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1.
JMIR Form Res ; 6(1): e27418, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34989693

RESUMO

BACKGROUND: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. OBJECTIVE: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. METHODS: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. RESULTS: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. CONCLUSIONS: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease-related health barriers and the users' confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management.

2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 1848-1851, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34891647

RESUMO

Cancer is an aggressive disease which imparts a tremendous socio-economic burden on the international community. Early detection is an important aspect in improving survival rates for cancer sufferers; however, very few studies have investigated the possibility of predicting which people have the highest risk to develop this disease, even years before the traditional symptoms first occur. In this paper, a dataset from a longitudinal study which was collected among 2291 70-year olds in Sweden has been analyzed to investigate the possibility for predicting 2-7 year cancer-specific mortality. A tailored ensemble model has been developed to tackle this highly imbalanced dataset. The performance with different feature subsets has been investigated to evaluate the impact that heterogeneous data sources may have on the overall model. While a full-features model shows an Area Under the ROC Curve (AUC-ROC) of 0.882, a feature subset which only includes demographics, self-report health and lifestyle data, and wearable dataset collected in free-living environments presents similar performance (AUC-ROC: 0.857). This analysis confirms the importance of wearable technology for providing unbiased health markers and suggests its possible use in the accurate prediction of 2-7 year cancer-related mortality in older adults.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34886532

RESUMO

As global demographics change, ageing is a global phenomenon which is increasingly of interest in our modern and rapidly changing society. Thus, the application of proper prognostic indices in clinical decisions regarding mortality prediction has assumed a significant importance for personalized risk management (i.e., identifying patients who are at high or low risk of death) and to help ensure effective healthcare services to patients. Consequently, prognostic modelling expressed as all-cause mortality prediction is an important step for effective patient management. Machine learning has the potential to transform prognostic modelling. In this paper, results on the development of machine learning models for all-cause mortality prediction in a cohort of healthy older adults are reported. The models are based on features covering anthropometric variables, physical and lab examinations, questionnaires, and lifestyles, as well as wearable data collected in free-living settings, obtained for the "Healthy Ageing Initiative" study conducted on 2291 recruited participants. Several machine learning techniques including feature engineering, feature selection, data augmentation and resampling were investigated for this purpose. A detailed empirical comparison of the impact of the different techniques is presented and discussed. The achieved performances were also compared with a standard epidemiological model. This investigation showed that, for the dataset under consideration, the best results were achieved with Random UnderSampling in conjunction with Random Forest (either with or without probability calibration). However, while including probability calibration slightly reduced the average performance, it increased the model robustness, as indicated by the lower 95% confidence intervals. The analysis showed that machine learning models could provide comparable results to standard epidemiological models while being completely data-driven and disease-agnostic, thus demonstrating the opportunity for building machine learning models on health records data for research and clinical practice. However, further testing is required to significantly improve the model performance and its robustness.

4.
Implement Sci Commun ; 2(1): 137, 2021 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-34895359

RESUMO

BACKGROUND: The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important for patient outcomes. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. METHODS: The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory action research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre- and post-implementation while champion interviews were also conducted post-implementation. RESULTS: Features of the guidance, the inner setting components such as readiness to change, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting, such as external policy incentives and individual characteristics, featured less commonly. Data from qualitative interviews revealed that the guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, quantitative data demonstrated reduced staff de-motivation amongst those who did attend was noted post-implementation (pre-Mdn = 19.50 versus post-Mdn = 22.00, U = 497.00, p = 0.07). CONCLUSIONS: A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance the implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR identified challenges to address in future projects such as staff cover and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

5.
HRB Open Res ; 4: 27, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34124574

RESUMO

Background: The care of people with dementia is of global concern. Physiotherapeutic intervention can be of benefit to patients with dementia. Physiotherapists can play a role in assessment, falls prevention, pain management and gait re-education. Dementia care forms a significant part of the workload of a physiotherapist. However, there is a paucity of evidence on what constitutes effective education and training for physiotherapists working in dementia care. Objective: This scoping review aims to explore and map the evidence on education and training for physiotherapists working in dementia care. Inclusion criteria: Studies that explore dementia training and/or education for physiotherapists or for multidisciplinary teams, in which physiotherapists have been included. Studies that explore student physiotherapy training will also be considered. Qualitative, quantitative, mixed methods studies, case studies and observational studies will be included. Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews. Databases to be searched as part of this review include: Medline, SocINDEX, CINAHL and, PsycINFO, with no limitation on publication date. Google Scholar and Open-Grey will be searched for grey literature, limited to the first 100 searches. Titles and abstracts will be screened for inclusion and identified full texts reviewed independently by two reviewers. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool. A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review.

