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1.
Res Social Adm Pharm ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035870

RESUMO

BACKGROUND: In the SIMENON study, medication use reviews were conducted for older polymedicated home-dwelling patients across 56 Belgian community pharmacies. OBJECTIVE: To evaluate the impact of the service on patient-reported outcome measures and patient-reported experience measures, and to evaluate the suitability of the chosen instruments. METHODS: A before-after design was used to measure the impact of the medication use review in a subset of patients, participating in the SIMENON study. Patients completed self-report questionnaires before and 3 and 12 weeks after the intervention by letter, phone or e-mail. Six outcomes were evaluated: medication-related quality of life, adherence, self-management, patient satisfaction, fall incidents and use of emergency healthcare services. RESULTS: Questionnaires at baseline and endpoint were available for 83 patients (median age 77 years; median of 7 drugs) of 24 pharmacies. The Living with Medicines Questionnaire showed low medication burden at baseline (84.8/205) which increased to 85.7 three weeks later (n = 57; p = 0.219). Scores significantly reduced to 81.9 at twelve weeks (p = 0.031). The Probabilistic Medication Adherence Scale (n = 67) showed high median adherence scores at baseline (14/18) which remained unaltered (p = 0.974). The patient activation measure found low self-management in one third of the sample at baseline and endpoint (35.5% and 37.1% respectively; p = 0.243). The Patient Satisfaction with Pharmacist Services Questionnaire (n = 66) demonstrated high patient satisfaction. The number of patients with a hospitalization in the last three months decreased non-significantly from 14.8% to 11.1% in the post-measurement after 12 weeks (p = 0.227). No effect was observed on emergency room visits and falls. CONCLUSIONS: The medication use review reduced medication burden but did not impact the patient's adherence and self-management. However, adherence scores were high, medication burden was low at baseline and the sample size was limited. The Living with Medicines instrument is a promising instrument for future research to assess medication-related quality of life in older polymedicated patients.

2.
Res Social Adm Pharm ; 16(2): 168-177, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31078447

RESUMO

BACKGROUND: The potential benefit of community pharmacist's involvement in continuity of care is well-known. However, it is not standard practice to exchange information with the community pharmacist (CP) after hospitalization. OBJECTIVE: To construct and validate an evidence-based prototype of a discharge report for the community pharmacist. METHODS: First, a review of literature, guidelines and established initiatives was performed to construct a preliminary discharge report. Secondly, the content of the discharge report was reviewed and optimized using semi-structured individual interviews with CPs and general practitioners (GPs). RESULTS: The review identified six guidelines for information exchange with the CP originating from three countries, 17 research papers and three local initiatives. Overall, 49 different elements for a discharge document were identified. Based on recurring elements, a preliminary discharge report was created. Interviews with ten CPs and nine GPs provided insights into which information is considered crucial for patient safety and why. This allowed an optimization of the document. The final discharge report consists of three categories: administrative, medication and medical data. The medication data includes medication registered at hospital admission as well as at hospital discharge, drug indications, reasons for initiating, adjusting or discontinuing therapies and start/stop dates. The medical data contains reasons for hospitalization, comorbidities and allergies. CONCLUSIONS: The literature review and semi-structured interviews resulted in an evidence-based prototype of a discharge report for the community pharmacist. This document contains both administrative, medical and medication data.

3.
Qual Health Res ; 30(4): 583-597, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31303115

RESUMO

Researchers propose that the convoy of care model should be used to study care networks of frail, older individuals. Care convoys are defined as the evolving collection of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled health care, monitoring, and advocacy. This study reports on community-dwelling older adults' experiences of their care convoy, how care convoys change over time, and perceived (positive) outcomes. A qualitative analysis among 65 semi-structured interviews with frail, community-dwelling older adults demonstrates a great variety in the composition of care convoys. Participants were often actively involved in their care convoy and valued the social/relational aspect of care. Care and support covered a wide range of activities, with some activities being provided by specific types of caregivers. Participants expressed the adequacy of their care convoy in terms of satisfaction and sufficiency. Noteworthy, participants who were satisfied with their care convoy did not necessarily receive sufficient help. Policies and practice should recognize the relational aspect of care, the complex interplay between all actors, and the dynamic character of care convoys.

