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Development and validation of a functional ability index for older adults: a multicohort study. 老年人功能能力指数的开发与验证:一项多队列研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae231
Yi Chang, Suman Sapkota, Bipin Thapa, Lina Ma, Linghui Sheng, Chaodong Wang, Jagadish K Chhetri, Piu Chan

Background: The aim of this study was to develop and validate a functional ability index (FAI) that incorporates aspects of intrinsic capacity and environmental factors of older individuals based on the World Health Organization framework of healthy ageing.

Methods: Data of 7016 participants ≥60 years participating in the baseline survey of China Health and Retirement Longitudinal Study was used for the development and internal validation of the FAI. External validation was performed in a separate cohort of 1295 older individuals aged ≥60 years. Functional independency was considered the primary outcome and additional proxies of healthy ageing were considered as secondary outcomes. Cluster dendrogram was used to identify the distinct hierarchical clusters of all included variables for inclusion in the FAI. Backward elimination logistic regression model was implemented to identify the most significant variables associated with independency to be included in the FAI.

Results: The FAI score ranged from 0 to 19 and individuals having FAI ≥ 12 were more likely to be independent and at lower risk of negative outcomes. For each unit increase in the FAI the risk of having independency increased by 30%-58% cross-sectionally in the two cohorts, whilst the 2-year risk of independency increased by 20%. The FAI demonstrated a C-statistic of 0.73 (95% confidence interval, 0.72 and 0.75) for the primary outcome.

Conclusions: The FAI we developed effectively measured the functional ability status of community dwelling older individuals. FAI could serve as a tool for evaluating older individual's functional ability in routine health assessment.

研究背景本研究的目的是在世界卫生组织健康老龄化框架的基础上,开发并验证一种包含老年人内在能力和环境因素的功能能力指数(FAI):方法:利用参加中国健康与退休纵向研究基线调查的 7016 名年龄≥60 岁的参与者的数据,对 FAI 进行开发和内部验证。在1295名年龄≥60岁的老年人组成的独立队列中进行了外部验证。功能独立性被视为主要结果,健康老龄化的其他代用指标被视为次要结果。聚类树枝图用于识别所有纳入 FAI 的变量的不同层次聚类。采用后向消除逻辑回归模型来确定与独立相关的最重要变量,并将其纳入 FAI:FAI 分值介于 0 到 19 之间,FAI ≥ 12 的个体更有可能是独立的,且出现负面结果的风险较低。在两个队列中,FAI每增加一个单位,独立的风险就会增加30%-58%,而两年后独立的风险则会增加20%。FAI 对主要结果的 C 统计量为 0.73(95% 置信区间为 0.72 和 0.75):我们开发的 FAI 能有效测量社区老年人的功能能力状况。FAI可作为常规健康评估中评估老年人功能能力的工具。
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引用次数: 0
Geriatric medicine and Olympic elite sports-parallels and philosophies. 老年医学和奥林匹克精英体育--相似之处和理念。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae212
Claire McDonald, Avan A Sayer, Miles D Witham

The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to geriatric medicine. However, there are important parallels between the practice of geriatric medicine and elite sports and lessons that we can learn from our sports science colleagues. Elite athletes and older people are operating at the margins of physiological capacity. Both benefit from tailored, scientifically informed training programmes delivered and monitored by a multidisciplinary team. There are parallels between the comprehensive geriatric assessment and the philosophy of marginal gains pioneered by British Cycling. Insights into the biology of skeletal muscle function are beginning to translate into the development of clinical interventions and substances that offer an unfair advantage in sport by improving muscle strength and physical performance may be of therapeutic benefit in sarcopenia. The 2024 Olympics provide an opportunity for us to learn lessons for excellence in our research and provide an opportunity to promote exercise across the life course-important for healthy ageing.

