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1.
Gerontology ; : 1-9, 2021 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-34864733

RESUMO

BACKGROUND: Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibitor of metalloproteinases-2 [TIMP-2]·insulin-like growth factor binding protein-7 [IGFBP7], a new FDA-cleared renal tubular stress biomarker, was used. MATERIALS AND METHODS: 68 residents from facilities of sheltered housing with urine samples collected at heat waves in 2015 and at control visits were included. Urinary [TIMP-2]·[IGFBP7] was compared between the heat waves and the control visits. Multivariate linear models were adjusted for age, frailty index, and functional comorbidity index. RESULTS: The median age was 82.0 years, 82.3% were women. The percentage of elevated levels of urinary [TIMP-2]·[IGFBP7] (>0.3 [ng/mL]2/1,000) in the total study population was higher at the heat waves than at the control visits (25.0% vs. 17.7%). The effect of the heat waves on urinary [TIMP-2]·[IGFBP7] was stronger in men than in women: The percentage of elevated levels was 75.0% in men and 14.3% in women. In the multivariate analysis, the mean urinary [TIMP-2]·[IGFBP7] was 0.48 (95% CI 0.25; 0.70) (ng/mL)2/1,000 higher in men than in women. Except gender, a number of additional variables did not show an association with urinary [TIMP-2]·[IGFBP7] at the heat waves or the control visits. CONCLUSIONS: At heat waves, urinary [TIMP-2]·[IGFBP7] was elevated and higher in men than in women. This suggests gender-specific differences in renal heat tolerance in older people.

2.
Eur Rev Aging Phys Act ; 18(1): 9, 2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118878

RESUMO

BACKGROUND: A growing number of older adults suffer hip and pelvic fractures leading to hospital admission. They often result in reduced physical activity (PA) and impaired mobility. PA can be objectively measured with body-worn sensors. Usually, global cumulative PA parameters are analysed, such as walking duration, upright-time and number of steps. These traditional parameters mix different domains of PA, such as physical capacity (PC), behaviour and living environment. We examined the change of global cumulative PA measures during rehabilitation and after discharge in patients with hip or pelvic fracture and whether more 'in-depth' PA parameters, such as walking interval length, variability of interval length and sit-to-stand transitions and their changes during rehabilitation and 3 months after discharge might better reflect the above mentioned three clinically relevant domains of PA. METHODS: This study is a secondary data analysis of a randomised controlled trial to improve PA and fall-related self-efficacy in hip or pelvic fracture patients (≥60 years) with concerns about falling. Changes of accelerometer-measured global cumulative and in-depth PA parameters (activPAL3) were analysed in an observational design before and after discharge combining both groups. For comparison, the same analyses were applied to the traditional PC measures gait speed and 5-chair-rise. RESULTS: Seventy-five percent of the 111 study participants were female (mean age: 82.5 (SD = 6.76) years. Daily walking duration, upright time and number of steps as aspects of global PA increased during inpatient rehabilitation as well as afterwards. The in-depth PA parameters showed differing patterns. While the total number of walking bouts increased similarly, the number of longer walking bouts decreased by 50% after discharge. This pattern was also seen for the average walking interval length, which increased by 2.34 s (95% confidence interval (CI): 0.68; 4.00) during inpatient rehabilitation and decreased afterwards below baseline level (- 4.19 s (95% CI: - 5.56; - 2.82)). The traditional PC measures showed similar patterns to the in-depth PA parameters with improvements during rehabilitation, but not at home. CONCLUSION: Our findings suggest that the in-depth PA parameters add further information to the global cumulative PA parameters. Whereas global cumulative PA parameters improved significantly during inpatient rehabilitation and after discharge, in-depth PA parameters as well as PC did not continuously improve at home. In contrast to global cumulative PA parameters the in-depth parameters seem to reflect contextual factors such as the build environment and aspects of PC, which are traditionally assessed by clinical PC measures. These in combination with digital mobility measures can help clinicians to assess the health status of fragility fracture patients, individually tailor therapy measures and monitor the rehabilitation process.