6.
JMIR Mhealth Uhealth ; 9(6): e23832, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34081020

RESUMO

BACKGROUND: Older adults may use wearable devices for various reasons, ranging from monitoring clinically relevant health metrics or detecting falls to monitoring physical activity. Little is known about how this population engages with wearable devices, and no qualitative synthesis exists to describe their shared experiences with long-term use. OBJECTIVE: This study aims to synthesize qualitative studies of user experience after a multi-day trial with a wearable device to understand user experience and the factors that contribute to the acceptance and use of wearable devices. METHODS: We conducted a systematic search in CINAHL, APA PsycINFO, PubMed, and Embase (2015-2020; English) with fixed search terms relating to older adults and wearable devices. A meta-synthesis methodology was used. We extracted themes from primary studies, identified key concepts, and applied reciprocal and refutational translation techniques; findings were synthesized into third-order interpretations, and finally, a "line-of-argument" was developed. Our overall goal was theory development, higher-level abstraction, and generalizability for making this group of qualitative findings more accessible. RESULTS: In total, we reviewed 20 papers; 2 evaluated fall detection devices, 1 tested an ankle-worn step counter, and the remaining 17 tested activity trackers. The duration of wearing ranged from 3 days to 24 months. The views of 349 participants (age: range 51-94 years) were synthesized. Four key concepts were identified and outlined: motivation for device use, user characteristics (openness to engage and functional ability), integration into daily life, and device features. Motivation for device use is intrinsic and extrinsic, encompassing many aspects of the user experience, and appears to be as, if not more, important than the actual device features. To overcome usability barriers, an older adult must be motivated by the useful purpose of the device. A device that serves its intended purpose adds value to the user's life. The user's needs and the support structure around the device-aspects that are often overlooked-seem to play a crucial role in long-term adoption. Our "line-of-argument" model describes how motivation, ease of use, and device purpose determine whether a device is perceived to add value to the user's life, which subsequently predicts whether the device will be integrated into the user's life. CONCLUSIONS: The added value of a wearable device is the resulting balance of motivators (or lack thereof), device features (and their accuracy), ease of use, device purpose, and user experience. The added value contributes to the successful integration of the device into the daily life of the user. Useful device features alone do not lead to continued use. A support structure should be placed around the user to foster motivation, encourage peer engagement, and adapt to the user's preferences.


Assuntos
Monitores de Aptidão Física , Dispositivos Eletrônicos Vestíveis , Idoso , Idoso de 80 Anos ou mais , Exercício Físico , Humanos , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa
7.
HRB Open Res ; 4: 23, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34136749

RESUMO

Background: Antipsychotics are commonly prescribed to people living with dementia in nursing home settings, despite strong guideline recommendations against their use except in limited circumstances. We aimed to transparently describe the development process for a complex intervention targeting appropriate requesting and prescribing of antipsychotics to nursing home residents with dementia in Ireland, by nurses and general practitioners (GPs) respectively. Methods: We report the development process for the 'Rationalising Antipsychotic Prescribing in Dementia' (RAPID) complex intervention, in accordance with the 'Guidance for reporting intervention development studies in health research' (GUIDED) checklist.  The UK Medical Research Council framework for developing and evaluating complex interventions guided our overall approach, incorporating evidence and theory into the intervention development process. To unpack the intervention development process in greater detail, we followed the Behaviour Change Wheel approach. Guided by our stakeholders, we conducted three sequential studies (systematic review and qualitative evidence synthesis, primary qualitative study and expert consensus study), to inform the intervention development. Results: The RAPID complex intervention was developed in collaboration with a broad range of stakeholders, including people living with dementia and family carers, between 2015 and 2017. The finalised RAPID complex intervention was comprised of the following three components; 1) Education and training sessions with nursing home staff; 2) Academic detailing with GPs; 3) Introduction of an assessment tool to the nursing home. Conclusions: This paper describes the steps used by the researchers to develop a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia in Ireland, according to the GUIDED checklist. We found that the GUIDED checklist provided a useful way of reporting all elements in a cohesive manner and complemented the other tools and frameworks used. Transparency in the intervention development processes can help in the translation of evidence into practice.

