Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.07.008
Iracema Leroi MD , Prof Christopher J Armitage PhD , Elizabeth M Camacho PhD , Anna Pavlina Charalambous PhD , J P Connelly MSc , Prof Fofi Constantinidou PhD , Renaud David PhD , Prof Piers Dawes PhD , Prof Rachel A Elliott PhD , Mark Hann PhD , Alison Holden MSc , Emma Hooper MSc , Sean P Kennelly PhD , Evangelia Kontogianni MSc , Prof Brian A Lawlor MD , Julie Longobardi MSc , Luke Paterson MSc , Antonis M Politis PhD , Prof David Reeves PhD , Christine Schwimmer PhD , Eric Frison PhD
<div><h3>Background</h3><div>The effect of hearing and vision difficulties on the risk of developing dementia and worsening outcomes in people already living with dementia is well established. We evaluated the clinical impact of a hearing and vision rehabilitation and support programme on quality of life in people with mild-to-moderate dementia and concurrent sensory difficulties.</div></div><div><h3>Methods</h3><div>We conducted a parallel-group, multicentre, observer-blind, superiority randomised controlled trial in seven older adult clinics in five European countries (Cyprus, France, Greece, Ireland, and the UK). People with mild-to-moderate dementia with adult-acquired hearing difficulties, vision difficulties, or both were randomly assigned (1:1) along with their care partner to an 18-week home-basedsensory support intervention (SSI) of tailored hearing and vision rehabilitation and support, or to care as usual. Randomisation was blocked (block size of four, six, or eight) and stratified by country, with allocation assigned via a remote web-based system. The SSI included: full hearing assessment, vision assessment, or both; fitting of hearing aids, glasses, or other sensory aids; and home-based support from a sensory support therapist to assist adherence and uptake of sensory aids, foster social networking, and optimise the home sensory environment. Care as usual involved no additional intervention beyond services normally available to people with dementia at the respective sites. The primary outcome was health-related quality of life (Dementia Quality of Life Instrument [DEMQoL]) score at 36 weeks, reported as an adjusted mean difference. Analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN Registry, ISRCTN17056211.</div></div><div><h3>Findings</h3><div>Between May 4, 2018, and May 6, 2021, 252 people with mild-to-moderate dementia were randomly assigned, of whom 251 (n=126 in the SSI group and n=125 in the care as usual group) were included in the analysis. The mean age of participants was 79·6 years (SD 5·8), and 132 (53%) were women. After a median follow-up time of 37·7 weeks (IQR 36·2–39·0), the mean DEMQoL score was 92·8 (SD 15·2) in the SSI group and 92·8 (14·0) in the care as usual group (adjusted difference 0·18, 95% CI –2·13 to 2·30, p=0·87). Among 114 adverse events reported for 56 (44%) participants in the SSI group, ten events in nine participants were related or possibly related to the intervention (medical device pain or discomfort n=6, ear pain n=1, scratch to the ear n=1, sore eye n=1, redness n=1; all of grade 1). Serious adverse events were reported for 25 (20%) participants in the SSI group and 16 (13%) in the care as usual group. Six (5%) participants in the SSI group and five (4%) in the care as usual group died. None of the serious adverse events or deaths were related to the study intervention or procedures.</div></div><div><h3>Interpretation</h3><div>This study s
{"title":"Hearing and vision rehabilitation for people with dementia in five European countries (SENSE-Cog): a randomised controlled trial","authors":"Iracema Leroi MD , Prof Christopher J Armitage PhD , Elizabeth M Camacho PhD , Anna Pavlina Charalambous PhD , J P Connelly MSc , Prof Fofi Constantinidou PhD , Renaud David PhD , Prof Piers Dawes PhD , Prof Rachel A Elliott PhD , Mark Hann PhD , Alison Holden MSc , Emma Hooper MSc , Sean P Kennelly PhD , Evangelia Kontogianni MSc , Prof Brian A Lawlor MD , Julie Longobardi MSc , Luke Paterson MSc , Antonis M Politis PhD , Prof David Reeves PhD , Christine Schwimmer PhD , Eric Frison PhD","doi":"10.1016/j.lanhl.2024.07.008","DOIUrl":"10.1016/j.lanhl.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>The effect of hearing and vision difficulties on the risk of developing dementia and worsening outcomes in people already living with dementia is well established. We evaluated the clinical impact of a hearing and vision rehabilitation and support programme on quality of life in people with mild-to-moderate dementia and concurrent sensory difficulties.