4.
Implement Sci ; 14(1): 104, 2019 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829252

RESUMO

BACKGROUND: The COME-ON study was a cluster-controlled trial of a complex intervention that consisted of a blended training program, local interdisciplinary meetings, and interdisciplinary case conferences in Belgian nursing homes. The intervention was associated with significant improvements in the appropriateness of prescribing. The aims of this study were to describe the implementation of the intervention and to explore the experiences of participants, for the purpose of identifying factors associated with implementation and perceived impact and to draw lessons for future implementation. METHODS: We performed a mixed-method process evaluation. Questionnaires and reports were used to collect quantitative data on implementation and experiences from the 24 NHs and participating healthcare professionals (coordinating physicians, general practitioners, pharmacists, and nurses) in the intervention group. Multidisciplinary focus groups focusing on factors associated with implementation and perceived impact were conducted in 11 NHs. RESULTS: Overall, the rate of implementation and the satisfaction of participants were good, despite some variability between NHs and HCPs. Although perceived impact on nursing home residents varied, most participants perceived a positive impact for themselves. Factors associated with implementation and perceived impact were identified at different levels: intervention, healthcare professionals, organization, and external context. The interdisciplinary and face-to-face approaches were recognized as key elements for the success of the intervention, despite organizational constraints. The attitude of general practitioners was identified both as a barrier to and a facilitator for implementation and its success. The professional role and competency of the pharmacist influenced perceived impact. The pre-existing relationships between HCPs and the presence of a leader facilitated implementation and perceived impact. Remuneration was deemed necessary for the study and for future implementation. CONCLUSIONS: Overall, the intervention, and more specifically its interdisciplinary aspect, was well implemented and appreciated by HCPs. This probably contributed to the positive effect on the appropriateness of prescribing. Future implementation must take into account the various factors found to affect implementation and perceived impact, in order to maximize effect and sustainability. Trial registration Current Controlled Trials ISRCTN66138978; registered 18 November 2015, retrospectively registered, https://www.isrctn.com/ISRCTN66138978.

5.
BMC Geriatr ; 19(1): 346, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31822285

RESUMO

BACKGROUND: Many instruments to identify frail older people have been developed. One of the consequences is that the prevalence rates of frailty vary widely dependent on the instrument selected. The aims of this study were 1) to examine the concordances and differences between a unidimensional and multidimensional assessment of frailty, 2) to assess to what extent the characteristics of a 'frail sample' differ depending on the selected frailty measurement because 'being frail' is used in many studies as an inclusion criterion. METHOD: A cross-sectional study was conducted among 196 community-dwelling older adults (≥60 years), which were selected from the census records. Unidimensional frailty was operationalized according to the Fried Phenotype (FP) and multidimensional frailty was measured with the Comprehensive Frailty Assessment Instrument (CFAI). The concordances and differences were examined by prevalence, correlations, observed agreement and Kappa values. Differences between sample characteristics (e.g., age, physical activity, life satisfaction) were investigated with ANOVA and Kruskall-Wallis test. RESULTS: The mean age was 72.74 (SD 8.04) and 48.98% was male. According to the FP 23.59% was not-frail, 56.92% pre-frail and 19.49% frail. According to the CFAI, 44.33% was no-to-low frail, 37.63% was mild frail and 18.04% was high frail. The correlation between FP and the CFAI was r = 0.46 and the observed agreement was 52.85%. The Kappa value was κ = 0.35 (quadratic κ = 0.45). In total, 11.92% of the participants were frail according to both measurements, 7.77% was solely frail according to the FP and 6.21% was solely frail according to the CFAI. The 'frail sample respondents' according to the FP had higher levels of life satisfaction and net income, but performed less physical activities in comparison to high frail people according to the CFAI. CONCLUSION: The present study shows that the FP and CFAI partly measure the same 'frailty-construct', although differences were found for instance in the prevalence of frailty and the composition of the 'frail participants'. Since 'being frail' is an inclusion criterion in many studies, researchers must be aware that the choice of the frailty measurement has an impact on both the estimates of frailty prevalence and the characteristics of the selected sample.

