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1.
Child Abuse Negl ; 130(Pt 2): 105308, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34544592

RESUMO

BACKGROUND: A high incidence of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) has been reported for children with experiences of trauma and other forms of adversity. OBJECTIVE: The present study aims to explore symptoms of RAD and DSED in children in two protection alternatives (international adoption and residential care) after experiences of early adversity. PARTICIPANTS AND SETTING: The participants were 146 children: 40 children adopted into Spanish families from Russia, 49 children in residential care in Spanish institutions (40.8% in long-term foster centers) and 57 community comparison children. METHODS: The Relationship Problems Questionnaire was used to explore both RAD and DSED. All adoptive parents and institutional caregivers retrospectively reported the problems at time of placement (Wave 0), as well as the symptoms observed at the time of the study, with children aged 4-8 years old (Wave 1). At this stage, the assessment of the community comparison group was added. RESULTS: Adopted and children in residential care presented high levels of RAD and DSED symptoms at placement. For adoptees, previous experiences of abuse and neglect were marginally associated with the initial presence of RAD symptoms and a significant recovery was observed after an average of three years in their families, with a certain level of longitudinal continuity between initial and later assessments. In children currently placed in long-term residential centers in Spain, DSED symptoms worsened from W0 to W1. CONCLUSIONS: Adoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.


Assuntos
Adoção , Criança Institucionalizada , Apego ao Objeto , Comportamento Problema , Transtorno Reativo de Vinculação na Infância , Adoção/psicologia , Criança , Maus-Tratos Infantis/psicologia , Criança Institucionalizada/psicologia , Pré-Escolar , Humanos , Institucionalização , Internacionalidade , Comportamento Problema/psicologia , Psicologia da Criança , Transtorno Reativo de Vinculação na Infância/diagnóstico , Transtorno Reativo de Vinculação na Infância/epidemiologia , Transtorno Reativo de Vinculação na Infância/psicologia , Instituições Residenciais , Estudos Retrospectivos , Participação Social/psicologia , Espanha
2.
Hist Psychiatry ; 33(4): 429-445, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36408552

RESUMO

This article studies the University of Tartu psychiatric hospital and its patient population in the Russian Baltic Province of Livonia in 1881-95, using the hospital's admission registry book as the primary source. Although it was a university clinic following the German academic tradition, both upper- and lower-class patients were admitted (25 and 75 per cent, respectively, of 2,184 hospitalizations), with a median stay of 70 days. Admission and length of stay often depended on a family's or community's financial capabilities. Considerably more men and unmarried patients were admitted, and 130 hospitalized women were diagnosed with female-specific illnesses. This study argues that gender and social class should be jointly analysed, as admission and discharge outcomes are influenced by both factors simultaneously.


Assuntos
Hospitalização , Institucionalização , Masculino , Humanos , Feminino , Hospitais Psiquiátricos , Federação Russa
3.
Glob Health Sci Pract ; 10(5)2022 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-36316131

RESUMO

Integrated service delivery approaches have shown promise to increase use of services including postpartum family planning (PPFP) by young, first-time mothers (FTMs) but have proven challenging to scale and institutionalize. Integration adds complexity, requiring careful assessment of effects on a range of key system functions from demand creation and service delivery to oversight and governance. Through an innovative design process, we selected approaches to increase FTMs' PPFP use through existing health systems. We generated programmatic options and then sought to select approaches based on (1) potential impact on FTMs' PPFP uptake and (2) potential to institutionalize in the health system. The latter represented an innovation in addressing management systems' drivers of scalability and sustainability; to accomplish it, we developed a participatory design process to assess the potential of an approach to be institutionalized in a specific context.We adapted a management systems theory, the Viable System Model (VSM), which presents 5 essential organizational functions and the relations required between them to improve the viability (performance and institutionalization) of organizational systems. Drawing from the VSM, we developed a process for reviewing the effects of proposed approaches on provider workload, client flow, infrastructure, revisions to guidelines and job descriptions, coordination and management, and information systems. The VSM provided a structure to identify potential displacement of capacity in the health system and mitigate often neglected organizational challenges that compromise institutionalization. The process informed the elimination of approaches with potential for impact but that had deal-breakers to institutionalization, such as increased workload or shifted job descriptions, in the Bangladeshi context. For the selected approaches, consideration of systems elements fostered discussion of expected risks to institutionalization, highlighting needed mitigation efforts and monitoring during implementation.