</div></div><div><h3>Methods</h3><div>We conducted a parallel-group, multicentre, observer-blind, superiority randomised controlled trial in seven older adult clinics in five European countries (Cyprus, France, Greece, Ireland, and the UK). People with mild-to-moderate dementia with adult-acquired hearing difficulties, vision difficulties, or both were randomly assigned (1:1) along with their care partner to an 18-week home-basedsensory support intervention (SSI) of tailored hearing and vision rehabilitation and support, or to care as usual. Randomisation was blocked (block size of four, six, or eight) and stratified by country, with allocation assigned via a remote web-based system. The SSI included: full hearing assessment, vision assessment, or both; fitting of hearing aids, glasses, or other sensory aids; and home-based support from a sensory support therapist to assist adherence and uptake of sensory aids, foster social networking, and optimise the home sensory environment. Care as usual involved no additional intervention beyond services normally available to people with dementia at the respective sites. The primary outcome was health-related quality of life (Dementia Quality of Life Instrument [DEMQoL]) score at 36 weeks, reported as an adjusted mean difference. Analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN Registry, ISRCTN17056211.</div></div><div><h3>Findings</h3><div>Between May 4, 2018, and May 6, 2021, 252 people with mild-to-moderate dementia were randomly assigned, of whom 251 (n=126 in the SSI group and n=125 in the care as usual group) were included in the analysis. The mean age of participants was 79·6 years (SD 5·8), and 132 (53%) were women. After a median follow-up time of 37·7 weeks (IQR 36·2–39·0), the mean DEMQoL score was 92·8 (SD 15·2) in the SSI group and 92·8 (14·0) in the care as usual group (adjusted difference 0·18, 95% CI –2·13 to 2·30, p=0·87). Among 114 adverse events reported for 56 (44%) participants in the SSI group, ten events in nine participants were related or possibly related to the intervention (medical device pain or discomfort n=6, ear pain n=1, scratch to the ear n=1, sore eye n=1, redness n=1; all of grade 1). Serious adverse events were reported for 25 (20%) participants in the SSI group and 16 (13%) in the care as usual group. Six (5%) participants in the SSI group and five (4%) in the care as usual group died. None of the serious adverse events or deaths were related to the study intervention or procedures.</div></div><div><h3>Interpretation</h3><div>This study s","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100625"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100640
Danielle S Powell , Nicholas S Reed
{"title":"Sensory loss rehabilitation among people with dementia: a low-risk strategy to enhance quality of life","authors":"Danielle S Powell , Nicholas S Reed","doi":"10.1016/j.lanhl.2024.100640","DOIUrl":"10.1016/j.lanhl.2024.100640","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100640"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.08.007
Ruoyu Yin MPhil , Laura Martinengo PhD , Prof Helen Elizabeth Smith PhD , Mythily Subramaniam PhD , Konstadina Griva PhD , Lorainne Tudor Car PhD
This systematic review aimed to synthesise qualitative evidence on the views and experiences of older adults in using digital mental health interventions (DMHIs) for the prevention or self-management of mental disorders. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO, and the first 100 results of Google Scholar for eligible studies and we included 37 papers reporting 35 studies in this Review. Most DMHIs were delivered using mobile apps (n=11), websites (n=6), and video-conferencing tools (n=6). The use of DMHIs in older adults was affected by negative perceptions about ageing and mental health, the digital divide (eg, insufficient digital literacy), personal factors (eg, motivation) and health status, interpersonal influences (eg, guidance and encouragement), intervention features (eg, pace and content), technology-related factors (eg, accessibility), and the perceived benefits and risks of using DMHIs. Future DMHIs for older adults should involve other stakeholders such as health-care professionals, provide content relevant to the needs of older people, be more accessible, and address concerns about privacy and confidentiality.