6.
Res Social Adm Pharm ; 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31759887

RESUMO

BACKGROUND: A medication use review (MUR) aims to optimize medication use, patient knowledge and can improve health outcomes. This pharmaceutical care service is not yet available in Belgium. OBJECTIVES: To describe drug-related problems (DRPs) detected during a MUR, subsequent interventions proposed by pharmacists and evolution of DRPs until follow-up and to identify patient-related variables associated with the number of reported DRPs. METHODS: Belgian community pharmacists provided a MUR to older polymedicated ambulatory patients and registered DRPs, interventions and resolution at follow-up using the PharmDISC classification. The relationship between 14 patient-related variables and the number of reported DRPs was investigated with univariate analysis. A prediction model was developed with significant variables using negative binomial regression analysis. RESULTS: Across 56 pharmacies, 453 patients received a MUR and 1196 DRPs were registered (median 3DRPs/patient, range 0-10). Only for 11.7% of patients no problems were identified. The top-3 causes were interaction (15.2%), inappropriate timing or frequency (13.5%) and adverse effect (11.9%). The top-3 recommended interventions by pharmacists were transmission of information (25.1%), in-depth patient counselling (15.0%) and therapy stop (8.2%). After six weeks, 42.6% of DRPs were resolved; data was missing for 33.3%. A higher number of chronic drugs, female gender and living alone were associated with more DRPs. The prediction model found that per additional chronic drug, the number of problems increases by 4.3% (95% CI: 2.0-6.6%). Male gender decreases DRPs by 22.1% (95% CI: 10.4-32.0%). Living alone provided no additional predictive value in the prediction model. Confounding process- and pharmacist-related variables also influenced the number of reported DRPs. CONCLUSION: A MUR appears an effective strategy to detect and resolve DRPs. The number of chronic medications and female gender predict a higher number of DRPs. These findings are a starting point for evidence-based eligibility criteria for a MUR service in Belgium.

7.
Res Social Adm Pharm ; 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31495661

RESUMO

BACKGROUND AND OBJECTIVE: Medication errors in nursing homes are highly prevalent and occur in different stages of the medicines pathway. The application of the SEIPS (System Engineering Initiative for Patient Safety) model facilitates the identification of work system factors that contribute to errors. Therefore, the aim of our research was to investigate in-depth the medicines pathway in nursing homes by using the SEIPS model and to develop a set of key activities and aggregated key interventions to be used as a basis for quality-improvement strategies. METHODS: A variety of qualitative methods, including observations, semi-structured interviews, the development of a flowchart, an expert meeting and a working symposium, were used to identify processes and work system components. Key interventions and activities were developed in three rounds (one development and two validation rounds) across the different research methods to fine-tune the defined key interventions and activities. RESULTS: Our analysis revealed a large variety of tasks as well as persons elements, aspects related to technology and tools, organisational factors and environmental elements that all interact and influence the medicines pathway. The large number of tasks could be linked to eight overarching processes: prescribing, purchase and ordering, delivery, storage, preparation, administration, monitoring and (re-)admission. After three rounds (one development and two validation rounds), a final set of 137 key activities and 27 aggregated key interventions, concretising the eight processes, was obtained. CONCLUSION: The in-depth analysis of processes within the medicines pathway in nursing homes resulted in a set of key activities and aggregated key interventions which may serve as a basis for the nursing home sector and policy makers to enhance a safe and efficient medicines pathway.

8.
J Am Med Dir Assoc ; 20(11): 1404-1411, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31402136

RESUMO

OBJECTIVES: To investigate the impact of a complex multifaceted intervention on the appropriateness of prescribing for Belgian nursing home (NH) residents. DESIGN: A multicenter, nonblinded, cluster-randomized controlled trial, with randomization at the NH level, was set up [Cluster-Controlled Trial of an Intervention to Improve Prescribing in Nursing Homes (COME-ON) Study]. The complex intervention consisted of repeated interdisciplinary case conferences (ICCs) involving the general practitioner, pharmacist, and nurse, aimed at performing a medication review for each NH resident included. The ICCs were supported by a blended training program and local interdisciplinary meetings (discussion of the appropriate use of specific medication classes at the NH level). Control NHs delivered usual care. (isrctn.com: ISRCTN66138978). SETTING AND PARTICIPANTS: Belgian NHs with at least 35 NH residents were eligible to participate. Eligible residents were those aged 65 years or over, not receiving palliative care, and being treated by a participating general practitioner. MEASURES: The primary outcome measure related to appropriateness of prescribing at resident level and was considered successful when at least 1 potentially inappropriate medication (PIM) or potential prescribing omission (PPO) present at baseline had been solved at the end of study and when there were no new PIMs or PPOs at the end of study compared with baseline. Secondary outcomes included clinical outcomes, medication use, criterion-specific prevalence of PIMs and PPOs, and ICC outcomes. RESULTS: In total, 54 NHs (24 intervention; 30 control) and 1804 NH residents (847 intervention; 957 control) participated. Using a 3-level mixed-effects model accounting for data clustering, a significant effect in favor of the intervention was observed (odds ratio 1.479 [95% confidence interval 1.062-2.059, P = .021]). There was no significant difference between groups for most clinical outcomes. The median number of medications did not change over time in either group. CONCLUSIONS AND IMPLICATIONS: The complex multifaceted intervention tested in the COME-ON study successfully improved appropriateness of prescribing in NHs.