3.
Eur J Health Econ ; 22(6): 873-885, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33813666

RESUMO

BACKGROUND: Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients. METHODS: This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves. RESULTS: 14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective. CONCLUSION: Survival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.


Assuntos
Fraturas do Quadril , Seguro de Assistência de Longo Prazo , Idoso , Análise Custo-Benefício , Custos de Cuidados de Saúde , Fraturas do Quadril/terapia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos
4.
BMC Geriatr ; 20(1): 439, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129263

RESUMO

BACKGROUND: A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality. METHODS: In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality. RESULTS: The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2. CONCLUSION: This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).


Assuntos
Assistência de Longa Duração , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Humanos , Estudos Longitudinais , Morbidade , Estudos Retrospectivos
5.
Age Ageing ; 49(5): 771-778, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32832985

RESUMO

BACKGROUND: fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT. METHODS: one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention. RESULTS: in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45). CONCLUSIONS: the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.


Assuntos
Acidentes por Quedas , Fraturas do Quadril , Acidentes por Quedas/prevenção & controle , Idoso de 80 Anos ou mais , Exercício Físico , Medo , Feminino , Fraturas do Quadril/diagnóstico , Humanos , Masculino , Caminhada
6.
PLoS One ; 15(5): e0232969, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428007

RESUMO

OBJECTIVE: Hip fractures are among the most frequently occurring fragility fractures in older adults, associated with a loss of quality of life, high mortality, and high use of healthcare resources. The aim was to apply the superlearner method to predict osteoporotic hip fractures using administrative claims data and to compare its performance to established methods. METHODS: We devided claims data of 288,086 individuals aged 65 years and older without care level into a training (80%) and a validation set (20%). Subsequently, we trained a superlearner algorithm that considered both regression and machine learning algorithms (e.g., support vector machines, RUSBoost) on a large set of clinical risk factors. Mean squared error and measures of discrimination and calibration were employed to assess prediction performance. RESULTS: All algorithms used in the analysis showed similar performance with an AUC ranging from 0.66 to 0.72 in the training and 0.65 to 0.70 in the validation set. Superlearner showed good discrimination in the training set but poorer discrimination and calibration in the validation set. CONCLUSIONS: The superlearner achieved similar predictive performance compared to the individual algorithms included. Nevertheless, in the presence of non-linearity and complex interactions, this method might be a flexible alternative to be considered for risk prediction in large datasets.


Assuntos
Fraturas do Quadril/etiologia , Aprendizado de Máquina , Fraturas por Osteoporose/etiologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Alemanha/epidemiologia , Fraturas do Quadril/epidemiologia , Humanos , Modelos Logísticos , Masculino , Dinâmica não Linear , Fraturas por Osteoporose/epidemiologia , Estudos Retrospectivos , Fatores de Risco
7.
PLoS One ; 15(3): e0230648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203564

RESUMO

OBJECTIVE: To investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance. DATA SOURCES/STUDY SETTING: Patient-level statutory health and long-term care insurance claims data from 2009-2011 and official statistical data from Germany. STUDY DESIGN: We performed a retrospective cohort study. Investigated multinomial outcome categories were increase in care dependency (new onset or a higher care dependency than pre-fracture), no change as reference and death as competing risk in the quarterly period following hip fracture (follow-up 3 months). Regional variation was operationalized with the variance of regional-level random intercepts based on generalized linear mixed models. We adjusted for patient and regional characteristics. PRINCIPAL FINDINGS: The study included 122,887 hip fracture patients in 95 German postal code regions. Crude outcomes were 30.87% increase in care dependency and 14.35% death. Results indicated modest variation on regional level. Male sex, increasing age, increasing comorbidity, pertrochanteric and subtrochanteric fracture site compared to femoral neck, time from hospital admission to surgery of 3 or more days, as well as increasing inpatient length of stay, non-participation in rehabilitation and regions with lower hospital density were positively associated with an increase in care dependency. CONCLUSIONS: Several characteristics on patient and regional level associated with the outcome were identified. Variation in the increase in care dependency after hip fracture appeared to be attributable primarily to patient characteristics. Variation on regional level was only modest.