本系统性综述旨在综合老年人在使用数字心理健康干预措施（DMHIs）预防或自我管理精神障碍方面的观点和经验的定性证据。我们检索了 PubMed、Embase、Cumulative Index to Nursing and Allied Health Literature、Web of Science、PsycINFO 和 Google Scholar 的前 100 条结果，以查找符合条件的研究。大多数 DMHI 使用移动应用程序（11 篇）、网站（6 篇）和视频会议工具（6 篇）提供。影响老年人使用 DMHIs 的因素包括：对老龄化和心理健康的负面看法、数字鸿沟（如数字素养不足）、个人因素（如动机）和健康状况、人际影响（如指导和鼓励）、干预特点（如节奏和内容）、技术相关因素（如可及性）以及使用 DMHIs 的感知收益和风险。未来针对老年人的 DMHI 应让其他利益相关者（如医疗保健专业人员）参与进来，提供与老年人需求相关的内容，使其更易于使用，并解决隐私和保密问题。
{"title":"The views and experiences of older adults regarding digital mental health interventions: a systematic review of qualitative studies","authors":"Ruoyu Yin MPhil , Laura Martinengo PhD , Prof Helen Elizabeth Smith PhD , Mythily Subramaniam PhD , Konstadina Griva PhD , Lorainne Tudor Car PhD","doi":"10.1016/j.lanhl.2024.08.007","DOIUrl":"10.1016/j.lanhl.2024.08.007","url":null,"abstract":"<div><div>This systematic review aimed to synthesise qualitative evidence on the views and experiences of older adults in using digital mental health interventions (DMHIs) for the prevention or self-management of mental disorders. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO, and the first 100 results of Google Scholar for eligible studies and we included 37 papers reporting 35 studies in this Review. Most DMHIs were delivered using mobile apps (n=11), websites (n=6), and video-conferencing tools (n=6). The use of DMHIs in older adults was affected by negative perceptions about ageing and mental health, the digital divide (eg, insufficient digital literacy), personal factors (eg, motivation) and health status, interpersonal influences (eg, guidance and encouragement), intervention features (eg, pace and content), technology-related factors (eg, accessibility), and the perceived benefits and risks of using DMHIs. Future DMHIs for older adults should involve other stakeholders such as health-care professionals, provide content relevant to the needs of older people, be more accessible, and address concerns about privacy and confidentiality.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100638"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100642
Aoife Leahy PhD , Louise Barry PhD , Gillian Corey MHSC , Aoife Whiston PhD , Helen Purtill PhD , Elaine Shanahan MD , Denys Shchetkovsky MB BCh , Damien Ryan MB BCh , Monica O’Loughlin RGN , Prof Margaret O'Connor MB BCh BAO , Rose Galvin PhD
Background
Multidisciplinary comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older adults but there is limited evidence on its effectiveness in the emergency department. We aimed to assess the benefits of CGA in the emergency department for older adults living with frailty.
Methods
In this randomised controlled trial, we enrolled older adults (≥75 years) who presented to the emergency department with medical complaints at University Hospital Limerick (Limerick, Ireland). Participants screened positive for frailty on the Identification of Seniors at Risk screening tool (score ≥2). Patients requiring resuscitation as well as those with COVID-19, psychiatric, surgical, or trauma complaints were excluded. Participants were randomly allocated 1:1 to geriatrician-led multidisciplinary CGA and management or usual care. Outcome assessors were masked to treatment allocation. The primary efficacy outcome was time spent in the emergency department, defined as the time from registration on the computer database until time of discharge or admission to an inpatient ward in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT04629690.
Findings
Between Nov 9, 2020, and May 13, 2021, we recruited 228 patients. 113 participants were included in the intervention group (mean age 82·4 years [SD 4·9]; 63 [56%] women; 113 [100%] White Irish) and 115 in the control group (83·1 [5·6]; 61 [53%]; 112 [97%]). Median time in the emergency department was 11·5 h (IQR 5–27) in the intervention group and 20 h (7–29) in the control group (median difference [Hodges–Lehmann estimator] 3·1 h [95% CI 0·6–7·5]; p=0·013). There were no adverse events related to the intervention.