9.
PLoS One ; 14(8): e0221096, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31412074

RESUMO

BACKGROUND: Providing care for patients with advanced cancer is often the responsibility of the partner. Being confronted with an incurable cancer diagnosis can be highly disruptive for the patient's partner and can be considered a potentially traumatic event. However, most caregivers seem to adapt well during the process of providing care. This finding is in line with the concept of resilience in literature: a dynamic process of adapting well, resulting from the interplay between intrinsic and extrinsic resources and risks. Resilience is age-related, with the elderly population being higher in resilience as compared to the younger generation. However, resilience has been understudied in middle-aged caregivers. AIM: To explore what intrinsic and extrinsic resources facilitate or hamper resilience in the middle-aged partner of a patient with incurable cancer. METHODS: Nine middle-aged partners of patients who died at home of cancer were selected and interviewed in depth within the first year following the death of their partner. A thematic analysis utilizing an inductive approach was conducted. FINDINGS: Resilience was challenged by the partner's diagnosis of incurable cancer. All participants made use of a set of interacting, caregiver-specific and context-related resources, facilitating a resilient process and leading to positive feelings and even personal growth. The partners demonstrated individual competences: adaptive flexibility, positivism, a sense of self-initiative and adaptive dependency. Furthermore, they relied on their context: cancer-related professionals and relatives. Context and situation interact continuously. The resulting dynamics were based on the context-availability, meaningful relationships and the patient's role. CONCLUSION: A resilient trajectory results from an interplay between individual and contextual resources. To build resilience in middle-aged partners of patients with incurable cancer, health care professionals should address all available resources. Moreover, they should be aware of being part of the caregiver's context, a complex adaptive system that can be either resilience-supporting or -threatening.

10.
Gerodontology ; 36(4): 382-394, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31274218

RESUMO

OBJECTIVES: To explore the failure of the oral health-related section of the interRAI (ohr-interRAI), this study investigated test content validity (A.) and reasons for inaccurate assessments (B.). BACKGROUND: Poor oral health negatively affects quality of life and is associated with a number of systemic diseases. The interRAI instruments, internationally used for geriatric assessment, should accurately detect oral conditions that require care. Previous research showed that the ohr-interRAI and related precursor versions do not achieve this goal. MATERIALS AND METHODS: (A.) A group of 12 experts rated completeness, relevance, clarity of wording and feasibility of the ohr-interRAI. Content validity indices were calculated per item (threshold 0.78). (B.) Focus group discussions with 23 caregivers were organized. A semi-structured question guide made sure that all topics of interest were covered. Qualitative content structuring analysis was applied after transcription. RESULTS: (A.) Experts agreed on the relevance of the items on chewing, pain, gingival inflammation and damaged teeth. They regarded none of the items as worded clearly and only prosthesis use and pain were considered to be assessable by untrained caregivers. All experts agreed that the ohr-interRAI was incomplete. (B.) Focus group discussions revealed that in the care environment oral health had low priority. Aspects related to the ohr-interRAI itself and aspects related to the assessment situation impeded the oral health assessment. The approach of the caregivers to complete the ohr-interRAI was inappropriate to accurately detect oral care needs. CONCLUSIONS: Findings challenge test content validity of the ohr-interRAI and reveal reasons for inaccurate assessments.


