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1.
Nurs Open ; 8(3): 1232-1242, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482652

RESUMO

AIM: To assess the quality of life in frail older persons (65+ years) living in nursing homes and to examine differences between quality of life perceptions among different gender and age groups. DESIGN: Cross-sectional. METHODS: Data were collected during 2015-2017 based on two questionnaires (WHOQOL-OLD and WHOQOL-BREF). Seventy-eight older persons living in nursing homes in southern Sweden answered the questionnaires in structured interviews. Descriptive and comparative statistics were used to analyse the data. The study was guided by Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines. RESULTS: The frail older persons reported low autonomy related to few opportunities to engage in everyday activities and were unable to do the things they liked to do and not feeling in control of their future. Another important result was that frail older persons seemed to have no or little fear of death and dying. No significant differences between gender or age on quality of life were revealed.


Assuntos
Idoso Fragilizado , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Casas de Saúde , Inquéritos e Questionários
2.
Nihon Ronen Igakkai Zasshi ; 58(3): 333-340, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34483155
3.
Tijdschr Gerontol Geriatr ; 52(2)2021 Jun 09.
Artigo em Holandês | MEDLINE | ID: mdl-34498438

RESUMO

The increasing number of elderly people living at home demands a strengthening of primary care for (vulnerable) older adults. Therefore, in 2015 the VU University Medical Centre in Amsterdam founded the Universitaire Praktijk Ouderengeneeskunde (UPO) (University Practice for Elderly Care). This practice makes the expertise of the Elderly Care physician (SO) available in primary care through a close and easy accessible collaboration between the SO and the General Practitioner. The aim of this research is an evaluation of the UPO, in order to determine the added value of this care innovation and to identify areas for improvement. This research consists of a quantitative part in which the characteristics of the 190 treated UPO patients have been assessed. Also, costs have been estimated of UPO care compared to expected usual care. The qualitative part of this study consists of 22 interviews with the most important UPO stakeholders. The results of this study show  that 1) the UPO seems to meet a demand from general practitioners to support them in the care of vulnerable elderly people with mostly cognitive disorders, 2) this care seems to save costs and 3) the UPO was appreciated by most of those involved. The current results call for applying this care innovation in other regions and to evaluate it on a larger scale.


Assuntos
Clínicos Gerais , Universidades , Idoso , Idoso Fragilizado , Humanos , Atenção Primária à Saúde
4.
Tijdschr Gerontol Geriatr ; 52(2)2021 Jun 09.
Artigo em Holandês | MEDLINE | ID: mdl-34498440

RESUMO

The prevalence of multimorbidity increases with age, with over 70% of people aged 75 years and over having three or more chronic conditions, often combined with frailty. In current medical practice, evidence-based medicine with evidence-based guidelines forms the basis for treatment. The aim of this study is to determine the practical applicability of the current medical specialist guidelines for the treatment of the heterogeneous group of older patients. All guidelines from the Dutch guidelines database were examined. Twelve guidelines identified as elderly-specific were compared with the recommendations from the 'methodology for the development of guidelines tailored to the elderly'. In 117 guidelines (54%) general terms such as 'older' or 'elderly' were found. An age limit was mentioned in 26 guidelines (12%). The term 'frailty' was mentioned in 38 guidelines (18%), the term 'comorbidity' in 107 (50%) and cognitive problems in eight (4%). Five age-specific guidelines distinguished frail from non-frail older people. Three guidelines discussed relevant outcome measures for the elderly. The results show that the practical applicability of current guidelines is not optimal for the various groups of older people. In our opinion, the improvement of the guidelines preferably by implementation of the Dutch methodology for senior-proof guidelines is a necessary first step in making the current second-line evidence-based guidelines in the Netherlands usable for the growing group of frail and multimorbid elderly.