Interpretation
Geriatrician-led multidisciplinary assessment of older adults living with frailty was associated with reduced time spent in the emergency department setting at index visit and lower rates of nursing home admission, greater increases in quality of life, and lower decreases in function at both 30 days and 180 days. Multicentre trials are needed to confirm the external validity of the findings. This study provides an evidence base for similar teams in an emergency department setting.
{"title":"Frailty screening with comprehensive geriatrician-led multidisciplinary assessment for older adults during emergency hospital attendance in Ireland (SOLAR): a randomised controlled trial","authors":"Aoife Leahy PhD , Louise Barry PhD , Gillian Corey MHSC , Aoife Whiston PhD , Helen Purtill PhD , Elaine Shanahan MD , Denys Shchetkovsky MB BCh , Damien Ryan MB BCh , Monica O’Loughlin RGN , Prof Margaret O'Connor MB BCh BAO , Rose Galvin PhD","doi":"10.1016/j.lanhl.2024.100642","DOIUrl":"10.1016/j.lanhl.2024.100642","url":null,"abstract":"<div><h3>Background</h3><div>Multidisciplinary comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older adults but there is limited evidence on its effectiveness in the emergency department. We aimed to assess the benefits of CGA in the emergency department for older adults living with frailty.</div></div><div><h3>Methods</h3><div>In this randomised controlled trial, we enrolled older adults (≥75 years) who presented to the emergency department with medical complaints at University Hospital Limerick (Limerick, Ireland). Participants screened positive for frailty on the Identification of Seniors at Risk screening tool (score ≥2). Patients requiring resuscitation as well as those with COVID-19, psychiatric, surgical, or trauma complaints were excluded. Participants were randomly allocated 1:1 to geriatrician-led multidisciplinary CGA and management or usual care. Outcome assessors were masked to treatment allocation. The primary efficacy outcome was time spent in the emergency department, defined as the time from registration on the computer database until time of discharge or admission to an inpatient ward in the intention-to-treat population. This study is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04629690</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>Between Nov 9, 2020, and May 13, 2021, we recruited 228 patients. 113 participants were included in the intervention group (mean age 82·4 years [SD 4·9]; 63 [56%] women; 113 [100%] White Irish) and 115 in the control group (83·1 [5·6]; 61 [53%]; 112 [97%]). Median time in the emergency department was 11·5 h (IQR 5–27) in the intervention group and 20 h (7–29) in the control group (median difference [Hodges–Lehmann estimator] 3·1 h [95% CI 0·6–7·5]; p=0·013). There were no adverse events related to the intervention.</div></div><div><h3>Interpretation</h3><div>Geriatrician-led multidisciplinary assessment of older adults living with frailty was associated with reduced time spent in the emergency department setting at index visit and lower rates of nursing home admission, greater increases in quality of life, and lower decreases in function at both 30 days and 180 days. Multicentre trials are needed to confirm the external validity of the findings. This study provides an evidence base for similar teams in an emergency department setting.</div></div><div><h3>Funding</h3><div>Health Research Board (ILP-HSR-2017–014).</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100642"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100641
Yau-Hua Yu
{"title":"Oral health: integral component of overall health and important determinant of ageing","authors":"Yau-Hua Yu","doi":"10.1016/j.lanhl.2024.100641","DOIUrl":"10.1016/j.lanhl.2024.100641","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100641"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.lanhl.2024.100657
Philippa Harris
{"title":"Highlights of the EuGMS congress 2024","authors":"Philippa Harris","doi":"10.1016/j.lanhl.2024.100657","DOIUrl":"10.1016/j.lanhl.2024.100657","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 11","pages":"Article 100657"},"PeriodicalIF":13.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure is a substantial global health concern that severely affects patients' quality of life. We aimed to compare the effects of early integration of palliative care (EIPC) and standard cardiac care on health status and mood of patients with non-terminal heart failure.