Assuntos
Serviços de Planejamento Familiar , Mães , Feminino , Humanos , Bangladesh , Período Pós-Parto , Institucionalização , Análise de Sistemas
5.
Hist Cienc Saude Manguinhos ; 29(3): 661-680, 2022.
Artigo em Português | MEDLINE | ID: mdl-36074355

RESUMO

A little-known facet of the trajectory of Pedro Nava is analyzed, namely, his involvement in the institutionalization of rheumatology in Brazil. Drawing on multiple primary sources, including medical journals, correspondence, notebooks, technical reports, and newspaper stories, the range of mechanisms Nava galvanized in the effort to legitimize this new area of medicine in Brazil as of the 1940s are shown. These include his efforts to forge networks outside the country, create new departments, take active part in the journal Brasil Médico, develop a specialized lexicon for rheumatology, liaise with the State, and found new associations.


O artigo analisa um aspecto pouco conhecido da trajetória de Pedro Nava: seu envolvimento na institucionalização da reumatologia no Brasil. Por meio de uma gama de materiais de arquivo, como revistas médicas, correspondência, cadernetas, relatórios técnicos e matérias de jornal, procura recuperar diversos mecanismos mobilizados por Nava no movimento de legitimação de uma nova área da medicina no Brasil a partir dos anos 1940. Como se busca demonstrar, seus esforços incluíram a criação de redes no exterior, a fundação de departamentos, a participação ativa no periódico Brasil Médico , o desenvolvimento de um léxico próprio para a reumatologia, relações com o Estado e a criação de associações.


Assuntos
Reumatologia , Brasil , Humanos , Institucionalização
6.
Value Health Reg Issues ; 32: 47-53, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36075139

RESUMO

OBJECTIVES: This study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions. HTA CAPACITY BUILDING: University-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA INSTITUTIONALIZATION AND ITS USE IN PRICING AND REIMBURSEMENT DECISIONS: Institutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration's pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet. RECOMMENDATIONS AND FUTURE DIRECTIONS: Over the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.


Assuntos
Fortalecimento Institucional , Avaliação da Tecnologia Biomédica , Estados Unidos , Humanos , Jordânia , Custos e Análise de Custo , Institucionalização
7.
Bone Joint J ; 104-B(8): 980-986, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35909371

RESUMO

AIMS: We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture. METHODS: Of 1,577 consecutive patients aged > 65 years with a fragility hip fracture admitted to one institution, for whom there were complete data, 1,255 (72%) were studied. Clinicians assigned CFS scores on admission. Audit personnel routinely prospectively completed the Standardised Audit of Hip Fracture in Europe form, including the following outcomes: 30-day survival; in-hospital complications; length of acute hospital stay; and new institutionalization. The relationship between the CFS scores and outcomes was examined graphically and the visual interpretations were tested statistically. The predictive values of the CFS and Nottingham Hip Fracture Score (NHFS) to predict 30-day mortality were compared using receiver operating characteristic area under the curve (AUC) analysis. RESULTS: Significant non-linear associations between CFS and outcomes were observed. Risk of death within 30 days rose linearly for CFS 1 to 5, but plateaued for CFS > 5. The incidence of complications and length of stay rose linearly for CFS 1 to 4, but plateaued for CFS > 4. In contrast, the risk of new institutionalization rose linearly for CFS 1 to 8. The AUCs for 30-day mortality for the CFS and NHFS were very similar: CFS AUC 0.63 (95% CI 0.57 to 0.69) and NHFS AUC 0.63 (95% CI 0.57 to 0.69). CONCLUSION: Use of the CFS may provide useful information on outcomes for fitter patients presenting with hip fracture, but completion of the CFS by the admitting orthopaedic team does not appear successful in distinguishing between higher CFS categories, which define patients with frailty. This makes a strong case for the role of the orthogeriatrician in the early assessment of these patients. Further work is needed to understand why patients assessed as being of mild, moderate, and severe frailty do not result in different outcomes. Cite this article: Bone Joint J 2022;104-B(8):980-986.