Assuntos
Fragilidade , Idoso , Doença Crônica , Comorbidade , Idoso Fragilizado , Fragilidade/diagnóstico , Humanos , Países Baixos , Prevalência
5.
Nihon Ronen Igakkai Zasshi ; 58(3): 459-469, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34483174

RESUMO

AIM: We examined the effect of "IkiIki Hyakusai Taiso" as way to prevent the physical decline in community-dwelling elderly in Nose Town, Osaka Prefecture. METHODS: Participants were community-dwelling elderly who participated in the Preventive Care program "IkiIki Hyakusai Taiso" from October 2015 to June 2019 in Nose Town, Osaka Prefecture, Japan. They performed exercises once a week. An assessment of the physical function, basic health checklist, and questionnaire about daily life were collected. Frailty was determined based on responses to the basic health checklist. RESULTS: A total of 1,028 community-dwelling elderly people participated in this project. There were 766 (74.5%) women. The mean age of the participants was 72.6±8.0 years old, and 506 participants (49.2%) were part of the young-old generation. The physical function measurement values, including the 5-meter walking speed, time up and go test (TUG), 5 times sit to stand, and grip strength all significantly improved. Ninety percent of the participants participated in this program every time it was held. Regarding the self-rated health questionnaire, the rate of "feeling good due to participating in the program" increased from 29.1% to 45.4% after participating in this program for 6 months. The prevalence of partial social activities was mostly an increasing trend among the participants of this program. CONCLUSION: Our findings showed that "IkiIki Hyakusai Taiso" improves and maintains the physical function and self-rated health among community-dwelling elderly individuals. Therefore, "IkiIki Hyakusai Taiso" seems to be a very useful preventive care program in the community.


Assuntos
Fragilidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Fragilidade/prevenção & controle , Avaliação Geriátrica , Humanos , Vida Independente , Japão , Equilíbrio Postural , Estudos de Tempo e Movimento
6.
BMC Geriatr ; 21(1): 482, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481482

RESUMO

BACKGROUND: Oral health is essential for daily living and plays a pivotal role in overall health conditions and well-being. This study evaluated the impact of self-reported oral health on geriatric conditions, institutionalization, and mortality. METHODS: This study analyzed the population of the Aging Study of Pyeongchang Rural Area that had undergone geriatric assessments between 2016 and 2017. The oral health status of the participants was determined using three items from the General Oral Health Assessment Index, and the participants were classified into three groups according to the total sum of the scores as good (3), fair (4-7), or poor (8-15). The outcomes were the incidence of geriatric syndromes at 2 years and the composite outcome of mortality and institutionalization. RESULTS: Among the 1189 participants, 44.1 % were women, and the mean age of the study population was 75.0 years. Good, fair, and poor oral health were observed in 597 (50.2 %), 406 (34.1 %), and 186 (15.6 %) individuals, respectively. Worsening oral health status was associated with the incidences of various geriatric syndromes at follow-up, and these associations were attenuated after adjusting for baseline demographic and geriatric parameters. Similarly, the significant association between baseline oral health status and the incidence of the composite outcome was attenuated after adjusting for demographic and geriatric parameters. CONCLUSIONS: Oral health affected the geriatric health conditions in this prospective, longitudinal cohort of community-dwelling older adults. The correlations and interactions of oral health status with other functional parameters may deserve consideration as a geriatric domain.


Assuntos
Fragilidade , Saúde Bucal , Idoso , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Vida Independente , Estudos Prospectivos , Síndrome
7.
Nutrients ; 13(7)2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34371823

RESUMO

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.


Assuntos
Serviços de Saúde Comunitária/métodos , Fragilidade/epidemiologia , Serviços de Saúde para Idosos , Desnutrição/epidemiologia , Terapia Nutricional/métodos , Sarcopenia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/terapia , Humanos , Vida Independente , Masculino , Desnutrição/diagnóstico , Desnutrição/terapia , Prevalência , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/terapia
8.
BMJ Open ; 11(8): e041091, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408025

