COVID-19 patients into intensive care units (ICU) is currently decreasing but their congestion have restricted our therapeutic strategies during the last months. METHODS: In the COVID-19 era eighteen patients (8 men, 10 women) with a mean age of 80 years, needing undelayable abdominal surgery underwent awake open surgery at our Department. Prior to surgery, all patients underwent COVID-19 investigation. In all cases locoregional anesthesia (LA) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. RESULTS: Mean operative time was 104 minutes. In only one case conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. Only one perioperative complication occurred. Early readmissions after surgery were never observed. CONCLUSIONS: On the basis of our experience awake laparotomy under LA resulted feasible, safe, painless and, in specific cases, the only viable option. For patients presenting fragile cardiovascular and respiratory, reserves and in whom general anesthesia (GA) would presumably increase morbidity and mortality we encourage LA as an alternative to GA. In the COVID-19 era, it has become part of our ICU-preserving strategy allowing us to carry out undeferrable surgeries.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Anciano Frágil , Laparotomía/estadística & datos numéricos , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Anestesia General , Anestesia Local/métodos , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Urgencias Médicas/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Tempo Operativo , Dolor Postoperatorio/prevención & control , Pandemias , Neumonía Viral/diagnóstico , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos
14.
Nutrients ; 12(11)2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33147894

RESUMEN

BACKGROUND: The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. METHODS: Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. RESULTS: The three groups (n = 77; mean ± SD, 88 ± 5years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p= 0.03). CONCLUSIONS: Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Suplementos Dietéticos , Fragilidad/mortalidad , Neumonía Viral/mortalidad , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Anciano de 80 o más Años , Betacoronavirus , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/terapia , Femenino , Anciano Frágil/estadística & datos numéricos , Fragilidad/sangre , Fragilidad/virología , Hospitalización , Humanos , Masculino , Ensayos Clínicos Controlados no Aleatorios como Asunto , Pandemias , Neumonía Viral/sangre , Neumonía Viral/terapia , Tasa de Supervivencia
15.
Rev Med Suisse ; 16(714): 2160-2164, 2020 Nov 11.
Artículo en Francés | MEDLINE | ID: mdl-33174697

RESUMEN

What are the criteria for admitting an elderly polymorbid patient to intensive care ? The multidimensional geriatric evaluation is a tool to screen for geriatric syndromes, with the division of elderly patients into 3 categories: robust, vulnerable and dependent. Targeting certain co-morbidities such as cognitive disorders, delirium, frailty, polymedication and malnutrition, allows clinicians to estimate the risks of mortality and functional and cognitive handicaps during a stay in intensive care. Based on a review of the literature, this article offers some guidelines for triage of older patients for admission to intensive care, using an ethical, multidisciplinary approach that takes into account the patient's fears and preferences.


Asunto(s)
Cuidados Críticos/estadística & datos numéricos , Anciano Frágil , Fragilidad/diagnóstico , Evaluación Geriátrica , Anciano , Trastornos del Conocimiento/diagnóstico , Delirio/diagnóstico , Anciano Frágil/psicología , Humanos , Desnutrición/diagnóstico
16.
JAMA ; 324(18): 1869-1877, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33170241