Assuntos
Síndrome de Fadiga Crônica , Fragilidade , Fraturas do Quadril , Estudos de Coortes , Fragilidade/complicações , Fragilidade/diagnóstico , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Institucionalização , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
8.
J Am Med Dir Assoc ; 23(11): 1883.e1-1883.e8, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35926574

RESUMO

OBJECTIVES: Geriatric inpatient rehabilitation aims to restore function, marked by physical performance, to enable patients to return and remain home after hospitalization. However, after discharge some patients are soon readmitted, institutionalized, or may die. Whether changes in physical performance during geriatric rehabilitation are associated with these short-term adverse outcomes is unknown. This study aimed to determine the association of changes in physical performance during geriatric inpatient rehabilitation with short-term adverse outcomes. DESIGN: Observational longitudinal study. SETTING AND PARTICIPANTS: Geriatric rehabilitation inpatients of the REStORing health of acutely unwell adulTs (RESORT) cohort study of the Royal Melbourne Hospital (Melbourne, Australia) were included. METHODS: The change from admission to discharge in the Short Physical Performance Battery (SPPB) score, balance, gait speed (GS), chair stand test (CST), and hand grip strength (HGS) were calculated and analyzed using logistic regression analysis with readmission, incidence of institutionalization, and mortality, and ≥1 adverse outcome within 3 months postdischarge. RESULTS: Of 693 inpatients, 11 died during hospitalization and 572 patients (mean age 82.6 ± 7.6 years, 57.9% female) had available physical performance data. Within 3 months postdischarge, 47.3% of patients had ≥1 adverse outcome: readmission was 20.8%, institutionalization was 26.6%, and mortality was 7.9%. Improved SPPB score, balance, GS, CST, and HGS were associated with lower odds of institutionalization and mortality. Improved GS was additionally associated with lower odds of readmission [odds ratio (OR) 0.35, 95% CI 0.16-0.79]. CST score had the largest effect, with a 1-point increase associating with 40% lower odds of being institutionalized (OR 0.60, 95% CI 0.42-0.86), 52% lower odds of mortality (OR 0.48, 95% CI 0.29-0.81), and a 24% lower odds of ≥1 adverse outcome (OR 0.76, 95% CI 0.59-0.97). CONCLUSIONS AND IMPLICATIONS: Improvement in physical performance was associated with lower odds of short-term institutionalization and mortality indicating the prognostic value of physical performance improvement during geriatric inpatient rehabilitation.


Assuntos
Pacientes Internados , Readmissão do Paciente , Adulto , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Estudos de Coortes , Força da Mão , Alta do Paciente , Estudos Longitudinais , Assistência ao Convalescente , Institucionalização , Desempenho Físico Funcional , Avaliação Geriátrica
9.
Nutrients ; 14(15)2022 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-35956299

RESUMO

Malnutrition in older adults impacts health status, increased mortality, and morbidity. Malnutrition may increase the development of geriatric syndromes and contribute to a higher prevalence of falls and osteoporotic fractures that lead to loss of independence and an increased rate of institutionalization. The role of malnutrition in the pathogenesis of other geriatric syndromes seems to be well established. However, the data concerning nutritional interventions are confounding. Moreover, long-term undernutrition seems to be one of the factors that strongly influences the efficacy of interventions. This review outlines the current literature on this topic, and aims to guide physicians to make proper decisions to prevent the vicious cycle of falls, fractures, and their negative outcomes in patients with malnutrition.