RESUMO

OBJECTIVES: The aim of this study was to explore the extent of implementation of the General Medical Services 2018/2019 'frailty identification and management' contract in general practitioner (GP) practices in England, and link implementation outcomes to a range of practice and Clinical Commissioning Group (CCG) factors. DESIGN: A cross-sectional study design using publicly available datasets relating to the year 2018 for all GP practices in England. SETTINGS: English general practices. DATA: The analysis was conducted across 6632 practices in 193 CCGs with 9 995 558 patients aged 65 years or older. OUTCOMES: Frailty assessment rates, frailty coding rates and frailty prevalence rates, plus rates of medication reviews, falls assessments and enriched Summary Care Records (SCRs). ANALYSIS: Summary statistics were calculated and multilevel negative binomial regression analysis was used to investigate relationships of the six outcomes with explanatory factors. RESULTS: 14.3% of people aged 65 years or older were assessed for frailty, with 35.4% of these-totalling 5% of the eligible population-coded moderately or severely frail. 59.2% received a medications review, but rates of falls assessments (3.7%) and enriched SCRs (21%) were low. However, percentages varied widely across practices and CCGs. Practice differences in contract implementation were most strongly accounted for by their grouping within CCGs, with weaker but still important associations with some practice and CCG factors, particularly healthcare demand-related factors of chronic caseload and (negatively) % of patients aged 65 years or older. CONCLUSION: CCG appears the strongest determinant of practice engagement with the frailty contract, and fuller implementation may depend on greater engagement of CCGs themselves, particularly in commissioning suitable interventions. Practices understandably targeted frailty assessments at patients more likely to be found severely frail, resulting in probable underidentification of moderately frail individuals who might benefit most from early interventions. Frailty prevalence estimates based on the contract data may not reflect actual rates.


Assuntos
Fragilidade , Clínicos Gerais , Idoso , Estudos Transversais , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/terapia , Humanos , Atenção Primária à Saúde
9.
BMC Health Serv Res ; 21(1): 884, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454494

RESUMO

BACKGROUND: To provide value-based care for patients with multi-morbidity, innovative integrated care programmes and comprehensive evaluations of such programmes are required. In Norway, a new programme called "Holistic Continuity of Patient Care" (HCPC) addresses the issue of multi-morbidity by providing integrated care within learning networks for frail elderly patients who receive municipal home care services or a short-term stay in a nursing home. This study conducts a multi-criteria decision analysis (MCDA) to evaluate whether the HCPC programme performs better on a large set of outcomes corresponding to the 'triple aim' compared to usual care. METHODS: Prospective longitudinal survey data were collected at baseline and follow-up after 6-months. The assessment of HCPC was implemented by a novel MCDA framework. The relative weights of importance of the outcomes used in the MCDA were obtained from a discrete choice experiment among five different groups of stakeholders. The performance score was estimated using a quasi-experimental design and linear mixed methods. Performance scores were standardized and multiplied by their weights of importance to obtain the overall MCDA value by stakeholder group. RESULTS: At baseline in the HCPC and usual care groups, respectively, 120 and 89 patients responded, of whom 87 and 41 responded at follow-up. The average age at baseline was 80.0 years for HCPC and 83.6 for usual care. Matching reduced the standardized differences between the groups for patient background characteristics and outcome variables. The MCDA results indicated that HCPC was preferred to usual care irrespective of stakeholders. The better performance of HCPC was mostly driven by improvements in enjoyment of life, psychological well-being, and social relationships and participation. Results were consistent with sensitivity analyses using Monte Carlo simulation. CONCLUSION: Frail elderly with multi-morbidity represent complex health problems at large costs for society in terms of health- and social care. This study is a novel contribution to assessing and understanding HCPC programme performance respecting the multi-dimensionality of desired outcomes. Integrated care programmes like HCPC may improve well-being of patients, be cost-saving, and contribute to the pursuit of evidence based gradual reforms in the care of frail elderly.