Methods
EPCHF was a multicentre, parallel, two-arm, open-label, randomised controlled trial carried out at University Hospital Bonn and University Hospital Düsseldorf in Germany. Eligible patients (aged 18 years or older) had heart failure, with New York Heart Association class II or more and NT-proBNP concentrations greater than or equal to 400 pg/mL. Patients were randomly assigned (1:1) to receive EIPC with standard cardiac care or standard cardiac care alone. Randomisation was computer-generated with allocation concealment, variable block sizes, and stratification by investigational site. The primary endpoints were health status and mood, measured every 3 months over 12 months using the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT–PAL) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), analysed by intention to treat. This trial is registered with DRKS.de, DRKS00013922.
Findings
Between May 21, 2019, and Nov 15, 2021, 843 patients were assessed for eligibility, 205 of whom were enrolled (100 assigned to EIPC and 105 assigned to standard cardiac care). 143 (70%) patients were male and 62 (30%) were female. Over 12 months, both groups significantly improved in FACIT–PAL and KCCQ Overall Summary Score (OSS) with no significant differences between the groups (FACIT–PAL adjusted mean difference 0·98 points [95% CI –1·28 to 3·23]; p=0·40; KCCQ-OSS adjusted mean difference –2·06 points [–7·89 to 3·78]; p=0·49). Nine (9%) patients in the EIPC group and seven (7%) patients in the standard cardiac care group died from any cause, with no significant differences in time to death between the two groups (hazard ratio [HR] 1·32 [95% CI 0·49 to 3·54]; p=0·58). 22 (22%) patients in the EIPC group and 21 (21%) patients in the standard cardiac care group were hospitalised at least once due to heart failure, with no significant differences in time to heart-failure-related hospitalisation between the two groups (HR 1·09 [0·61 to 1·98]; p=0·77). 70 (70%) patients in the EIPC group and 62 (59%) in the standard cardiac care group had any adverse events (p=0·10).
Interpretation
In this open-label, randomised clinical trial, standard cardiac care, featuring guideline-directed optimisation of medical therapy and regular 3-monthly follow-ups was found to be as effective as when combined with EIPC in improving health status and mood in patients with non-terminal heart failure. Future clinical practices should consider EIPC based on individual patient needs.
Funding
Federal Ministry of Education and Research.
背景：心力衰竭是一个严重影响患者生活质量的全球性健康问题。我们旨在比较早期整合姑息治疗（EIPC）和标准心脏治疗对非终末期心力衰竭患者健康状况和情绪的影响：EPCHF是一项多中心、平行、双臂、开放标签、随机对照试验，在德国波恩大学医院和杜塞尔多夫大学医院进行。符合条件的患者（18 岁或以上）均患有心力衰竭，纽约心脏协会分级为 II 级或以上，NT-proBNP 浓度大于或等于 400 pg/mL。患者被随机分配（1:1）接受 EIPC 和标准心脏治疗，或仅接受标准心脏治疗。随机分配由计算机生成，采用分配隐藏、可变区块大小和按研究地点分层的方式。主要终点是健康状况和情绪，在12个月内每3个月使用慢性疾病治疗-姑息治疗功能评估（FACIT-PAL）和堪萨斯城心肌病问卷（KCCQ）进行测量，并按意向治疗进行分析。该试验已在DRKS.de注册，编号为DRKS00013922.Findings：2019年5月21日至2021年11月15日期间，843名患者接受了资格评估，其中205名患者入选（100名被分配至EIPC，105名被分配至标准心脏护理）。143名患者（70%）为男性，62名患者（30%）为女性。在12个月内，两组患者的FACIT-PAL和KCCQ综合评分（OSS）均有明显改善，组间无明显差异（FACIT-PAL调整后平均差异为0-98分[95% CI -1-28 to 3-23]；P=0-40；KCCQ-OSS调整后平均差异为-2-06分[-7-89 to 3-78]；P=0-49）。EIPC组有9名（9%）患者因任何原因死亡，标准心脏护理组有7名（7%）患者因任何原因死亡，两组患者的死亡时间无显著差异（危险比[HR] 1-32 [95% CI 0-49 to 3-54]; p=0-58）。EIPC组22（22%）名患者和标准心脏护理组21（21%）名患者因心衰至少住院一次，两组患者因心衰住院的时间无显著差异（HR 1-09 [0-61 to 1-98]; p=0-77）。EIPC组有70名（70%）患者出现不良事件，标准心脏护理组有62名（59%）患者出现不良事件（P=0-10）：在这项开放标签、随机临床试验中发现，标准心脏治疗，包括以指南为指导的优化药物治疗和3个月定期随访，在改善非终末期心力衰竭患者的健康状况和情绪方面与EIPC联合治疗同样有效。未来的临床实践应根据患者的个体需求考虑EIPC：联邦教育与研究部。