第 30 届奥林匹克运动会于 2024 年 7 月举行。乍一看,体育科学和精英运动员的训练似乎与老年医学关系不大。然而,老年医学和精英体育之间存在着重要的相似之处,我们可以从体育科学同行那里学到一些经验。精英运动员和老年人都处于生理能力的边缘。两者都受益于由多学科团队提供和监测的量身定制、科学合理的训练计划。老年病综合评估与英国自行车运动首创的边际收益理念有相似之处。对骨骼肌功能生物学的深入了解正开始转化为临床干预措施的开发,而在体育运动中通过提高肌肉力量和体能表现来提供不公平优势的物质,可能对肌肉疏松症有治疗作用。2024 年奥运会为我们提供了一个在研究中吸取经验教训的机会,也为我们提供了一个在整个生命过程中推广运动的机会--这对健康老龄化非常重要。
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引用次数: 0
Facilitating equitable research access for people living in care homes. 为住在护理院的人提供公平的研究机会。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae220
Maria Drummond, Kirsty Cartin, Susan D Shenkin, Jennifer Kirsty Burton
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引用次数: 0
Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before-after analysis based on a quality improvement project. 术后谵妄风险自动预测工具与非药物谵妄预防相结合对谵妄发生率和住院时间的益处:基于质量改进项目的前后分析。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae219
Benjamin T Dodsworth, Kelly A Reeve, Martin Zozman, Philipp Meier, Felix Buddeberg, Marius Möller, Simone Pascale Wildhaber, Mary-Anne Kedda, Sönke Böttger, Reto Stocker, Nayeli Schmutz Gelsomino

Background: Postoperative delirium (POD) significantly impacts older surgical patients, necessitating effective prevention strategies.

Objective: To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time.

Methods: This quality improvement project, set in a 335-bed Swiss private hospital, employed a before-after design to evaluate the impact of PIPRA and preventive measures on POD, LOS and nursing time in non-cardiac and non-intracranial surgery inpatients aged 60 or older. The control phase focused on enhancing POD screening, whilst the intervention phase incorporated PIPRA for risk assessment and staff training to enable targeted non-pharmacological prevention in patients at risk.

Results: A total of 866 patients were included; 299 control and 567 intervention. The odds ratio of POD, comparing the intervention group to the control, was 0.71 [95% confidence interval (CI) 0.44-1.16] when adjusting for baseline patient characteristics. The intervention was associated with an LOS 0.94 (95% CI 0.85-1.05) and nursing time 0.96 (95% CI 0.86-1.07) times that of the control, adjusted for baseline patient characteristics. Medium risk patients (21.6% of patients) had an LOS 0.74 (95% CI 0.59-0.92) and required nursing time 0.79 (95% CI from 0.62-1.00) times the control, adjusted for baseline patient characteristics, equivalent to an LOS reduction of 1.36 days and nursing time saving of 19.3 hours per patient.

Conclusions: Medium risk patients in the intervention group had shorter LOS and nursing time compared to the control group, underscoring the importance of targeted prevention.

背景:术后谵妄(POD)严重影响老年手术患者:术后谵妄(POD)对老年手术患者的影响很大,需要采取有效的预防策略:评估介入前预防风险评估(PIPRA)自动谵妄风险预测工具与非药物预防策略对 POD 发生率、住院时间(LOS)和护理时间的效果:该质量改进项目在瑞士一家拥有 335 张病床的私立医院开展,采用前后对比的设计方法,评估 PIPRA 和预防措施对 60 岁及以上非心脏和非颅内手术住院患者的 POD、住院时间和护理时间的影响。对照阶段侧重于加强 POD 筛查,而干预阶段则将 PIPRA 用于风险评估和人员培训,以便对高危患者进行有针对性的非药物预防:共纳入 866 名患者,其中对照组 299 人,干预组 567 人。在调整患者基线特征后,干预组与对照组相比,POD 的几率比为 0.71 [95% 置信区间 (CI) 0.44-1.16]。经调整患者基线特征后,干预组的生命周期是对照组的 0.94 倍(95% 置信区间:0.85-1.05),护理时间是对照组的 0.96 倍(95% 置信区间:0.86-1.07)。中危患者(占患者总数的 21.6%)的 LOS 为对照组的 0.74(95% CI 0.59-0.92)倍,所需的护理时间为对照组的 0.79(95% CI 0.62-1.00)倍,调整基线患者特征后,相当于每位患者的 LOS 缩短了 1.36 天,护理时间节省了 19.3 小时:与对照组相比,干预组的中危患者的住院时间和护理时间更短,这凸显了有针对性预防的重要性。
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引用次数: 0
Feasibility and acceptability of the HOLObalance telerehabilitation system compared with standard care for older adults at risk of falls: the HOLOBalance assessor blinded pilot randomised controlled study. 与针对有跌倒风险的老年人的标准护理相比,HOLObalance 远程康复系统的可行性和可接受性:HOLOBalance 评估师盲法随机对照试验研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae214
Marousa Pavlou, Carol Ann Flavell, Fariba Mostajeran Gourtani, Christos Nikitas, Dimitris Kikidis, Athanasios Bibas, Dimitris Gatsios, Vassilis Tsakanikas, Dimitrios I Fotiadis, Dimitrios Koutsouris, Frank Steinicke, Isabelle Daniela Walz, Christoph Maurer, Sofia Papadopoulou, Michalis Tsoukatos, Athanasios Pardalis, Doris-Eva Bamiou