Assuntos
Atenção à Saúde/estatística & dados numéricos , Fraturas do Quadril/economia , Seguro Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Alemanha , Humanos , Masculino , Análise Multivariada , Estudos Retrospectivos
8.
Aging Clin Exp Res ; 32(7): 1255-1262, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32146698

RESUMO

BACKGROUND: OFRA is a large health insurance fund-driven program which aims to reduce the risk of falls and fractures in older people living in rural areas. The programme offered specific mobility and falls prevention classes and bone density measurement by a DXA scan free of charge to more than 10,000 people, and was promoted by staff of the health insurance fund either by a visit at home, or a phone call, or a visit at home and a subsequent phone call. The aim of this study was to analyse the uptake of an exercise class and the use of a DXA scan after advice. METHODS: Telephone interviews were conducted in a randomly selected subgroup of 780 persons 9 months after first contact. Rates of uptake of an exercise class or use of a DXA scan were calculated. Predictors of uptake and use were analysed applying logistic regression models. RESULTS: The rate of uptake after advice for specific mobility and fall prevention class was 29.6%. For DXA scan, the rate of use after advice was 16.7%. Rates of uptake and use increased if the first contact by a visit at home or a phone call was followed by an additional subsequent phone call. CONCLUSION: A direct motivational approach in older people by a health insurance fund is feasible and results in relevant participation and utilization rates in exercise classes and DXA scans.


Assuntos
Densidade Óssea , Fraturas por Osteoporose/prevenção & controle , Absorciometria de Fóton , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Seguro Saúde , Masculino , Amplitude de Movimento Articular
9.
Dtsch Arztebl Int ; 117(4): 53-59, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-32036854

RESUMO

BACKGROUND: To meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany. METHODS: This observational study was based on health insurance claims data from 58 001 patients (79.4% women) aged ≥80 years admitted to the hospital with hip fracture between January 2014 and March 2016. They were treated in 828 German hospitals with or without orthogeriatric co-management. The outcome measure was cumulative mortality with adjustment of the regression analyses. RESULTS: The crude 30-day mortality was 10.3% for patients from hospitals with orthogeriatric co-management and 13.4% for patients from hospitals without orthogeriatric co-management. The adjusted 30-day mortality was 22% lower for patients in hospitals with orthogeriatric co-management (rate ratio 0.78; 95% CI [0.74; 0.82]; adjusted absolute difference -2.48%; 95% CI [-2.98; -1.98]). The difference in 30-day mortality remained nearly unchanged over the first 6 months. The risk reduction with orthogeriatric co-management was consistently observed in both women and men, across age groups, and in patients with and without care needs. The mean length of the index stay was 19.8 days in hospitals with orthogeriatric co-management and 14.4 days in hospitals without orthogeriatric co-management. CONCLUSION: A multidisciplinary orthogeriatric approach is associated with lower mortality and a longer index stay in hospital after hip fracture.


Assuntos
Fraturas do Quadril/mortalidade , Fraturas do Quadril/terapia , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Resultado do Tratamento
10.
Bone Rep ; 12: 100244, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31970265

RESUMO

To explore the association of incident hip fractures with metabolic syndrome (MetS) and its single components, we designed a prospective cohort study of hip fracture incidence among 117,053 participants of a population-based health surveillance program in Vorarlberg, the westernmost Austrian province. Incident hip fractures were recorded between 5 and 10 years after inclusion at baseline from 2003 to 2009. Applying Cox proportional hazard models for each MetS component and for a composite z-score for MetS, hazards for fracture were estimated in quintiles, as continuous z-score variables, and as pathological cut off values. Mean age was 50.1 ± 15.6 years at baseline, 5-10 years after which 947 incident hip fractures occurred. An association of a higher composite MetS score with decreased hip fracture risk was observed in women (HR 0.80, 95%-CI 0.88-0.96, p < 0.01) which disappeared upon adjustment for BMI. BMI was inversely associated with hip fracture risk in women and men (HR for the highest compared with the lowest quintile: 0.83 (95%-CI: 0.63-1.10, p trend < 0.05) and 0.55 (95%-CI: 0.38-0.79, p trend < 0.001), respectively). Only in women, hip fracture risk was reduced at high cholesterol levels (HR for the highest relative to the lowest quintile: 0.64, 95%-CI: 0.48-0.84, p trend < 0.05) and in hypercholesterolemic patients (HR 0.82, 95%-CI: 0.67-0.99, p < 0.05), but elevated in hyperglycemic patients (HR 1.33, 95%-CI: 1.05-1.70, p < 0.05). Hypertriglyceridemia was associated with increased male hip fracture risk (HR 1.33, 95%-CI: 1.03-1.72, p < 0.05). The inverse association between the MetS and hip fracture risk is mainly driven by one single component, namely BMI.