8.
Aging Ment Health ; : 1-8, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33982608

RESUMO

OBJECTIVES: Psychotropic medications are commonly inappropriately prescribed for people with dementia (PwD) residing in nursing homes. This population is often multi-morbid, receiving multiple medications and therefore at an increased risk of mortality. This overview aimed to collate all synthesised quantitative, qualitative, and mixed-method evidence pertaining to the effectiveness of interventions aimed at reducing inappropriate psychotropic prescribing for nursing home residents with dementia; the perceived barriers and facilitators to the implementation of these interventions; and the attitudes and experiences of stakeholders toward prescribing. Method: An overview of reviews was conducted (PROSPERO protocol registration CRD42020187288). Five databases were systematically searched from January 2010 through June 2020, supplemented by grey literature searching. Reviews presenting evidence pertaining to either randomised controlled trials (RCT) aiming to reduce inappropriate prescribing or qualitative/mixed method studies of stakeholder views, were included. RESULTS: Of 273 records identified, 11 systematic reviews were included. The quality of reviews ranged from critically low to moderate. There was mixed evidence for the use of education-only interventions. Multicomponent interventions (typically staff education combined with organisational and structural components), medication review, and interventions aimed at cultural change were evidenced as effective compared to care as usual. Stakeholders cited the importance of multidisciplinary collaboration and targeting organisational climate in changing psychotropic prescribing behaviours. CONCLUSIONS: The inappropriate use of psychotropic medications in nursing homes for PwD is a complex issue with many contextual factors. The evidence suggests a comprehensive approach, targeting organisational climate and multidisciplinary collaboration, along with staff education and training, may be an effective strategy.

9.
PLoS One ; 16(2): e0246528, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33539481

RESUMO

Parkinson's disease (PD) is a progressive neurological disorder of the central nervous system that deteriorates motor functions, while it is also accompanied by a large diversity of non-motor symptoms such as cognitive impairment and mood changes, hallucinations, and sleep disturbance. Parkinsonism is evaluated during clinical examinations and appropriate medical treatments are directed towards alleviating symptoms. Tri-axial accelerometers, gyroscopes, and magnetometers could be adopted to support clinicians in the decision-making process by objectively quantifying the patient's condition. In this context, at-home data collections aim to capture motor function during daily living and unobstructedly assess the patients' status and the disease's symptoms for prolonged time periods. This review aims to collate existing literature on PD monitoring using inertial sensors while it focuses on papers with at least one free-living data capture unsupervised either directly or via videotapes. Twenty-four papers were selected at the end of the process: fourteen investigated gait impairments, eight of which focused on walking, three on turning, two on falls, and one on physical activity; ten articles on the other hand examined symptoms, including bradykinesia, tremor, dyskinesia, and motor state fluctuations in the on/off phenomenon. In summary, inertial sensors are capable of gathering data over a long period of time and have the potential to facilitate the monitoring of people with Parkinson's, providing relevant information about their motor status. Concerning gait impairments, kinematic parameters (such as duration of gait cycle, step length, and velocity) were typically used to discern PD from healthy subjects, whereas for symptoms' assessment, researchers were capable of achieving accuracies of over 90% in a free-living environment. Further investigations should be focused on the development of ad-hoc hardware and software capable of providing real-time feedback to clinicians and patients. In addition, features such as the wearability of the system and user comfort, set-up process, and instructions for use, need to be strongly considered in the development of wearable sensors for PD monitoring.