Background: Falls have high socioeconomic costs. Information and communication technologies may support provision and monitoring of multisensory (MSR) physiotherapy programmes. The HOLOBalance platform used augmented reality holograms to provide patient-centred, individualised MSR.

Objectives: To determine the platform's safety, acceptability and feasibility, investigate functional gait and dynamic balance benefits and provide data for a definitive trial.

Design and setting: Single-blinded pilot randomised controlled feasibility study. Interventions were conducted at clinical sites or participants' homes in three European countries.

Participants: Community-dwelling older adults (median age 73 years; 64.2% female) at risk of falls were enrolled (May 2020-August 2021).

Methods: Participants were randomised to an 8-week clinic or home-based telerehabilitation MSR or OTAGO (control group) programme. Compliance, satisfaction, and adverse events determined feasibility. Clinical outcomes, assessed (blinded) within one-week prior to and post-intervention, included functional gait assessment (FGA), Mini BESTest and cognitive function.

Results: Randomisation to completion rate was 76.15% with 109 participants recruited (n = 289 screened). Drop-out rate was similar between groups. Adverse events were reported (n = 3) in the control group. Sixty-nine percent would recommend the HOLOBalance intervention. Findings were similar for the home and clinic-based arms of each intervention; data was combined for analysis. FGA (95%CI [1.63, 4.19]) and Mini-BESTest (95%CI [1.46, 3.93]) showed greater improvement in the HOLOBalance group with a clinically meaningful change of 4/30 noted for the FGA.

Conclusions: HOLObalance was feasible to implement and acceptable to older adults at risk of falls, with FGA and Mini-BEST improvements exceeding those for the OTAGO programme. A definitive trial is warranted.

背景:跌倒的社会经济成本很高。信息和通信技术可支持多感官(MSR)物理治疗方案的提供和监测。HOLOBalance 平台利用增强现实全息图提供以患者为中心的个性化 MSR:确定该平台的安全性、可接受性和可行性,调查功能性步态和动态平衡的益处,并为最终试验提供数据:单盲试验性随机对照可行性研究。干预在三个欧洲国家的临床机构或参与者家中进行:有跌倒风险的社区老年人(中位数年龄为 73 岁;64.2% 为女性)被纳入研究(2020 年 5 月至 2021 年 8 月):参与者被随机分配到为期 8 周的诊所或家庭远程康复 MSR 或 OTAGO(对照组)项目中。依从性、满意度和不良事件决定了该计划的可行性。干预前后一周内的临床结果评估(盲法)包括功能步态评估(FGA)、Mini BESTest和认知功能:随机完成率为 76.15%,共招募了 109 名参与者(n = 289 名筛选者)。各组的退出率相似。对照组有不良事件报告(n = 3)。69%的人愿意推荐 HOLOBalance 干预疗法。家庭干预组和诊所干预组的结果相似;数据合并进行分析。FGA(95%CI [1.63,4.19])和Mini-BESTest(95%CI [1.46,3.93])显示,HOLOBalance组的改善幅度更大,其中FGA的临床意义变化为4/30:结论:HOLObalance 的实施是可行的,有跌倒风险的老年人也能接受,FGA 和 Mini-BEST 的改善程度超过了 OTAGO 计划。有必要进行最终试验。
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引用次数: 0
Telomere length and 4-year changes in cognitive function in an older Mediterranean population at high risk of cardiovascular disease. 心血管疾病高风险地中海老年人群的端粒长度和认知功能的 4 年变化。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae216
María Fernández de la Puente, Amelia Marti, Silvia Canudas, Guillermo Zalba, Cristina Razquin, Virginia Boccardi, Patrizia Mecocci, Nancy Babio, Olga Castañer-Niño, Estefanía Toledo, Pilar Buil-Cosiales, Jordi Salas-Salvadó, Sonia García-Calzón

Background: Cognitive decline, a common process of brain ageing, has been associated with telomere length (TL). Delving into the identification of reliable biomarkers of brain ageing is essential to prevent accelerated cognitive impairment.