RESUMEN

Importance: Medicare recently concluded a national voluntary payment demonstration, Bundled Payments for Care Improvement (BPCI) model 3, in which skilled nursing facilities (SNFs) assumed accountability for patients' Medicare spending for 90 days from initial SNF admission. There is little evidence on outcomes associated with this novel payment model. Objective: To evaluate the association of BPCI model 3 with spending, health care utilization, and patient outcomes for Medicare beneficiaries undergoing lower extremity joint replacement (LEJR). Design, Setting, and Participants: Observational difference-in-difference analysis using Medicare claims from 2013-2017 to evaluate the association of BPCI model 3 with outcomes for 80 648 patients undergoing LEJR. The preintervention period was from January 2013 through September 2013, which was 9 months prior to enrollment of the first BPCI cohort. The postintervention period extended from 3 months post-BPCI enrollment for each SNF through December 2017. BPCI SNFs were matched with control SNFs using propensity score matching on 2013 SNF characteristics. Exposures: Admission to a BPCI model 3-participating SNF. Main Outcomes and Measures: The primary outcome was institutional spending, a combination of postacute care and hospital Medicare-allowed payments. Additional outcomes included other categories of spending, changes in case mix, admission volume, home health use, length of stay, and hospital use within 90 days of SNF admission. Results: There were 448 BPCI SNFs with 18 870 LEJR episodes among 16 837 patients (mean [SD] age, 77.5 [9.4] years; 12 173 [72.3%] women) matched with 1958 control SNFs with 72 005 LEJR episodes among 63 811 patients (mean [SD] age, 77.6 [9.4] years; 46 072 [72.2%] women) in the preintervention and postintervention periods. Seventy-nine percent of matched BPCI SNFs were for-profit facilities, 85% were located in an urban area, and 85% were part of a larger corporate chain. There were no systematic changes in patient case mix or episode volume between BPCI-participating SNFs and controls during the program. Institutional spending decreased from $17 956 to $15 746 in BPCI SNFs and from $17 765 to $16 563 in matched controls, a differential decrease of 5.6% (-$1008 [95% CI, -$1603 to -$414]; P < .001). This decrease was related to a decline in SNF days per beneficiary (from 26.2 to 21.3 days in BPCI SNFs and from 26.3 to 23.4 days in matched controls; differential change, -2.0 days [95% CI, -2.9 to -1.1]). There was no significant change in mortality or 90-day readmissions. Conclusions and Relevance: Among Medicare patients undergoing lower extremity joint replacement from 2013-2017, the BPCI model 3 was significantly associated with a decrease in mean institutional spending on episodes initiated by admission to SNFs. Further research is needed to assess bundled payments in other clinical contexts.


Asunto(s)
Artroplastia de Reemplazo/economía , Medicare/economía , Mecanismo de Reembolso , Instituciones de Cuidados Especializados de Enfermería/economía , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Humanos , Extremidad Inferior , Masculino , Persona de Mediana Edad , Atención Subaguda/economía , Estados Unidos
17.
Medicine (Baltimore) ; 99(46): e22873, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181655

RESUMEN

BACKGROUND: A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting the patients vulnerabilities. Exercise and early rehabilitation, nutritional intervention, traditional Chinese medicine (TCM), standardized medication guidance, and patient education can, separately, improve and even reverse the physical frailty status. However, the effect of combining a CGA and multi-disciplinary management on frailty in elderly patients remains unclear. The present study assessed the effects of a CGA and multi-disciplinary management on elderly patients with frailty in China. METHODS: In this study, 320 in patients with frailty ≥70 years old will be randomly divided into an intervention group and a control group. The intervention group will be given routine management, a CGA and multi-disciplinary management involving rehabilitation exercise, diet adjustment, multi-drug evaluation, acupoint massage in TCM and patient education for 12 months, and the control group will be followed up with routine management for basic diseases. The primary outcomes are the Fried phenotype and short physical performance battery (SPPB). The secondary outcomes are the clinical frailty scale (CFS), non-elective hospital readmission, basic activities of daily living (BADL), 5-level European quality of life 5 dimensions index (EQ-5D), nutrition risk screening-2002 (NRS-2002), medical insurance expenses, fall events, and all-cause mortality. In addition, a cost-effectiveness study will be carried out. DISCUSSION: This paper outlines the protocol for a randomized, single-blind, parallel multi-center clinical study. This protocol, if beneficial, will demonstrate the interaction of various intervention strategies, will help improve elderly frailty patients, and will be useful for clinicians, nurses, policymakers, public health authorities, and the general population. TRIAL REGISTRATION: Chinese Clinical Trials Register, ChiCTR1900022623. Registered on April 19, 2019, http://www.chictr.org.cn/showproj.aspx?proj=38141.