Assuntos
Fraturas Ósseas , Desnutrição , Idoso , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Avaliação Geriátrica , Humanos , Institucionalização , Desnutrição/complicações , Desnutrição/epidemiologia , Desnutrição/prevenção & controle , Estado Nutricional , Prevalência , Síndrome
10.
Hist Psychiatry ; 33(3): 293-307, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35979867

RESUMO

This article offers a preliminary analysis of psychiatric treatment during the Chinese Cultural Revolution on the basis of interviews and rare case records obtained from 'F Hospital' in southern China. In contrast to the prevailing view of psychiatry during this time, which highlights either rampant patient abuse or revolutionary ideology, we show that psychiatric treatment at this facility was not radically altered by the politics of the Maoist period. Instead, treatments were informed by a predominantly biomedical understanding of mental illness, one that derived from the prior training of the facility's lead physicians. Although political education was nominally incorporated into patient rehabilitation and outpatient care, it was not a constitutive element of inpatient treatment during the acute phase of illness.


Assuntos
Transtornos Mentais , Psiquiatria , China , Humanos , Institucionalização , Transtornos Mentais/terapia , Política
11.
Alzheimers Res Ther ; 14(1): 110, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35932034

RESUMO

BACKGROUND: Patients and caregivers express a desire for accurate prognostic information about time to institutionalization and mortality. Previous studies predicting institutionalization and mortality focused on the dementia stage. However, Alzheimer's disease (AD) is characterized by a long pre-dementia stage. Therefore, we developed prediction models to predict institutionalization and mortality along the AD continuum of cognitively normal to dementia. METHODS: This study included SCD/MCI patients (subjective cognitive decline (SCD) or mild cognitive impairment (MCI)) and patients with AD dementia from the Amsterdam Dementia Cohort. We developed internally and externally validated prediction models with biomarkers and without biomarkers, stratified by dementia status. Determinants were selected using backward selection (p<0.10). All models included age and sex. Discriminative performance of the models was assessed with Harrell's C statistics. RESULTS: We included n=1418 SCD/MCI patients (n=123 died, n=74 were institutionalized) and n=1179 patients with AD dementia (n=413 died, n=453 were institutionalized). For both SCD/MCI and dementia stages, the models for institutionalization and mortality included after backward selection clinical characteristics, imaging, and cerebrospinal fluid (CSF) biomarkers. In SCD/MCI, the Harrell's C-statistics of the models were 0.81 (model without biomarkers: 0.76) for institutionalization and 0.79 (model without biomarker: 0.76) for mortality. In AD-dementia, the Harrell's C-statistics of the models were 0.68 (model without biomarkers: 0.67) for institutionalization and 0.65 (model without biomarker: 0.65) for mortality. Models based on data from amyloid-positive patients only had similar discrimination. CONCLUSIONS: We constructed prediction models to predict institutionalization and mortality with good accuracy for SCD/MCI patients and moderate accuracy for patients with AD dementia. The developed prediction models can be used to provide patients and their caregivers with prognostic information on time to institutionalization and mortality along the cognitive continuum of AD.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Doença de Alzheimer/líquido cefalorraquidiano , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Biomarcadores/líquido cefalorraquidiano , Disfunção Cognitiva/líquido cefalorraquidiano , Progressão da Doença , Humanos , Institucionalização , Proteínas tau/líquido cefalorraquidiano
12.
Artigo em Inglês | MEDLINE | ID: mdl-35805247