Assuntos
Cuidadores , Saúde Bucal , Idoso , Grupos Focais , Avaliação Geriátrica , Humanos , Qualidade de Vida
12.
J Am Med Dir Assoc ; 20(9): 1137-1142.e2, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30979677

RESUMO

OBJECTIVE: Oral health is known to be associated with general health, but longitudinal relationships between oral health and general health indicators have not yet been fully explored in international research. SETTING AND PARTICIPANTS: The sample consisted of 3 longitudinal databases: a sample from Belgium from the Protocol 3 project (n = 8359), a combined sample from 6 European countries (n = 2501) from the IBenC study (Belgium, Finland, Iceland, Germany, Italy, and the Netherlands), and a sample from New Zealand (n = 15,012). All clients were 65 years or older and received long-term home care services. METHODS: Bayesian models were used to analyze the associations between 3 oral health indicators (chewing difficulty, nonintact teeth, and dry mouth) and 4 aspects of general health (activities of daily living functioning, cognition, depression, and health instability). In addition, the models explored the associations between current oral health and general health status and future oral health and general health status. RESULTS: Clients who had poorer oral health had a higher risk of suffering from poor general health. Especially chewing difficulty was associated with all general health indicators in all data sets (odds ratios > 1). Dry mouth and nonintact teeth showed significant associations with almost all general health indicators. Additionally, having poor oral health (respectively general health) was predictive of poor general health (respectively oral health) at future assessments (significant cross-lagged parameters). CONCLUSIONS/IMPLICATIONS: The results point out the need of the inclusion of oral health assessment and advice from dentists or oral health practitioners into the multidisciplinary conversation. In addition, identifying older people with oral health problems is essential in order to provide treatment and monitoring. Raising awareness for oral health is important, and policy makers should foster oral health promotion and care for older adults in order to keep them in good health.

13.
J Geriatr Oncol ; 10(5): 805-810, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30898534

RESUMO

OBJECTIVES: This prospective multicenter cohort study aimed to describe new cancer events in nursing home residents (NHR). MATERIALS AND METHODS: The study was performed in 39 nursing homes from the Armonea network in Belgium, covering 4262 nursing home beds. All NHR in these homes were prospectively followed during 1 year for occurrence of cancer events (diagnosis or clinical suspicion of a new cancer or progression of a known cancer). After training, each site's local staff identified NHR with cancer events in collaboration with the treating general practitioner (GP). NHR with cancer events were included after informed consent, and data about general health and cancer status were collected every 3 months up to 2 years. RESULTS: In only nine NHR (median age 87 years, range 72-92), a cancer event was recorded during follow-up including five new (suspected or diagnosed) cancer events (incidence rate = 123/100.000 NHR per year) and four NHR with (suspected or diagnosed) progressive disease. In four NHR with suspected cancer, no diagnostic procedure was performed, and in five no anticancer treatment was started. CONCLUSION: Clinically relevant cancer events (potentially requiring diagnostic or therapeutic action) occur at a much lower frequency in NHR than expected from cancer incidence data in the general older population. Although some underreporting of cancer events cannot be excluded, this prospective study supports several previous retrospective observations that cancer events are rare in very frail older persons. Moreover, diagnostic and therapeutic actions for (suspected) cancer events are often not undertaken in this population.

14.
Am J Geriatr Psychiatry ; 27(5): 463-471, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30765289

RESUMO

OBJECTIVE: The goal of palliative care is to improve quality of life when recovery is no longer possible. The study's objective was to widen our vision of potential (unspoken) needs at the end of life with patients, close relatives, nurses, and general practitioners to aim at more versatile but personal care. The question asked was how important patients, close relatives, and healthcare providers considered the 11 core themes in defining a good death, as described in the 2016 article "Defining a good death" by Meier et al. METHODS: Specific questionnaires for general practitioners, nurses, patients, and family members were distributed in the working area of the regional palliative care network, Aalst-Dendermonde-Ninove, with the cooperation of five local quality groups, two nursing homes, and two groups of home care nurses, and data were analyzed. RESULTS: Questionnaires were completed by 67 nurses, 57 general practitioners, 16 patients, and 8 family members. Although the 34 subthemes were generally considered important for classifying a death as a good one, there were still significant differences between general practitioners and nurses, men and women, and different age groups. Nurses found 9 of the 34 themes significantly more important than general practitioners. All groups believed a pain-free death was most important. General practitioners, nurses, patients, and close relatives found the following themes important: support of family, respect for patient as an individual, being able to say goodbye, and euthanasia in case of unbearable suffering. CONCLUSION: In agreement with the patient, medical care should focus on a pain-free situation during the last phase of life and not on exhausting possible treatments to prolong life unnecessarily. Appropriate care at the end of life can be broader, and all 34 subthemes can be important in early healthcare planning. Significant differences between general practitioners and nurses deserve attention because patients and family members expect that healthcare providers will work together as a team.