Assuntos
Prestação Integrada de Cuidados de Saúde , Idoso Fragilizado , Idoso , Técnicas de Apoio para a Decisão , Humanos , Noruega , Estudos Prospectivos
10.
Rev Esc Enferm USP ; 55: e20210040, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34423808

RESUMO

OBJECTIVE: To analyze the association between self-reported fragility and quality of life in older adults. METHOD: Cross-sectional study carried out with Brazilian older adults between July and October 2020. Three instruments were applied to obtain bio sociodemographic, frailty data and quality of life. Data were analyzed using the Kruskal-Wallis test, Pearson correlation and multivariate linear regression, adopting a 95% confidence interval (p < 0.05). RESULTS: A total of 662 older adults participated. All facets of quality of life were significantly and negatively correlated with reduced strength, reduced walking speed, low physical activity, and reported fatigue, with the exception of weight loss. In the regression analysis, different frailty components were associated with quality of life, but all had a negative relationship. CONCLUSION: Self-reported frailty has a negative relationship with quality of life, that is, the increase in the frailty scale implies a reduction of different magnitudes in the quality of life of older adults.


Assuntos
Fragilidade , Qualidade de Vida , Idoso , Estudos Transversais , Idoso Fragilizado , Fragilidade/epidemiologia , Humanos , Autorrelato
11.
Artigo em Inglês | MEDLINE | ID: mdl-34444540

RESUMO

BACKGROUND: The frail elderly are prone to falls and fractures, which can result in dependency, disability, admission to institutions, and even death. They are at increased risk of frailty due to decreased physical activity, cognitive decline, and depression. Some evidence suggests that music therapy with physical activities may be particularly beneficial. OBJECTIVE: This study aimed to investigate the intervention effect of music therapy with physical activities (MTPA) on frail elderly in the community. METHODS: A quasi-experimental design was adopted. We selected 10 community care centers in southern Taiwan, in which elderly people over the age of 65 were assigned to a MTPA group and a comparison group after obtaining their informed consent. The MTPA group performed group music activities once a week for 120 min for 12 weeks, while the comparison group only continued with their daily activities. Instruments in this study included the Kihon Checklist, Senior Fitness Test (with Body Mass Index (BMI) and seven physical fitness items), Mini-Mental Status Examination (MMSE), and Geriatric Depression Scale Short Form (GDS-SF). RESULTS: A total of 132 community elders agreed to participate in this study, and 122 completed both the pretest and posttest, with 62 in the music therapy group and 60 in the comparison group. The results of ANCOVA showed that after intervention, except for BMI, the Kihon frailty assessment, seven fitness scores individually and in total, MMSE, and depression showed significant improvements in the music therapy group relative to the comparison group (all p < 0.05). CONCLUSION: MTPA can improve the frailty index, cognitive function, depression, and physical fitness index in the community elderly. The results of this study can be used as a reference for the design of activities for the community elderly, to provide them with appropriate activities, improve their physical functions, and improve or delay their disability.


Assuntos
Fragilidade , Musicoterapia , Música , Atividades Cotidianas , Idoso , Exercício Físico , Idoso Fragilizado , Fragilidade/prevenção & controle , Avaliação Geriátrica , Humanos , Vida Independente
12.
Sensors (Basel) ; 21(16)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34450734

RESUMO

Remote monitoring of physical frailty is important to personalize care for slowing down the frailty process and/or for the healthy recovery of older adults following acute or chronic stressors. Taking the Fried frailty criteria as a reference to determine physical frailty and frailty phenotypes (slowness, weakness, exhaustion, inactivity), this study aimed to explore the benefit of machine learning to determine the least number of digital biomarkers of physical frailty measurable from a pendant sensor during activities of daily living. Two hundred and fifty-nine older adults were classified into robust or pre-frail/frail groups based on the physical frailty assessments by the Fried frailty criteria. All participants wore a pendant sensor at the sternum level for 48 h. Of seventeen sensor-derived features extracted from a pendant sensor, fourteen significant features were used for machine learning based on logistic regression modeling and a recursive feature elimination technique incorporating bootstrapping. The combination of percentage time standing, percentage time walking, walking cadence, and longest walking bout were identified as optimal digital biomarkers of physical frailty and frailty phenotypes. These findings suggest that a combination of sensor-measured exhaustion, inactivity, and speed have potential to screen and monitor people for physical frailty and frailty phenotypes.