Methods: We selected 317 non-smoking 'Prevención con Dieta Mediterránea-Plus' (PREDIMED-Plus) participants (mean age, 65.8 ± 5.0 years) with metabolic syndrome from two trial centres who were following a lifestyle intervention. We measured TL and cognitive function at baseline and after 3 and 4 years of follow-up, respectively. Associations between baseline or 3-year changes in TL and baseline or 4-year changes in cognitive function were analysed using multivariable regression models.

Results: Baseline TL was not associated with baseline cognitive performance. Nevertheless, longer baseline TL was associated with improved 4-year changes in the Executive Function domain (β: 0.29; 95%CI: 0.12 to 0.44; P < 0.001) and the Global Cognitive Function domain (β: 0.19; 95%CI: 0.05 to 0.34; P = 0.010). Besides, a positive association was found between longer baseline TL and improved 4-year changes in the animal version of the Verbal Fluency Test (β: 0.33; 95%CI: 0.12 to 0.52; P = 0.002). By contrast, 3-year changes in TL were not associated with changes in cognitive function after 4 years.

Conclusions: Longer baseline TL could protect from cognitive decline and be used as a useful biomarker of brain ageing function in an older Mediterranean population at risk of cardiovascular disease and cognitive impairment.

背景:认知衰退是大脑老化的一个常见过程,与端粒长度(TL)有关。深入研究确定大脑老化的可靠生物标志物对于预防认知功能加速受损至关重要:我们从两个试验中心选取了 317 名患有代谢综合征的非吸烟 "Prevención con Dieta Mediterránea-Plus" (PREDIMED-Plus) 参与者(平均年龄为 65.8 ± 5.0 岁),他们正在接受生活方式干预。我们分别在基线以及随访 3 年和 4 年后测量了 TL 和认知功能。我们使用多变量回归模型分析了TL基线或3年变化与认知功能基线或4年变化之间的关系:结果:基线TL与基线认知表现无关。然而,较长的基线 TL 与执行功能领域(β:0.29;95%CI:0.12 至 0.44;P <0.001)和整体认知功能领域(β:0.19;95%CI:0.05 至 0.34;P = 0.010)的 4 年变化改善相关。此外,基线 TL 较长与动物版言语流畅性测试 4 年变化改善之间存在正相关(β:0.33;95%CI:0.12 至 0.52;P = 0.002)。相比之下,3年后TL的变化与4年后认知功能的变化无关:较长的基线TL可防止认知功能下降,并可作为地中海地区有心血管疾病和认知功能障碍风险的老年人群大脑老化功能的有用生物标志物。
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引用次数: 0
Assessing 1-year sodium-glucose co-transporter-2 inhibitor tolerance in older adults. 评估老年人对钠-葡萄糖共转运体-2 抑制剂的 1 年耐受性。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae237
Stephanie M Schafer, Marcia C Zeithamel, Nancee V Waterbury, Brian C Lund

Background: Evidence concerning tolerability of sodium-glucose co-transporter-2 (SGLT2) inhibitors in older adults is limited due to under-representation in clinical trials. Our study aimed to determine the extent to which SGLT2 inhibitor intolerance increases with age and explore additional factors associated with intolerance.

Methods: This retrospective observational study included patients in the Veterans Health Administration who initiated an SGLT2 inhibitor between 1 January 2013 and 31 December 2021. One-year discontinuation served as a proxy for intolerance. Relative risk (RR) for 1-year discontinuation was contrasted across age groups using log-binomial regression to adjust for confounding.