Assuntos
Hipocinesia/diagnóstico , Hipocinesia/fisiopatologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Humanos , Dispositivos Eletrônicos Vestíveis
10.
Transl Behav Med ; 11(2): 470-483, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-32589204

RESUMO

Nursing home residents with dementia are commonly prescribed antipsychotics despite the associated increased risk of harms. Interventions to optimize prescribing practice have been found to be effective in the short term, but there is a lack of evidence to support sustainability of effects, along with a lack of theory, public involvement, and transparency in the intervention development process. Using theory has been advocated as a means of improving intervention sustainability. The aim of this study was, therefore, to identify behavior change techniques (BCTs) for inclusion in a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia. A comprehensive approach to identifying a long list of all potential BCTs from three different sources was undertaken. The most appropriate BCTs were then selected through a two-round Delphi consensus survey with a broad range of experts (n = 18 panelists). Advisory groups of people with dementia, family carers, and professional stakeholders provided feedback on the final BCTs included. After two Delphi survey rounds, agreement was reached on 22 BCTs. Further refinement of the selected BCTs based on advisory group and panelists' feedback, along with use of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects/safety, and Equity) resulted in a final list of 16 BCTs. The next step in intervention development will be to identify the most appropriate mode of delivery of the 16 BCTs identified for inclusion. The study provides a case example of a systematic approach to incorporating evidence with stakeholder views in the identification of appropriate BCTs.


Assuntos
Antipsicóticos , Demência , Antipsicóticos/uso terapêutico , Terapia Comportamental , Demência/tratamento farmacológico , Retroalimentação , Humanos , Casas de Saúde
11.
Eur J Intern Med ; 85: 50-55, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33243612

RESUMO

BACKGROUND: Older people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017. AIM: To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes. DESIGN: Retrospective observational study. METHODS: We included all first patients seen by Home FIRsT between 7th May and 19th October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital. RESULTS: In the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, P<0.001) and 4AT (OR 1.26, 95% CI 1.13 - 1.42, P<0.001). Discharge to specialist outpatients (e.g. falls/bone health) was predicted by musculoskeletal/injuries/trauma presentations (OR 6.45, 95% CI 1.52 - 27.32, P=0.011). Discharge to the Geriatric Day Hospital was only predicted by frailty (OR 1.52, 95% CI 1.17 - 1.97, P=0.002). Age and sex were not predictive in any of the models. CONCLUSIONS: Routinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.


Assuntos
Serviço Hospitalar de Emergência , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Hospitalização , Humanos , Alta do Paciente , Estudos Prospectivos
12.
Ir J Psychol Med ; 38(3): 208-213, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32460926

RESUMO

As the COVID-19 pandemic escalates worldwide, it is apparent that many patients with more severe illness will also experience delirium. These patients pose a particular challenge in the application of optimal care due to issues with infectious risk, respiratory compromise and potential interactions between medications that can be used to manage delirium with antiviral and other treatments used for COVID-19. We describe a guidance resource adapted from existing guidelines for delirium management that has been tailored to the specific challenge of managing delirium in patients with COVID-19 infection. Issues around the assessment and treatment of these patients are examined and distilled into a simple (one-paged guidance resource that can assist clinicians in managing suspected delirium.


Assuntos
COVID-19 , Delírio , Delírio/tratamento farmacológico , Humanos , Pandemias , SARS-CoV-2
13.
BMC Geriatr ; 20(1): 376, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32998718