RESUMO

The present study about falls among the older adult population essentially explores bio-physiological factors. In light of the complexity of the factors that cause these accidents, it is important to identify the safety and self-care practices of institutionalized older adults and their relationship with falls in order to introduce prevention measures and personalized cognitive-behavioral strategies. The objective of this study was to: (a) determine the frequency of falls and their recurrence among institutionalized older adults, and (b) to associate the occurrence of falls among institutionalized adults with or without cognitive impairment to communication and safety practices. This was a quantitative, correlational, and longitudinal study with 204 institutionalized older adults living in two long-term care facilities in Portugal. The Scale of Practices and Behaviors for Institutionalized Elderly to Prevent Falls was administered to the sample. The prevalence of falls at a 12-month follow-up was 41.6%, of which 38.3% were recurring episodes. Older adults with cognitive decline showed lower mean scores for safety practices. Further research with larger samples should explore the relationships between communication and safety practices and falls, their recurrence, and fear of new falls.


Assuntos
Institucionalização , Idoso , Humanos , Estudos Longitudinais , Portugal , Prevalência
13.
J Alzheimers Dis ; 89(1): 359-366, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35871348

RESUMO

BACKGROUND: Disease modifying treatments (DMTs) currently under development for Alzheimer's disease, have the potential to prevent or postpone institutionalization and more expensive care and might delay institutionalization of persons with dementia. OBJECTIVE: The current study estimates costs of living in a nursing home for persons with dementia in the Netherlands to help inform economic evaluations of future DMTs. METHODS: Data were collected during semi-structured interviews with healthcare professionals and from the financial administration of a healthcare organization with several nursing homes. Personnel costs were calculated using a bottom-up approach by valuing the time estimates. Non-personnel costs were calculated using information from the financial administration of the healthcare organization. RESULTS: Total costs of a person with dementia per 24 hours, including both care staff and other healthcare providers, were € 151 for small-scale living wards and € 147 for independent living wards. Non-personnel costs were € 37 per day. CONCLUSION: This study provides Dutch estimates for total healthcare costs per day for institutionalized persons with dementia. These cost estimates can be used in cost-effectiveness analyses for future DMTs in dementia.


Assuntos
Demência , Demência/epidemiologia , Demência/terapia , Custos de Cuidados de Saúde , Humanos , Institucionalização , Países Baixos/epidemiologia , Casas de Saúde
14.
J Cachexia Sarcopenia Muscle ; 13(5): 2322-2330, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35818998

RESUMO

BACKGROUND: Frailty in older adults is associated with adverse geriatric outcomes. Physical frailty is often accompanied by problems in the cognitive, psychological, and social domains. This study investigated the ability of physical frailty combined with other health domains to predict institutionalization and mortality. METHODS: A national sample of 9171 Koreans aged 65 years or older were surveyed at baseline in 2008 and 3 year follow-up. Those who were prefrail or frail according to the Fried criteria were conceived to have physical frailty. Psychological frailty, cognitive frailty, and social frailty were defined as having depressive symptoms, cognitive impairment, and social vulnerabilities, respectively, in addition to physical frailty. Using Cox proportional hazards and competing-risks regression, the risk of mortality and institutionalization by the number and profiles of different frailty domains was analysed. RESULTS: At baseline, the 9171 participants were aged 73.1 (±6.8) years on average (median: 72, range: 65 to 103), and 59.2% were women. Multidomain frailty was highly prevalent (49.3%), with 6.1% concurrently displaying frailty in all four domains (mixed frailty). The risk of negative health outcomes increased with frailty in a higher number of domains with a subhazard ratio (SHR) of 3.48 (95% confidence interval [CI]: 1.83, 6.62; P < 0.001) for institutionalization and a hazard ratio (HR) of 3.95 (95% CI: 2.62, 5.93; P < 0.001) for mortality among those presenting mixed frailty. Psychological frailty (depressive symptoms combined with physical frailty) was strongly predictive of institutionalization (SHR = 2.85; 95% CI: 1.45, 5.59; P = 0.002) and mortality (HR = 2.47; 95% CI: 1.61, 3.78; P < 0.001). When combined with physical frailty and either depressive symptoms or social vulnerabilities, cognitive impairment also exhibited a significantly elevated risk of negative events. Physical frailty alone was not a strong predictor of adverse events, especially for mortality (HR = 1.13; 95% CI: 0.77, 1.67; P = 0.53). CONCLUSIONS: Co-occurrence of physical frailty with other domains is common in late life. The presence of frailty in multiple domains raises the risk of adverse outcomes, with the effects varying by multidimensional profiles.