Assuntos
Fragilidade , Atividades Cotidianas , Idoso , Biomarcadores , Exercício Físico , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Humanos , Aprendizado de Máquina , Fenótipo
13.
Medicine (Baltimore) ; 100(29): e26700, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398043

RESUMO

BACKGROUND: Senile insomnia seriously affects the quality of life of the elderly. With the increase of the proportion of insomnia in the elderly, compared with the elderly with normal sleep quality, the elderly with long-term insomnia are more likely to have dizziness, fatigue, and decreased immunity. Acupuncture has shown good effects in the treatment of insomnia. At present, there is a lack of systematic review on acupuncture in the treatment of senile insomnia. We conduct this study to evaluate the efficacy and safety of acupuncture in the treatment of senile insomnia. METHODS: We will search Chinese and English databases: China National Knowledge Infrastructure, Chinese Scientific and Journal Database, Wan Fang database (Wanfang), Chinese Biomedical Literature Database, PubMed, EMBASE, Cochrane library to identify articles of randomized clinical trials of acupuncture for senile insomnia. All above electronic databases will be searched from inception to September 1, 2021. RevMan 5.3 software will be used to conduct this systematic review. RESULTS: The study will prove the efficacy and safety of acupuncture for senile insomnia. CONCLUSION: We plan to submit this systematic review to a peer-reviewed journal. INPLASY REGISTRATION NUMBER: INPLASY202160106.


Assuntos
Idoso Fragilizado , Distúrbios do Início e da Manutenção do Sono/terapia , Terapia por Acupuntura , Idoso , Idoso de 80 Anos ou mais , Humanos , Projetos de Pesquisa
14.
J Am Med Dir Assoc ; 22(9): 1845-1852.e1, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34364846

RESUMO

OBJECTIVES: To evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission. DESIGN: Single-center prospective observational cohort study. SETTING AND PARTICIPANTS: The study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021. METHODS: Clinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes. RESULTS: A total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death. CONCLUSIONS AND IMPLICATIONS: The ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for patients with COVID-19 aged ≥80 years at the time of ED presentation.


Assuntos
COVID-19 , Fragilidade , Adulto , Idoso , Serviço Hospitalar de Emergência , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Mortalidade Hospitalar , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Medição de Risco , SARS-CoV-2
15.
Nutrients ; 13(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34371858

RESUMO

Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.


Assuntos
Dieta Saudável/métodos , Dieta/efeitos adversos , Fragilidade/prevenção & controle , Desnutrição/dietoterapia , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Causalidade , Comportamento Alimentar/fisiologia , Feminino , Idoso Fragilizado , Fragilidade/etiologia , Humanos , Masculino , Desnutrição/complicações , Desnutrição/fisiopatologia
16.
BMC Health Serv Res ; 21(1): 786, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34372851

RESUMO

BACKGROUND: Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients' participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. METHODS: A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. RESULTS: Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants' recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. CONCLUSION: Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients' needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.


Assuntos
Cuidado Transicional , Assistência ao Convalescente , Idoso , Cuidadores , Idoso Fragilizado , Humanos , Alta do Paciente
17.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371894

RESUMO

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Maori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77-84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0-64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002); both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4-25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6-1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.


Assuntos
Dieta/efeitos adversos , Idoso Fragilizado , Fragilidade/fisiopatologia , Estado Nutricional , Valor Nutritivo , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dieta/etnologia , Feminino , Fragilidade/diagnóstico , Fragilidade/etnologia , Avaliação Geriátrica , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Avaliação Nutricional , Estado Nutricional/etnologia , Valor Nutritivo/etnologia , Grupo com Ancestrais Oceânicos , Medição de Risco , Fatores de Risco , Fatores Sexuais
18.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371905