Asunto(s)
Atención Integral de Salud/métodos , Anciano Frágil , Fragilidad/rehabilitación , Evaluación Geriátrica/métodos , Servicios de Salud para Ancianos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , China , Terapia por Ejercicio/métodos , Femenino , Humanos , Masculino , Medicina China Tradicional/métodos , Terapia Nutricional/métodos , Estado Nutricional , Grupo de Atención al Paciente , Educación del Paciente como Asunto/métodos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Método Simple Ciego , Resultado del Tratamiento
18.
Nursing (Säo Paulo) ; 23(270): 4808-4815, nov.2020.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1145449

RESUMEN

Objetivo: investigar o custeio do diagnóstico e tratamento de câncer em idosos de um Centro Oncológico de Minas Gerais. Método: Os dados foram coletados através de fonte secundária do Registro Hospitalar do Câncer, de um Hospital Filantrópico do Interior de Minas Gerais, entre o ano de 2009 a 2016, com uma amostra de 3.666 idosos em tratamento oncológico. A análise dos resultados foi feita por meio de estatística descritiva simples. Todos os aspectos éticos foram resguardados. Resultados: Entre as principais fontes de diagnóstico das neoplasias destaca-se a histologia do tumor, correspondendo a 85,50%. Quanto ao custeio do diagnóstico e tratamento, em 25,09% e 86,05% dos casos, respectivamente, foram custeados pelo Sistema Único de Saúde. Conclusão: é importante ressaltar que o diagnóstico e tratamento precoce aumentam as chances de cura e que o Sistema Único de Saúde cobre a maioria dos custos, tornando possíveis as intervenções apropriadas para estes pacientes.(AU)


Objective: to investigate the cost of diagnosing and treating cancer in the elderly of an Oncology Center in Minas Gerais. Method: Data were collected through a secondary source of the Hospital Cancer Registry, from a Philanthropic Hospital in the Interior of Minas Gerais, between 2009 and 2016, with a sample of 3,666 elderly people undergoing cancer treatment. The results were analyzed using simple descriptive statistics. All ethical aspects were safeguarded. Results: Among the main sources of diagnosis of neoplasms, the histology of the tumor stands out, corresponding to 85.50%. As for the cost of diagnosis and treatment, 25.09% and 86.05% of cases, respectively, were covered by the Unified Health System. Conclusion: it is important to note that early diagnosis and treatment increase the chances of cure and that Unified Health System covers most costs, making appropriate interventions for these patients possible.(AU)


Objetivo: investigar el costo del diagnóstico y tratamiento del cáncer en ancianos de un Centro de Oncología en Minas Gerais. Método: Los datos se recolectaron a través de una fuente secundaria del Registro Hospitalario de Cáncer, de un Hospital Filantrópico del Interior de Minas Gerais, entre 2009 y 2016, con una muestra de 3,666 ancianos en tratamiento oncológico. Los resultados se analizaron mediante estadística descriptiva simple. Se salvaguardaron todos los aspectos éticos. Resultados: Entre las principales fuentes de diagnóstico de neoplasias destaca la histología del tumor, correspondiente al 85,50%. En cuanto al costo del diagnóstico y tratamiento, el 25,09% y el 86,05% de los casos, respectivamente, fueron cubiertos por el Sistema Único de Salud. Conclusión: es importante señalar que el diagnóstico y el tratamiento precoces aumentan las posibilidades de curación y que Unified Health System cubre la mayoría de los costos, haciendo posibles las intervenciones adecuadas para estos pacientes.(AU)


Asunto(s)
Humanos , Anciano , Enfermería Oncológica , Salud del Anciano , Anciano Frágil , Costos de la Atención en Salud , Diagnóstico , Neoplasias , Diagnóstico de Enfermería , Enfermería Geriátrica , Servicios de Salud para Ancianos
19.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-193596