Assuntos
Fragilidade , Idoso , Feminino , Idoso Fragilizado/psicologia , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Humanos , Vida Independente , Institucionalização , Masculino
15.
J Int Bioethique Ethique Sci ; 33(1): 105-106, 2022.
Artigo em Francês | MEDLINE | ID: mdl-35723991

RESUMO

Is sustainable development a means of rationally organizing scarcity and/or is it also an incentive to seek new approaches to shaping the democratic process?


Assuntos
Institucionalização , Humanos
16.
Hist Psychiatry ; 33(2): 180-199, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35588215

RESUMO

Historical studies on the institutionalization of the mentally ill have primarily relied on data for institutionalized patients rather than the population at risk. Consequently, the underlying factors of institutionalization are unclear. Using Swedish longitudinal microdata from 1900-59 reporting mental disorders, we examine whether supply factors, such as distance to institutions and number of asylum beds, influenced the risk of institutionalization, in addition to demand factors such as access to family. Institutionalization risks were associated with the supply of beds and proximity to an asylum, but also dependent on families' unmet demand for care of relatives. As the supply of mental care met this family-driven demand in the 1930s, the relative risk of institutionalization increased among those lacking family networks.


Assuntos
Transtornos Mentais , Pessoas Mentalmente Doentes , Hospitais Psiquiátricos , Humanos , Institucionalização , Transtornos Mentais/terapia , Suécia
17.
J Hist Behav Sci ; 58(4): 404-431, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35467027

RESUMO

To clarify the historical origins of theoretical and methodological problems faced by Argentinian psychology today, this article describes the philosophical and epistemological ideas held by psychoanalytically oriented professors and transmitted to undergraduate students during the institutionalization and professionalization of psychology at Argentinian universities between 1962 and 1983. Drawing from primary sources such as official publications and undergraduate syllabi, we analyze the systematic and normative perspective of those psychoanalysts on issues such as the nature of science, the scientific method, and the legitimate ways to do research. We argue that the philosophical approach they defended within psychology programs was markedly relativistic, solipsistic, and often recursive, leading them to conceive of psychoanalysis both as a meta-theory and a self-sufficient science. The fact that this "theory-laden" philosophy of science was gradually adopted by psychology graduates (or undergraduates) throughout their education could thus help explain several epistemological beliefs currently held by a majority of Argentinian psychologists.


Assuntos
Psicanálise , Humanos , Filosofia , Psicoterapia , Conhecimento , Institucionalização , Psicologia
18.
Osteoporos Int ; 33(7): 1465-1475, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35396653

RESUMO

Hip fractures are a serious public health issue with major consequences, especially for frail community dwellers. This study found a poor prognosis at 6 months post-trauma with regard to life expectancy and rehabilitation to pre-fracture independency levels. It should be realized that recovery to pre-trauma functioning is not a certainty for frail community-dwelling patients. INTRODUCTION: Proximal femoral fractures are a serious public health issue in the older patient. Although a significant rise in frail community-dwelling elderly is expected because of progressive aging, a clear overview of the outcomes in these patients sustaining a proximal femoral fracture is lacking. This study assessed the prognosis of frail community-dwelling patients who sustained a proximal femoral fracture. METHODS: A multicenter retrospective cohort study was performed on frail community-dwelling patients with a proximal femoral fracture who aged over 70 years. Patients were considered frail if they were classified as American Society of Anesthesiologists score ≥ 4 and/or a BMI < 18.5 kg/m2 and/or Functional Ambulation Category ≤ 2 pre-trauma. The primary outcome was 6-month mortality. Secondary outcomes were adverse events, health care consumption, rate of institutionalization, and functional recovery. RESULTS: A total of 140 out of 2045 patients matched the inclusion criteria with a median age of 85 (P25-P75 80-89) years. The 6-month mortality was 58 out of 140 patients (41%). A total of 102 (73%) patients experienced adverse events. At 6 months post-trauma, 29 out of 120 (24%) were readmitted to the hospital. Out of the 82 surviving patients after 6 months, 41 (50%) were unable the return to their home, and only 32 (39%) were able to achieve outdoor ambulation. CONCLUSION: Frail community-dwelling older patients with a proximal femoral fracture have a high risk of death, adverse events, and institutionalization and often do not reobtain their pre-trauma level of independence. Foremost, the results can be used for realistic expectation management.