RESUMO

BACKGROUND: Little is known about staff's attitudes in Irish acute hospital settings towards people living with dementia and their perceived dementia knowledge. The aim of this study was to understand the general level of dementia knowledge and attitudes towards dementia in different types of hospital staff, as well as to explore the potential influence of previous dementia training and experience (having a family member with dementia) and the potential moderating effects of personal characteristics. This data was required to plan and deliver general and targeted educational interventions to raise awareness of dementia throughout the acute services. METHODS: A cross-sectional survey was carried out among a diverse range of hospital staff (n = 1795) in three urban acute general hospitals in Ireland, including doctors, nurses, healthcare attendants, allied professionals, and general support staff. Participants' perceived dementia knowledge and attitudes were assessed as well as their previous dementia training and experience. To measure participant's attitude towards dementia, the validated Approaches to Dementia Questionnaire (ADQ) was used. RESULTS: Hospital staff demonstrated positive attitudes towards people living with dementia, and believed they had a fair to moderate understanding of dementia. Both 'having previous dementia training' and 'having a relative living with dementia' predicted attitude towards dementia and perceived dementia knowledge. Interestingly, certain personal staff characteristics did impact dementia training in predicting attitude towards dementia and perceived dementia knowledge. CONCLUSION: This study provides a baseline of data regarding the attitudes towards dementia and perceived dementia knowledge for hospital staff in Irish acute hospitals. The results can inform educational initiatives that target different hospital staff, in order to increase awareness and knowledge to improve quality of dementia care in Irish hospitals.


Assuntos
Atitude do Pessoal de Saúde , Demência , Estudos Transversais , Demência/diagnóstico , Demência/terapia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irlanda/epidemiologia , Recursos Humanos em Hospital , Inquéritos e Questionários
14.
Ann Palliat Med ; 9(Suppl 1): S34-S43, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32146821

RESUMO

BACKGROUND: A diagnosis of Parkinson's disease (PD) has a significant psychological impact on both the person diagnosed and their loved ones, and can have a negative effect on family relationships. Caring for someone with a long-term progressing illness may cause anticipatory grief, i.e., experienced before a bereavement. This has been widely studied in illnesses such as dementia and cancer, but less so in relation to PD. The study aims were: (I) to demonstrate the occurrence of anticipatory grief experienced by carers of people with PD; (II) to explore how this grief relates to caregiver burden and caregiver depression and demographic variables. METHODS: Family carers of people with moderate to advanced PD (Hoehn & Yahr stages 3-5) were invited to complete a survey, including demographic questions and three questionnaires: Zarit Burden Interview (ZBI); 16-item Geriatric Depression Scale (GDS); and Anticipatory Grief Scale (AGS). RESULTS: Anticipatory grief was common among carers of people with PD [mean AGS score =70.41; standard deviation (SD) =16.93; sample range, 38-102]. Though distinct concepts, carers with higher burden and depression scores also experienced more anticipatory grief symptoms. Carers experiencing higher anticipatory grief tended to be caring for someone of a younger age, displaying more non-motor symptoms, at a more advanced disease stage, and who considered either themselves and/or their loved one as depressed. CONCLUSIONS: Carers of people with advanced PD experienced anticipatory grief, as well as depression and a high caregiver burden. To improve carer outcomes, our focus should include the period both before and after the death of a loved one, and carers should receive regular psychological assessment and support.


Assuntos
Cuidadores/psicologia , Pesar , Doença de Parkinson/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Inquéritos e Questionários
15.
BMC Geriatr ; 20(1): 46, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32033532

RESUMO

BACKGROUND: To measure the effects of an augmented prescribed exercise programme versus usual care, on physical performance, quality of life and healthcare utilisation for frail older medical patients in the acute setting. METHODS: This was a parallel single-blinded randomised controlled trial. Within 2 days of admission, older medical inpatients with an anticipated length of stay ≥3 days, needing assistance/aid to walk, were blindly randomly allocated to the intervention or control group. Until discharge, both groups received twice daily, Monday-to-Friday half-hour assisted exercises, assisted by a staff physiotherapist. The intervention group completed tailored strengthening and balance exercises; the control group performed stretching and relaxation exercises. Length of stay was the primary outcome measure. Blindly assessed secondary measures included readmissions within 3 months, and physical performance (Short Physical Performance Battery) and quality of life (EuroQOL-5D-5 L) at discharge and at 3 months. Time-to-event analysis was used to measure differences in length of stay, and regression models were used to measure differences in physical performance, quality of life, adverse events (falls, deaths) and negative events (prolonged hospitalisation, institutionalisation). RESULTS: Of the 199 patients allocated, 190 patients' (aged 80 ± 7.5 years) data were analysed. Groups were comparable at baseline. In intention-to-treat analysis, length of stay did not differ between groups (HR 1.09 (95% CI, 0.77-1.56) p = 0.6). Physical performance was better in the intervention group at discharge (difference 0.88 (95% CI, 0.20-1.57) p = 0.01), but lost at follow-up (difference 0.45 (95% CI, - 0.43 - 1.33) p = 0.3). An improvement in quality of life was detected at follow-up in the intervention group (difference 0.28 (95% CI, 0.9-0.47) p = 0.004). Overall, fewer negative events occurred in the intervention group (OR 0.46 (95% CI 0.23-0.92) p = 0.03). CONCLUSION: Improvements in physical performance, quality of life and fewer negative events suggest that this intervention is of value to frail medical inpatients. Its effect on length of stay remains unclear. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02463864, registered prospectively 26.05.2015.