11.
J Rehabil Med ; 52(2): jrm00024, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-31748818

RESUMO

OBJECTIVE: Acute geriatric care (geriatric early rehabilitative treatment) and sub-acute (inpatient) geriat-ric rehabilitation are delivered to geriatric patients in Germany after hip fracture. The aim of this study was to compare patients' outcomes after hip fracture between 3 German federal states (Hesse, Bavaria, and Baden-Wuerttemberg) that nearly exclusively offered one of the two geriatric care systems. DESIGN: Retrospective cohort study with patient-related health insurance claims data. PATIENTS: Analyses were performed with data from 2009-2012 of over 30,000 patients aged ≥80 years with incident hip fracture. METHODS: Primary outcomes: "increase in care dependency", "nursing home admission"; secondary outcomes: "rehospitalization", "mortality". Multivariate regression models were applied. RESULTS: Compared with Hesse, the state with acute geriatric care, the risks of an "increase in care dependency" were lower in Bavaria (adjusted ratio = 0.84; 95% confidence interval (95% CI) 0.81-0.87) and Baden-Wurttemberg (0.88; 0.85-0.92), the 2 federal states with sub-acute geriatric rehabilitation. A reduction in the risk of nursing home admission was observed in Baden-Wuerttemberg (0.77; 95% CI 0.69-0.87), but not in Bavaria. Rehospitalization rates were lower in Bavaria and Baden-Wuerttemberg compared with Hesse. There was no difference in mortality. CONCLUSION: Some, but not all, outcomes were more favourable in the federal states with sub-acute geriatric rehabilitation than in the federal state with acute geriatric care.


Assuntos
Fraturas do Quadril/reabilitação , Idoso de 80 Anos ou mais , Análise de Dados , Feminino , Alemanha , Humanos , Masculino , Estudos Retrospectivos
12.
J Gerontol A Biol Sci Med Sci ; 75(2): 366-373, 2020 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-30789659

RESUMO

BACKGROUND: Considering that mortality rate and deficit accumulation varies considerably in men and women, we performed a sex-stratified analysis of the association between an estimated frailty index (eFI) with 6-year mortality in the Activity and Function in the Elderly (ActiFE) Study. METHODS: We constructed an eFI using a score (0 [no deficit] to 1 [deficit]) from 32 baseline items representing multiple domains. eFI represents the sum of all scores divided by 32. Cox proportional hazards models adjusted for age, smoking, alcohol intake, and education were used to evaluate this association. RESULTS: Among 1,204 participants (57.5% men), 18.5% men and 26.0% women were frail (eFI ≥ 0.2) with an age-adjusted mean eFI of 0.13 (95% confidence interval [CI] 0.12, 0.13) and 0.15 (95% CI 0.15, 0.16), respectively. Mortality rate in men (146 deaths) was 34.4 (95% CI 29.3, 40.5) and in women (50 deaths) 15.1 (95% CI 11.5, 19.9) per 1,000 person-years. A 0.1 increment of eFI was associated with a hazard ratio (HR) of 1.94 (95% CI 1.60, 2.35) in men and 2.06 (95% CI 1.58, 2.69) in women. Frail versus nonfrail men and women had a HR of 2.46 (95% CI 1.74, 3.48), and 2.98 (95% CI 1.55, 5.70), respectively. We detected sex differences in the order of the eight common contributor items to the eFI. CONCLUSIONS: We observed a statistically significant difference for the age-adjusted eFI and the frailty prevalence in men and women. However, our analysis does not suggest the presence of effect modification by sex in the association with mortality.