Assuntos
Fraturas do Fêmur , Fraturas do Quadril , Idoso , Idoso Fragilizado , Humanos , Vida Independente , Institucionalização , Prognóstico , Estudos Retrospectivos
19.
J Appl Gerontol ; 41(5): 1357-1364, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35220779

RESUMO

This study aimed to examine the institutionalization rate in patients with dementia in Taiwan, identify the predictors of institutionalization, and conduct a mediation analysis of caregiver burden between neuropsychiatric symptoms and institutionalization. We analyzed data from a retrospective cohort registered in dementia collaborative care (N = 518). The analyses applied univariate and multivariate Cox proportional hazard regression with Firth's penalized likelihood to assess the relationship between each predictor at entry and institutionalization for survival analysis. Thirty (5.8%) patients were censored due to institutionalization after a median follow-up of one-and-a-half years. Neuropsychiatric symptoms, loss of walking ability, and living alone predicted institutionalization. Caregiver burden may partially mediate the effects of neuropsychiatric symptoms and institutionalization. High caregiver burden due to presence of neuropsychiatric symptoms may partially contribute to institutionalization among people living with dementia in Taiwan. However, proper management of neuropsychiatric symptoms and caregiver empowerment may ameliorate institutionalization risk.


Assuntos
Demência , Cuidadores/psicologia , Demência/psicologia , Humanos , Institucionalização , Estudos Retrospectivos , Taiwan
20.
Artigo em Inglês | MEDLINE | ID: mdl-35104008

RESUMO

OBJECTIVES: Routinization reflects how older people cope with the health problems. It remains to be seen whether it should be considered as a risk factor of negative health outcomes, or rather, a mechanism of adjustment to health issues: mortality, institutionalization, dementia, disability, cognitive decline, depression and subjective health. METHODS: From longitudinal data of two large-scale French epidemiological studies, the study sample consists of 961 participants aged 77 years on average, living at home and with no neurocognitive disorder. The relationship between the level of routines measured by the Preferences for Routines Scale-Short form and the adverse health outcomes are studied considering the level of routines at baseline and in time-dependent using Cox proportional hazards models and Latent process mixed models. RESULTS: After adjustment for sociodemographic variables, the routinization score at baseline is not associated with any health outcomes while the routinization score as a time-dependent variable is significantly associated with an increased risk of dementia (hazard ratios (HR) = 1.08, 95% confidence intervals (CI) = 1.02-1.15, p = 0.016) and institutionalization (HR = 1.18, 95% CI = 1.03-1.36, p = 0.019), greater global cognitive decline (ß = -0.02, p = 0.001) and depressive symptoms (ß = 0.02, p = 0.023) and a decrease in subjective health (ß = 0.02, p = 0.008). CONCLUSIONS: The level of routines measured at a given time is not associated with long-term prediction of negative health outcomes, while in time-dependent, it reveals to be a significant predictor. It should be seen as a marker of adjustment process.


Assuntos
Disfunção Cognitiva , Demência , Pessoas com Deficiência , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Demência/psicologia , Humanos , Institucionalização , Modelos de Riscos Proporcionais , Fatores de Risco
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