Assuntos
Exercício Físico , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Hospitalização , Hospitais , Humanos , Desempenho Físico Funcional
16.
BMJ Open ; 10(2): e033069, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-32075829

RESUMO

OBJECTIVES: Multifactorial falls risk assessments reduce the rate of falls in older people and are recommended by international guidelines. Despite their effectiveness, their potential impact is often constrained by barriers to implementation. Attendance is an issue. The aim of this study was to explore why older people attend community-based multifactorial falls risk assessment clinics, and to map these reasons to a theoretical framework. DESIGN: This is a qualitative study. Semi-structured interviews were conducted and analysed thematically. Each theme and subtheme were then mapped onto the Theoretical Domains Framework (TDF) to identify the determinants of behaviour. PARTICIPANTS: Older adults (aged 60 and over) who attended community-based multifactorial falls risk assessments. RESULTS: Sixteen interviews were conducted. Three main themes explained participants' reasons for attending the multifactorial risk assessment; being that 'type of person', being 'linked in' with health and community services and having 'strong social support'. Six other themes were identified, but these themes were not as prominent during interviews. These were knowing what to expect, being physically able, having confidence in and being positive towards health services, imagining the benefits given previous positive experiences, determination to maintain or regain independence, and being 'crippled' by the fear of falling. These themes mapped on to nine TDF domains: 'knowledge', 'skills', 'social role and identity', 'optimism', 'beliefs about consequences', 'goals', 'environmental context and resources', 'social influences' and 'emotion'. There were five TDF domains that were not relevant to the reasons for attending. CONCLUSIONS: These findings provide theoretically based factors that influence attendance which can be used to inform the development of interventions to improve attendance to falls prevention programmes.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde para Idosos , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Medo , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Personalidade , Pesquisa Qualitativa , Medição de Risco , Apoio Social
17.
Arch Rehabil Res Clin Transl ; 2(1): 100038, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33543067

RESUMO

Objective: To identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. Design: A cohort study. Setting: Acute hospitalized care. Participants: Premorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused. Interventions: Not applicable. Main Outcome Measures: Age, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission. Results: Approximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (-29%, -9 to -44), and instructed bedrest (-69%, -55 to -79). Conclusion: Day-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.

18.
Rehabil Nurs ; 45(1): 16-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-29794568

RESUMO

PURPOSE: Stroke can cause physical and emotional problems affecting sexual well-being; healthcare professionals (HCPs) are often uncomfortable discussing this topic with patients. We explored the perspectives of HCPs and stroke survivors about barriers to discussing sexual well-being poststroke. DESIGN: A mixed methodology was employed. METHODS: A postal survey of stroke survivors (n = 50), a focus group with HCPs on a stroke unit (n = 6), and a focus group with community-living stroke survivors (n = 6) were used in this study. Focus group data were analyzed thematically. FINDINGS: No patient surveyed (60% response rate) had discussed sexual well-being with an HCP. Focus groups revealed barriers on multiple levels: structural, HCP, patient, and professional-patient interface. CONCLUSIONS: Healthcare professionals were poorly trained, adopted a passive role, and addressed sexual activity based on individual beliefs rather than having an agreed team approach. CLINICAL RELEVANCE: Relatively simple steps like inclusion in policy, training to empower HCPs, and the provision of written information for patients could help to improve practice.