Assuntos
Idoso Fragilizado , Fragilidade/mortalidade , Avaliação Geriátrica , Mortalidade/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Fatores de Risco
14.
Sensors (Basel) ; 19(24)2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31835673

RESUMO

This prospective study investigated feasibility and sensitivity of sensor-based physical activity (PA) measures to monitor changes in PA during geriatric rehabilitation and its relation to clinical parameters at admission. PA was routinely measured at day 2 and day 15 after admission in 647 patients (70.2% women, mean age = 82.0 (SD = 7.19) years) of a German geriatric hospital using a thigh-worn accelerometer. Clinical records were used to include age, Barthel Index, diagnosis, mobility, orientation and cognition. Mean values and 95% confidence intervals (95%-CI) of walking duration, walking bout duration and number of sit-to-stand transfers were calculated to quantify different domains of PA. All observed PA parameters improved during rehabilitation, regardless of age, diagnosis or physical and cognitive function at admission. Walking duration increased by 12.1 (95%-CI: 10.3; 13.8) min, walking bout duration by 2.39 (95%-CI: 1.77; 3.00) s, and number of sit-to-stand transfers by 7 (95%-CI: 5; 8). Floor and ceiling effects were not observed. Walking duration at day 2 as well as day 15 was continuously associated with Barthel Index and statistically significant improved for all levels of Barthel Index. In summary, this study showed that sensor-based PA monitoring is feasible to assess the individual progress in geriatric rehabilitation patients.


Assuntos
Exercício Físico/fisiologia , Avaliação Geriátrica , Atividade Motora/fisiologia , Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
15.
Eur Rev Aging Phys Act ; 16: 18, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31673299

RESUMO

Background: The aim of this study was to assess the effect of day of the week and wearing a device (reactivity) on objectively measured physical activity (PA) in older people. Methods: Walking duration as a measure for PA was recorded from 1333 German community-dwelling older people (≥65 years, 43.8% women) over 5 days using accelerometers (activPAL). Least-square means of PA with 95%-confidence intervals (95%-CI) from multi-level analysis were calculated for each day of the week and each measurement day (days after sensor attachment). Results: Walking duration on Sundays was significantly lower compared to working days (Sunday vs. Monday-Friday: - 12.8 min (95%-CI: - 14.7; - 10.9)). No statistically significant difference compared to working days was present for Saturdays. The linear slope for measurement day and walking duration was marginal and not statistically significant. Conclusions: Studies using PA sensors in older people should assess Sundays and working days to adequately determine the activity level of the participants.

16.
Aging Clin Exp Res ; 31(12): 1843-1846, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31486995

RESUMO

The aim of this study was to develop a simple visualized approach to classify persons into meaningful gait speed categories. Footprints of 310 instrumented gait analyses of 190 geriatric persons (mean age 79.1 years, 74 women) were used in a retrospective analysis to classify persons´ footprints into a left/right step overlapping, an intermediate or a long stepping pattern. The association between gait speed and step length was r = 0.91. More than 75% of the measurements classified as overlapping stepping pattern had a gait speed of below 0.5 m/s. All participants of the long stepping pattern group had a gait speed of faster than 1 m/s. The positive predictive values for classifying gait speed correctly were 71-100%. The proposed screening tool can be used in outpatient settings or home visits and is likely to be applicable if instrumented gait speed assessment is not available.


Assuntos
Avaliação Geriátrica/métodos , Velocidade de Caminhada , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos
17.
BMC Geriatr ; 19(1): 179, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248370

RESUMO

BACKGROUND: Identifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65-75 years old. METHODS: Four population-based cohort studies were pooled for the analysis: ActiFE-ULM (Germany), ELSA (United Kingdom), InCHIANTI (Italy), LASA (Netherlands). Included participants were 65-75 years old at baseline and reported no limitations in functional ability in ADL at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Participants who reported at least some limitations at three-year follow-up on any of the five items were classified as experiencing functional decline. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation by alternating the data from the four cohort studies to assess the discrimination and calibration across the cohorts. RESULTS: Two thousand five hundred sixty community-dwelling people were included in the analyses (mean age 69.7 ± 3.0 years old, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model included 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. The calibration intercept was 0.06 and the calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts. CONCLUSIONS: Based on pooled cohort data analyses we were able to show that the onset of functional decline in ADL in three years in older people aged 65-75 years can be predicted by specific physical performance measures, age, body mass index, presence of depressive symptoms, and chronic conditions. The prediction model showed good discrimination and calibration, which remained stable across the four cohorts, supporting external validity of our findings.