RESUMEN

La soledad y el apoyo social deficiente están reconocidos como predictores de morbimortalidad. Cuando una persona mayor vive sola y no recibe soporte familiar ni social para corregir desviaciones en su autocuidado, se produce una sobreutilización de servicios sanitarios y, posiblemente, un aumento de los ingresos hospitalarios. En 2018, el Consell de Salut del Centro de Salud (CS) República Argentina de Valencia realizó un estudio piloto de detección y abordaje de soledad no deseada en las personas del barrio en el que se estableció que un 45% de las personas que vivían solas y eran mayores de 75 años tendrían un posible diagnóstico de aislamiento social. OBJETIVOS: implementar una red comunitaria de voluntariado de acompañamiento-vigilancia en autocuidados para personas mayores con aislamiento social en el área del CS República Argentina, con el soporte del «Programa de acompañamiento en salud constante» (PASC) de la Cruz Roja, en colaboración con el centro de salud, y estudiar la relación entre soledad y salud. MÉTODOS: mediante un diseño escalado de detección y diagnóstico de aislamiento social, con la participación de técnicos de la Cruz Roja, profesionales del centro de salud y la colaboración de voluntariado de acompañamiento a personas mayores participantes. RESULTADOS: en 7 meses 1.200 personas fueron sensibilizadas de forma directa sobre la soledad y 49 voluntarios del barrio desarrollaron labores de acompañamiento y asistencia a talleres formativos y lúdicos. Los profesionales sanitarios analizaron 216 casos: 149 (69%) no se sintieron solos y 67 (31%) fueron diagnosticados de aislamiento social (código correspondiente a V64.01 según CIE-9). Participaron en el proyecto 54 personas (25%). Existe asociación entre la escala de detección de la soledad existencial (EDSOL) y la participación en el proyecto. La sensación de soledad no deseada presenta correlación positiva con problemas de movilidad, cronicidad y una tendencia de asociación con otras variables de salud (consumo elevado de fármacos, percepción negativa de calidad de vida, etc.). CONCLUSIONES: las intervenciones comunitarias promovidas desde el centro de salud sobre personas que viven solas contribuyen al abordaje del aislamiento no deseado y a su vez generan un barrio más solidario


Loneliness and poor social support are widely recognized as predictors of morbidity and mortality. When an elderly person lives alone and does not receive family or social support to correct minor deviations in basic self-care processes, this leads to overuse of health services and possibly, increased hospital admissions. In 2018, the Consell de Salut of the República Argentina Primary Health Centre in Valencia, began a pilot study to detect and tackle unwanted loneliness in people from the neighbourhood, in which it was established that 45% of people aged over 75 years old who lived alone may be diagnosed with social isolation. OBJECTIVES: To establish a community network of accompanying-surveillance volunteers in self-care for socially isolated elderly people in the area of the República Argentina Primary Care Centre with the support of the Red Cross Constant Health Accompaniment Programme. The specific objective is to study the relationship between loneliness and health. METHODS: Using a scaled design for the detection and diagnosis of social isolation, with the participation of the Red Cross technicians, professionals from the health center, and the collaboration of volunteer support for elderly participants. RESULTS: Over seven months a total of 1200 people have been directly made aware about loneliness and 49 volunteers from the neighbourhood performed accompaniment work and attended training and recreational workshops. Health professionals analyzed 216 cases, of which 149 (69%) did not feel alone and the remaining 67 (31%) were diagnosed with social isolation (code V64.01 according to ICD-9). A total of 54 (25%) agreed to take part in the project. An association was observed between the scale for detection of existential loneliness (EDSOL) and participation in the project. The feeling of unwanted loneliness correlates positively with mobility problems, chronicity and a tendency of association with other health variables such as high consumption of drugs and negative perception of quality of life. CONCLUSIONS: Community interventions promoted by the Primary Health Centre on people who live alone contribute to tackling unwanted isolation, which at the same time generates a more supportive neighbourhood


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Participación de la Comunidad/métodos , Redes Comunitarias , Anciano Frágil/psicología , Programas Voluntarios , Agencias Voluntarias , Soledad , Argentina , Calidad de Vida
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