{"title":"Early integration of palliative care versus standard cardiac care for patients with heart failure (EPCHF): a multicentre, parallel, two-arm, open-label, randomised controlled trial","authors":"Mahmoud Balata MD , Prof Lukas Radbruch MD , Michaela Hesse MD , Prof Ralf Westenfeld MD , Martin Neukirchen MD , Prof Roman Pfister MD , Yann-Nicolas Batzler MD , Can Öztürk MD , Refik Kavsur MD , Vedat Tiyerili MD , Prof Birgitta Weltermann MD , Robert Pölsler MD , Prof Thomas Standl MD , Prof Georg Nickenig MD , Prof Marc Ulrich Becher MD , Heart Failure Network Rhineland","doi":"10.1016/j.lanhl.2024.08.006","DOIUrl":"10.1016/j.lanhl.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure is a substantial global health concern that severely affects patients' quality of life. We aimed to compare the effects of early integration of palliative care (EIPC) and standard cardiac care on health status and mood of patients with non-terminal heart failure.</div></div><div><h3>Methods</h3><div>EPCHF was a multicentre, parallel, two-arm, open-label, randomised controlled trial carried out at University Hospital Bonn and University Hospital Düsseldorf in Germany. Eligible patients (aged 18 years or older) had heart failure, with New York Heart Association class II or more and NT-proBNP concentrations greater than or equal to 400 pg/mL. Patients were randomly assigned (1:1) to receive EIPC with standard cardiac care or standard cardiac care alone. Randomisation was computer-generated with allocation concealment, variable block sizes, and stratification by investigational site. The primary endpoints were health status and mood, measured every 3 months over 12 months using the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT–PAL) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), analysed by intention to treat. This trial is registered with DRKS.de, DRKS00013922.</div></div><div><h3>Findings</h3><div>Between May 21, 2019, and Nov 15, 2021, 843 patients were assessed for eligibility, 205 of whom were enrolled (100 assigned to EIPC and 105 assigned to standard cardiac care). 143 (70%) patients were male and 62 (30%) were female. Over 12 months, both groups significantly improved in FACIT–PAL and KCCQ Overall Summary Score (OSS) with no significant differences between the groups (FACIT–PAL adjusted mean difference 0·98 points [95% CI –1·28 to 3·23]; p=0·40; KCCQ-OSS adjusted mean difference –2·06 points [–7·89 to 3·78]; p=0·49). Nine (9%) patients in the EIPC group and seven (7%) patients in the standard cardiac care group died from any cause, with no significant differences in time to death between the two groups (hazard ratio [HR] 1·32 [95% CI 0·49 to 3·54]; p=0·58). 22 (22%) patients in the EIPC group and 21 (21%) patients in the standard cardiac care group were hospitalised at least once due to heart failure, with no significant differences in time to heart-failure-related hospitalisation between the two groups (HR 1·09 [0·61 to 1·98]; p=0·77). 70 (70%) patients in the EIPC group and 62 (59%) in the standard cardiac care group had any adverse events (p=0·10).</div></div><div><h3>Interpretation</h3><div>In this open-label, randomised clinical trial, standard cardiac care, featuring guideline-directed optimisation of medical therapy and regular 3-monthly follow-ups was found to be as effective as when combined with EIPC in improving health status and mood in patients with non-terminal heart failure. Future clinical practices should consider EIPC based on individual patient needs.</div></div><div><h3>Funding</h3><div>Federal Ministry of Education and Research.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 10","pages":"Article 100637"},"PeriodicalIF":13.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.lanhl.2024.100639
Aoife McFeely MB , Antoinette O’Connor MB PhD , Prof Sean P Kennelly MB PhD