Assuntos
Atividades Cotidianas/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Força da Mão/fisiologia , Velocidade de Caminhada/fisiologia , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/psicologia , Doença Crônica , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Vida Independente/psicologia , Vida Independente/tendências , Itália/epidemiologia , Masculino , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Fatores de Risco , Reino Unido/epidemiologia
18.
Artigo em Alemão | MEDLINE | ID: mdl-30887088

RESUMO

More and longer heatwaves can be expected in Germany as a consequence of climate change. Older persons are predominantly threatened with the associated health-related problems and premature death. So far, heat action plans have failed to prevent excess mortality. Therefore, new approaches of prevention must be found.General practitioner, ambulant care, hospital, and nursing home settings were investigated in a project funded by the German ministry of health. Workshops were conducted and the results are presented here.Sufficient knowledge and continuous care are available in hospitals and nursing homes. The basic challenge for general practitioners and ambulatory caregivers is to provide appropriate care for older persons living alone and in need of help. Proactive care during extremely hot days cannot be provided due to staff shortages. Experience from other countries indicates that a new course of action must be found. The main tasks of general practitioners should be the identification and consultation of persons at risk. Experience from previous years have demonstrated that formal structures of nursing and medical care alone failed to prevent the recurrence of a catastrophe caused by a heatwave and that human loss is substantial.A possible approach could be volunteer-based disaster protection, which is well-developed in Germany. After proclamation of a major (heat) disaster in the community, close cooperation with general practitioners would be essential. A registry of persons at health risk from heat waves would also be essential. The feasibility and effectiveness of the suggested approach should be tested and ultimately regulated at a political level.


Assuntos
Calor Extremo , Clínicos Gerais , Transtornos de Estresse por Calor/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Mudança Climática , Alemanha , Humanos , Casas de Saúde
19.
J Aging Phys Act ; 27(5): 688­695, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30747583

RESUMO

Time spent out-of-home can increase physical activity (PA) levels. However, the association between the purpose for leaving home and the mode of transport on time out-of-home and PA are not straightforward. In a large sample of community-dwelling older adults (≥65 years), daily walking duration was measured prospectively over 1 week using body-fixed sensors and time-out-of-home questionnaires. Data from 1,277 participants yielded 6,500 full days for analysis. The following statistically significant associations were seen: public transport use increased the time spent out-of-home by 88 min and daily walking duration by 16 min. Social contacts or the use of a car increased the time out-of-home, but decreased PA. Shopping or "going by foot" decreased the time spent out-of-home by 19 and 62 min, respectively, while both increased the daily walking duration by 5 min. The association between time out-of-home and PA (daily walking duration) is strongly dependent on the activity and mode of transport.


Assuntos
Transportes/estatística & dados numéricos , Caminhada/estatística & dados numéricos , Acelerometria , Atividades Cotidianas , Idoso/estatística & dados numéricos , Idoso de 80 Anos ou mais/estatística & dados numéricos , Estudos Transversais , Exercício Físico , Feminino , Humanos , Masculino , Fatores de Tempo
20.
Z Gerontol Geriatr ; 52(1): 10-16, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29594444

RESUMO

BACKGROUND: Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature. METHODS: The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed. Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects of the epidemiology of hip fractures. RESULTS: Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in age-standardized hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors, diseases and drugs have been found to be associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10-40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures. CONCLUSION: The epidemiology of hip fractures is characterized by a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.


Assuntos
Fraturas do Quadril , Osteoporose , Criança , Pré-Escolar , Feminino , Alemanha/epidemiologia , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Institucionalização
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