15.
Acta Clin Belg ; 74(4): 263-271, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29932849

RESUMO

BACKGROUND AND OBJECTIVES: Patients often experience drug-related problems at admission or after discharge from hospital. The objective of this study was to identify the main problems in medication management at transition between settings of care, as experienced by health care professionals (HCPs) and patients. METHODS: Focus group discussions were organised between December 2009 and February 2010; nine focus groups with primary and secondary care HCPs and patients and two with stakeholders. Focus group discussions were audiotaped and observation files were constructed. For the analysis, a thematic framework approach was used. Between November 2015 and April 2016, 19 additional interviews and 1 focus group were performed with general practitioners (GP) and community pharmacists (CP). RESULTS: This qualitative study provided a long list of problems that could be summarised in five clusters: (1) problems at admission, e.g. incomplete list of medication, absence of information in case of emergency admission; (2) problems at discharge, e.g. lack of communication with GP, insufficient supplies of medication for the weekend; (3) problems as to professions, e.g. GP's opinion different to that of the medical specialist; (4) problems as to patients and family, e.g. failure to understand treatment; (5) problems as to processes, e.g. medication substitutions. CONCLUSION: HCPs and patients experience many problems in medication management at transition between settings of care. The fact that these problems occur at different stages and persist over time stresses the necessity for multilevel solutions.


Assuntos
Barreiras de Comunicação , Serviços Comunitários de Farmácia , Continuidade da Assistência ao Paciente , Hospitalização/estatística & dados numéricos , Conduta do Tratamento Medicamentoso , Atenção Primária à Saúde/métodos , Atenção Secundária à Saúde/métodos , Atitude do Pessoal de Saúde , Bélgica , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Feminino , Grupos Focais , Humanos , Masculino , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Pessoa de Meia-Idade , Preferência do Paciente , Melhoria de Qualidade/organização & administração
16.
BMC Geriatr ; 18(1): 249, 2018 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-30342479

RESUMO

BACKGROUND: According to some studies, interventions can prevent or delay frailty, but their effect in preventing adverse outcomes in frail community-dwelling older people is unclear. The aim is to investigate the effect of an intervention on adverse outcomes in frail older adults. METHODS: A systematic review and meta-analysis of Medline, Embase, the Cochrane Library, and Social Sciences Citation Index. Randomized controlled studies that aimed to treat frail community-dwelling older adults, were included. The outcomes were mortality, hospitalization, formal health costs, accidental falls, and institutionalization. Several sub-analyses were performed (duration of intervention, average age, dimension, recruitment). RESULTS: Twenty-five articles (16 original studies) were included. Six types of interventions were found. The pooled odds ratios (OR) for mortality when allocated in the experimental group were 0.99 [95% CI: 0.79, 1.25] for case management and 0.78 [95% CI: 0.41, 1.45] for provision information intervention. For institutionalization, the pooled OR with case management was 0.92 [95% CI: 0.63, 1.32], and the pooled OR for information provision intervention was 1.53 [95% CI: 0.64, 3.65]. The pooled OR for hospitalization when allocated in the experimental group was 1.13 [95% CI: 0.95, 1.35] for case management. Further sub-analyses did not yield any significant findings. CONCLUSION: This systematic review and meta-analysis does not provide sufficient scientific evidence that interventions by frail older adults can be protective against the included adverse outcomes. A sub-analysis for some variables yielded no significant effects, although some findings suggested a decrease in adverse outcomes. TRIAL REGISTRATION: Prospero registration CRD42016035429 .


Assuntos
Intervenção Médica Precoce/tendências , Idoso Fragilizado , Fragilidade/terapia , Vida Independente/tendências , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Administração de Caso/tendências , Intervenção Médica Precoce/métodos , Idoso Fragilizado/psicologia , Fragilidade/diagnóstico , Fragilidade/psicologia , Custos de Cuidados de Saúde/tendências , Hospitalização/tendências , Humanos , Vida Independente/psicologia , Institucionalização/tendências , Resultado do Tratamento
17.
BMC Geriatr ; 18(1): 194, 2018 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-30149798