People with intellectual disability are a vulnerable cohort who face challenges accessing health care. Compared with the general population, people with intellectual disability have an elevated risk of developing dementia, which often presents at a younger age and with atypical symptoms. The lifelong cognitive and functional difficulties faced by people with intellectual disability further complicate the diagnostic process. Specialised intellectual disability memory services and evaluation using reliable biomarkers of neurodegeneration are needed to improve diagnostic and prognostic certainty in this group. Inadequate specialist services and paucity of research on biomarkers in this population hinders progress and impedes the delivery of adequate health care. Although cerebrospinal fluid-based biomarkers and radiological biomarkers are used routinely in the evaluation of Alzheimer’s disease in the general population, biological variation within the clinically heterogenous group of people with intellectual disability could affect the clinical utility of existing biomarkers. As disease-modifying therapies become available for the treatment of early Alzheimer’s disease, and hopefully other neurodegenerative conditions in the future, biomarkers will serve as gatekeepers to establish the eligibility for such therapies. Inadequate representation of adults with intellectual disability in biomarker research will result in their exclusion from treatment with disease-modifying therapies, thus perpetuating the inequity in health care that is already faced by this group. The aim of this Series paper is to summarise current evidence on the application of biomarkers for Alzheimer’s disease in a population with intellectual disability (that is not attributable to Down syndrome) and suspected cognitive decline.
{"title":"Use of biomarkers in the diagnosis of Alzheimer’s disease in adults with intellectual disability","authors":"Aoife McFeely MB , Antoinette O’Connor MB PhD , Prof Sean P Kennelly MB PhD","doi":"10.1016/j.lanhl.2024.100639","DOIUrl":"10.1016/j.lanhl.2024.100639","url":null,"abstract":"<div><div>People with intellectual disability are a vulnerable cohort who face challenges accessing health care. Compared with the general population, people with intellectual disability have an elevated risk of developing dementia, which often presents at a younger age and with atypical symptoms. The lifelong cognitive and functional difficulties faced by people with intellectual disability further complicate the diagnostic process. Specialised intellectual disability memory services and evaluation using reliable biomarkers of neurodegeneration are needed to improve diagnostic and prognostic certainty in this group. Inadequate specialist services and paucity of research on biomarkers in this population hinders progress and impedes the delivery of adequate health care. Although cerebrospinal fluid-based biomarkers and radiological biomarkers are used routinely in the evaluation of Alzheimer’s disease in the general population, biological variation within the clinically heterogenous group of people with intellectual disability could affect the clinical utility of existing biomarkers. As disease-modifying therapies become available for the treatment of early Alzheimer’s disease, and hopefully other neurodegenerative conditions in the future, biomarkers will serve as gatekeepers to establish the eligibility for such therapies. Inadequate representation of adults with intellectual disability in biomarker research will result in their exclusion from treatment with disease-modifying therapies, thus perpetuating the inequity in health care that is already faced by this group. The aim of this Series paper is to summarise current evidence on the application of biomarkers for Alzheimer’s disease in a population with intellectual disability (that is not attributable to Down syndrome) and suspected cognitive decline.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 10","pages":"Article 100639"},"PeriodicalIF":13.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.lanhl.2024.100650
The Lancet Healthy Longevity
{"title":"Mental health deserves attention at all ages","authors":"The Lancet Healthy Longevity","doi":"10.1016/j.lanhl.2024.100650","DOIUrl":"10.1016/j.lanhl.2024.100650","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 10","pages":"Article 100650"},"PeriodicalIF":13.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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