RESUMO

This study aimed to identify food environment factors in the local community that could affect the levels of nutritional status and frailty in 372 older adults (at least 65 years old) experiencing food insecurity and enrolled in the integrated Community Health Promotion Program (CHPP) in two districts of Seoul. The local food environment was assessed using perceived food store accessibility questionnaires. In order to quantify nutrient intake, the 24-h recall method was applied. Malnutrition was measured using the Mini Nutritional Assessment tool, while frailty was assessed using the Frailty Measurement Questionnaire developed for the CHPP. Malnourished or frail elderly adults commonly had a lower intake of cereals and potatoes, meats, and vegetables than those who were not, and their resulting intake levels of energy, protein, iron, and vitamin groups were also significantly lower (all p-values < 0.05). Among the local community food store environment factors, the sufficiency of food stores (odds ratio (OR) = 1.988, 95% confidence interval (CI] = 1.211-3.262), freshness of foods (OR = 1.767, 95% CI = 1.075-2.886), and variety in foods (OR = 1.961, 95% CI = 1.197-3.212) were significant factors affecting the risk of malnutrition. For frailty, the freshness of foods (OR = 1.997, 95% CI = 1.053-3.788), variety in foods (OR = 2.440, 95% CI = 1.277-4.661), and small purchase of foods (OR = 2.645, 95% CI = 1.362-5.139) were significant environmental factors. In conclusion, we found that the perceived food store environment in the local community can influence the occurrence of malnutrition and frailty in vulnerable, urban older adults.


Assuntos
Insegurança Alimentar , Idoso Fragilizado , Fragilidade/epidemiologia , Desnutrição/epidemiologia , Estado Nutricional , Supermercados , Saúde da População Urbana , Fatores Etários , Idoso , Feminino , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Avaliação Geriátrica , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Avaliação Nutricional , Medição de Risco , Fatores de Risco , Seul/epidemiologia , Inquéritos e Questionários
19.
Br J Nurs ; 30(15): 894-898, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379467

RESUMO

Frailty in old age has become synonymous with medication use. As people age, the risk of disease burden increases. Older age is often linked with complex healthcare needs, with a rise in the number of comorbidities. This often results in the need to use multiple medications. Frailty is a global concern and requires early interventions to help people maintain their health as they age. Advanced clinical practitioners have an important role in supporting frail people living in the community. This article will review the literature and explore strategies that advanced practitioners can implement to optimise wellbeing and reduce medicines-related harm for this vulnerable population.


Assuntos
Prática Avançada de Enfermagem , Idoso Fragilizado , Fragilidade , Conduta do Tratamento Medicamentoso , Idoso , Comorbidade , Fragilidade/enfermagem , Humanos , Conduta do Tratamento Medicamentoso/organização & administração
20.
BMC Geriatr ; 21(1): 465, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407755

RESUMO

BACKGROUND: Previous reports suggest that the attributes of frailty are multidimensional and include nutrition, cognition, mentality, and other aspects. We aim to develop an early warning model of frailty based on nutritional risk screening and apply the frailty early warning model in the clinic to screen high-risk patients and provide corresponding intervention target information. METHODS: The proposed study includes two stages. In the first stage, we aim to develop a prediction model of frailty among older inpatients with nutritional risk. Study data were collected from a population-based aging cohort study in China. A prospective cohort study design will be used in the second stage of the study. We will recruit 266 older inpatients (age 65 years or older) with nutritional risk, and we will apply the frailty model in the clinic to explore the predictive ability of the model in participants, assess patients' health outcomes with implementation of the frailty model, and compare the model with existing frailty assessment tools. Patients' health outcomes will be measured at admission and at 30-day follow-up. DISCUSSION: This project is the first to develop an early prediction model of frailty for older inpatients according to nutritional risk in a nationally representative sample of Chinese older inpatients of tertiary hospitals. The results will hopefully help to promote the development of more detailed frailty assessment tools according to nutritional risk, which may ultimately lead to reduced health care costs and improvement in independence and quality of life among geriatric patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800017682 , registered August 9, 2018; and ChiCTR2100044148 , registered March 11, 2021.


Assuntos
Fragilidade , Idoso , China/epidemiologia , Estudos de Coortes , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Pacientes Internados , Estudos Prospectivos , Qualidade de Vida
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