RESUMO

BACKGROUND: Frail community-dwelling older adults, whom might experience problems regarding physical, cognitive, psychological, social and environmental factors, are at risk for adverse outcomes such as disability, institutionalization and mortality. People in need of help do not always find their way to care and support services and are left undetected. The aim of the D-SCOPE project is to detect frail community-dwelling older adults who previously went unnoticed and to improve their access to care and support. Goal is to increase their frailty-balance, quality of life, meaning in life, life satisfaction, mastery, community inclusion and ageing well in place. METHODS/DESIGN: The study is a prospective, longitudinal randomized four-armed controlled trial with follow-up at 6 months. The study group aims to include 900 community-dwelling older adults aged 60 years and over from 3 municipalities in Flanders (Belgium). While selecting the study group, risk profiles for frailty will be taken into account. Participants will be randomly selected from the census records in each municipality. Data will be collected prospectively at baseline (T0) and at follow-up, 6 months after baseline (T1). At baseline, participants who are at least mild frail on one of the 5 domains of frailty (CFAI-plus) or feel frail based on the subjective assessment of frailty will be randomly assigned to (1) the study group or (2) the control group. A mixed method design with the inclusion of quantitative and qualitative data analyses will be used to evaluate the efficacy and experiences of the detection and prevention program on frailty. DISCUSSION: The study will contribute to an innovative vision concerning the organization of care and support, and a timely and accurate detection and support of community-dwelling older adults at risk for frailty. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov, on May 26, 2017, identifier: NCT03168204 .


Assuntos
Idoso Fragilizado , Fragilidade/epidemiologia , Fragilidade/prevenção & controle , Vida Independente , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Emoções/fisiologia , Feminino , Seguimentos , Idoso Fragilizado/psicologia , Fragilidade/psicologia , Humanos , Vida Independente/psicologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida/psicologia
18.
Sci Rep ; 8(1): 8871, 2018 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-29891862

RESUMO

Oral health (OH) and general health (GH) indicators are representations of the health status of the body. The OH indicators provide information about the oral health status while the GH indicators are used to assess the functional, cognitive, and mental conditions. OH is reported to be associated with GH. However, some specific associations, especially longitudinal relationships between OH and GH indicators, have not been fully explored. We examined the prediction ability from OH to GH and vice versa using a Belgian registry. We collected information from 8359 elderly participants, who were older than 65, lived at home, and received home care. The demographic and clinical information including three binary OH indicators and four ordinal GH indicators were collected. The participants were recorded at baseline and every six months afterwards. We opted for a generalization of a vector autoregressive model to ordinal responses. This model allows to estimate autocorrelations and cross-lagged correlations, addressing the prediction of GH from OH in a cross-sectional and longitudinal manner. We showed that individuals who had poorer OH had a higher risk of suffering from poor GH status. The percentages of correct or close prediction for GH indicators from OH indicators are high, being around 80% for all GH indicators. Additionally, having a poor OH (resp. GH) status was additionally predictive of a poor GH (resp. OH) status at following assessments. Our finding suggests using historical records of OH as well as GH indicators to draw better health care plan for geriatrics population.


Assuntos
Nível de Saúde , Saúde Bucal , Idoso , Idoso de 80 Anos ou mais , Bélgica , Correlação de Dados , Feminino , Humanos , Estudos Longitudinais , Masculino
19.
BMC Palliat Care ; 17(1): 88, 2018 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-29933758

RESUMO

BACKGROUND: Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual's preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. METHODS: Following the Belgian Centre for Evidence-Based Medicine's procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). RESULTS: Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. CONCLUSION: No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.


Assuntos
Planejamento Antecipado de Cuidados/tendências , Demência/terapia , Diretrizes para o Planejamento em Saúde , Tomada de Decisões , Demência/psicologia , Prática Clínica Baseada em Evidências/métodos , Humanos , Cuidados Paliativos/métodos , Inquéritos e Questionários
20.
Arch Public Health ; 76: 16, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29545947

RESUMO

For our master thesis in medicine, we aimed to determine how many deaths were caused by and with dementia in 2014 and we compared our results with figures from abroad. The mortality rates of 2014 in Flanders were used to determine the amount of deaths related to dementia. These figures are collected by Vlaams Agentschap Zorg & Gezondheid (VAZG) and coded per ICD-10 classification. Of all deaths in Flanders in 2014, 6.60% were caused by dementia and 4.29% were caused by another condition, while also suffering from dementia. Data from abroad are ambiguous. While working on our thesis about "death & dementia", we questioned the reliability of mortality statistics. Possible explanations could be; the complexity of completing death certificates correctly and the challenges involved in properly constructing a chain of causes of death. The accuracy of mortality data can be improved by training and redrafting death certificates.

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