Results: Of 232 495 patients who initiated an SGLT2 inhibitor, 60 582 (26.1%) discontinued within one year. A difference was observed across age groups, <65, 65-74, 75-84 and ≥85 years, where 25.8%, 25.3%, 28.5% and 34.9% of patients discontinued, respectively (P < .001). After adjustment for confounding factors, patients 75-84 and ≥85 years were at 8% (RR = 1.08; 95% CI: 1.05, 1.10) and 21% increased risk (RR = 1.21; 95% CI: 1.15, 1.26) for discontinuation, respectively, relative to patients <65 years. Additional risk factors were identified: female (RR = 1.41; 95% CI: 1.37, 1.45), estimated glomerular filtration rate stage 4 (RR = 1.49; 95% CI: 1.39, 1.60), underweight (RR = 1.15; 95% CI: 1.03, 1.29), urinary tract infection history (RR = 1.25; 95% CI: 1.21, 1.30) and yeast infection history (RR = 1.39; 95% CI: 1.27, 1.51).

Conclusion: No clinically meaningful differences in SGLT2 inhibitor intolerance were observed in patients up to 84 years. Our findings support having closer follow-up when initiating in patients 85 years and older.

背景:由于钠-葡萄糖共转运体-2(SGLT2)抑制剂在临床试验中的代表性不足,有关老年人耐受性的证据非常有限。我们的研究旨在确定 SGLT2 抑制剂耐受性随年龄增长而增加的程度,并探讨与耐受性相关的其他因素:这项回顾性观察研究纳入了退伍军人健康管理局在 2013 年 1 月 1 日至 2021 年 12 月 31 日期间开始使用 SGLT2 抑制剂的患者。停药一年作为不耐受的替代指标。使用对数二叉回归法对不同年龄组停药一年的相对风险(RR)进行对比,以调整混杂因素:在 232 495 名开始服用 SGLT2 抑制剂的患者中,有 60 582 人(26.1%)在一年内停药。不同年龄组之间存在差异:在 84 岁以下的患者中,未观察到有临床意义的 SGLT2 抑制剂不耐受差异。我们的研究结果支持在 85 岁及以上患者开始用药时进行更密切的随访。
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引用次数: 0
Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study. 在急症医院环境中实施跌倒预防计划时多个利益相关群体的考虑因素:一项定性研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae208
Charlotte McLennan, Catherine Sherrington, Wendy Tilden, Matthew Jennings, Bethan Richards, Anne-Marie Hill, Greg Fairbrother, Francis Ling, Vasi Naganathan, Abby Haynes

Background: Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies.

Methods: Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach.

Results: Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies.

Conclusion: Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

背景:在国际上,医院跌倒仍是一个常见且代价高昂的患者安全问题。有证据表明,医院跌倒可以通过多因素计划以及对患者和员工的教育来预防,但这些计划和教育在实践中往往没有得到常规或有效的实施。多个关键利益相关群体的观点可为跌倒预防策略的实施提供参考:方法:从两家急诊公立医院的病房中招募不同学科的临床医生、患者及其家属。为了广泛了解参与者对实施跌倒预防计划的看法,我们进行了半结构式访谈和焦点小组讨论。采用归纳式主题方法对数据进行了分析:来自 50 名参与者的数据揭示了影响急症医院预防跌倒计划实施的利益相关者群体的三个关键主题:(i) "预防跌倒是当务之急,但由谁来负责?"参与者同意应解决医院跌倒问题,但并不一定认为自己对此负有责任;(ii) "失去权力的利益相关者",参与者表示对急症医院预防跌倒工作感到沮丧和无能为力;(iii) "分担责任可能是一种解决方案",参与者对集体行动对有效实施预防跌倒策略的积极影响持乐观态度:主要利益相关者群体一致认为,医院预防跌倒是当务之急,然而,与角色认知、优先事项竞争、劳动力压力和无能为力相关的挑战意味着跌倒预防在实践中可能经常被忽视。加强各学科、各组织层级以及患者、家属和员工对预防跌倒实施工作的责任分担,可能有助于克服这一问题。
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引用次数: 0
Care trajectories and transitions at the end of life: a population-based cohort study. 生命末期的护理轨迹和过渡:一项基于人群的队列研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae218
Isabelle Dufour, Josiane Courteau, Véronique Legault, Claire Godard-Sebillotte, Pasquale Roberge, Catherine Hudon

Background: End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied.