Assuntos
Pessoal de Saúde/psicologia , Pacientes/psicologia , Comportamento Sexual/psicologia , Saúde Sexual/educação , Acidente Vascular Cerebral/complicações , Pessoal de Saúde/estatística & dados numéricos , Humanos , Pacientes/estatística & dados numéricos , Acidente Vascular Cerebral/psicologia
19.
Neurogastroenterol Motil ; 32(1): e13726, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31576631

RESUMO

BACKGROUND: A hallmark feature of Parkinson's disease (PD) is the build-up of α-synuclein protein aggregates throughout the brain; however α-synuclein is also expressed in enteric neurons. Gastrointestinal (GI) symptoms and pathology are frequently reported in PD, including constipation, increased intestinal permeability, glial pathology, and alterations to gut microbiota composition. α-synuclein can propagate through neuronal systems but the site of origin of α-synuclein pathology, whether it be the gut or the brain, is still unknown. Physical exercise is associated with alleviating symptoms of PD and with altering the composition of the gut microbiota. METHODS: This study investigated the effects of bilateral nigral injection of adeno-associated virus (AAV)-α-synuclein on enteric neurons, glia and neurochemistry, the gut microbiome, and bile acid metabolism in rats, some of whom were exposed to voluntary exercise. KEY RESULTS: Nigral overexpression of α-synuclein resulted in significant neuronal loss in the ileal submucosal plexus with no change in enteric glia. In contrast, the myenteric plexus showed a significant increase in glial expression, while neuronal numbers were maintained. Concomitant alterations were observed in the gut microbiome and related bile acid metabolism. Voluntary running protected against neuronal loss, increased enteric glial expression, and modified gut microbiome composition in the brain-injected AAV-α-synuclein PD model. CONCLUSIONS AND INFERENCES: These results show that developing nigral α-synuclein pathology in this PD model exerts significant alterations on the enteric nervous system (ENS) and gut microbiome that are receptive to modification by exercise. This highlights brain to gut communication as an important mechanism in PD pathology.


Assuntos
Sistema Nervoso Entérico/patologia , Microbioma Gastrointestinal , Transtornos Parkinsonianos , Substância Negra/metabolismo , alfa-Sinucleína/toxicidade , Animais , Vetores Genéticos , Humanos , Injeções Intraventriculares , Masculino , Ratos , Ratos Sprague-Dawley , Ratos Transgênicos , Transfecção , alfa-Sinucleína/administração & dosagem
20.
Gerontologist ; 59(5): e490-e500, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31298698

RESUMO

BACKGROUND AND OBJECTIVES: People with dementia and carers do not always access respite services in a timely manner, or in some cases, at all. Although carers' perspectives on respite access have been explored, other stakeholder perspectives, especially providers and people with dementia, are underrepresented in the existing literature. The aim of this study was to synthesize multiple stakeholders' perspectives, including people with dementia, on accessing respite services in the context of dementia. RESEARCH DESIGN AND METHODS: Purposive maximum variation sampling was used. Semi-structured interviews were conducted with 35 key stakeholders, including people with dementia (n = 6), carers (n = 9), respite frontline staff (n = 4), respite managers (n = 8), primary care professionals (n = 3), and policy-makers/academics (n = 5). The process of consent is outlined. Data were interpreted inductively using thematic analysis. Reflexivity was considered throughout the research process. RESULTS: Three themes ("Service Acceptability," "Navigational Knowledge and Skills," "Constructing and Adjudicating Respite Need") were identified that relate to how access to respite services is negotiated between service providers and dyads. DISCUSSION AND IMPLICATIONS: A number of the findings support previous research; however, novel findings discussed relating to the access negotiation process include (a) the ambiguous legitimacy of respite needs, in a system configured to deliver a biomedical model of care and which considers nonmedical care as a family responsibility, and (b) the constraining effects of disparate conceptualizations of "respite" between carers and providers. Future research should interrogate the appropriate boundaries of public responsibility in relation to respite service planning/delivery for dementia, with particular reference to client preferences for community and in-home provision.


Assuntos
Cuidadores/psicologia , Demência/enfermagem , Cuidados Intermitentes , Pessoal Administrativo/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Médicos de Atenção Primária/psicologia , Pesquisa Qualitativa
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