Objective: To propose a typology of CTs, including care transitions, for older individuals in the 2 years preceding death.

Design: Retrospective cohort study.

Methods: We used multidimensional state sequence analysis and data from the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between a Canadian health survey and Quebec health administrative data.

Results: In total, 2080 decedents were categorised into five CT groups. Group 1 demonstrated low HCU until the last few months, whilst group 2 showed low HCU over the first year, followed by a steady increase. A gradual increase over the 2 years was observed for groups 3 and 4, though more pronounced towards the end for group 3. A persistent high HCU was observed for group 5. Groups 2 and 4 had higher proportions of cancer diagnoses and palliative care, as opposed to comorbidities and dementia for groups 3 and 5. Overall, 68.4% of individuals died in a hospital, whilst 27% received palliative care there. Care transitions increased rapidly towards the end, most notably in the last 2 weeks.

Conclusion: This study provides an understanding of the variability of CTs in the last two years of life, including place of death, a critical step towards quality improvement.

背景:对于 65 岁及以上的老年人来说,生命末期的特点往往是医疗保健使用(HCU)模式不理想,对健康和生活质量造成负面影响。了解这一时期的护理轨迹(CTs)和过渡可以突出潜在的改进领域,但对这一问题的研究还很少:目的:对老年人死亡前两年的护理轨迹(包括护理过渡)进行分类:设计:回顾性队列研究:我们使用了多维状态序列分析和护理轨迹丰富数据(TorSaDE)队列中的数据,该数据是加拿大健康调查和魁北克健康管理数据之间的联系:共有 2080 名死者被分为五个 CT 组。第一组在最后几个月前HCU较低,而第二组在第一年内HCU较低,随后稳步上升。第 3 组和第 4 组的 HCU 在两年内逐渐增加,但第 3 组在最后阶段更为明显。第 2 组和第 4 组的癌症诊断和姑息治疗比例较高,而第 3 组和第 5 组的合并症和痴呆症比例较低。总体而言,68.4%的患者死于医院,27%的患者在医院接受了姑息治疗。临终时,护理过渡迅速增加,尤其是在最后两周:这项研究有助于了解生命最后两年中 CT 的变化情况,包括死亡地点,这是提高质量的关键一步。
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引用次数: 0
Exploring the lack of continuity of care in older cancer patients under China's 'integrated health system' reform. 探讨中国 "整合医疗体系 "改革下老年癌症患者缺乏连续性护理的问题。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae213
Jiawei Geng, Ran Li, Xinyu Wang, Rongfang Xu, Jibing Liu, Dixi Zhu, Gaoren Wang, Therese Hesketh

Background: Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused.

Objectives: To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China.

Methods: A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically.

Results: Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system.

Conclusion: The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care.

背景:持续护理对老年患者的健康状况至关重要,尤其是对那些有复杂需求的患者。它是初级医疗保健的一项关键功能。尽管中国在政策上努力促进医疗服务的连续性和整合医疗系统,但基层医疗中心(PHC)的使用率普遍很低:探讨老年癌症患者对持续性医疗服务的体验和感知,并研究初级保健中心如何在中国医疗体系中发挥持续性医疗服务的作用:方法: 在中国江苏省南通市的两家三甲医院开展了一项采用半结构式访谈的定性研究。结果:对 29 名患者进行的访谈突出了三个主题:"在中国医疗系统中的连续性"、"在中国医疗系统中的连续性 "和 "在中国医疗系统中的连续性":对 29 名患者的访谈突出了三个关键主题:患者在与不同级别的医生联系时缺乏指导;在专科医生主导的随访护理下,患者的需求未得到满足;各级医疗机构之间的协调和沟通不畅。这项研究清楚地表明,尽管中国正在推动整合医疗系统,但患者对医疗连续性缺乏个人认识和体验,这是一个关键问题:结论:在目前的医疗体系中,老年患者在癌症治疗的各个阶段对连续性护理的需求在很大程度上没有得到衡量。与三甲医院相比,初级保健中心的优势包括方便、医生负担较轻且有更多时间、自付费用较低,尤其是对有长期医疗需求的患者而言。然而,要改善初级保健中心在持续护理方面的关键作用,还需要解决缺乏综合医疗记录和初级保健中心角色不明确等障碍。
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Age and ageing
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