首页 > 最新文献

BMC Geriatrics最新文献

英文 中文
Horticultural therapy impact on people with dementia. 园艺疗法对痴呆症患者的影响。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12877-024-05489-x
Adi Vitman-Schorr, Moran Chen, Ayelet Naveh, Tamar Hirshenzon Peiper, Orly Ganany Dagan

Background: Dementia is a progressive disease, and as the disease progresses, many families seek help through activities and therapies. In contrast to some other therapies, horticultural therapy (HT) is widely accepted by most people with dementia (PWD) because it invites them to the natural world.

Objectives: To explore whether HT emotional and communication measures (i.e. appropriate expression of emotions, ability to communicate with others) are higher than in other activities offered to PWD in adult day care centers (ADCC) and continuing care retirement community (CCRC), and whether there is a difference between the impact of HT on the number of "positive actions" (communication actions and actions that fit the guided activity) vs. the other activities.

Research design and methods: Fifty-one PWD attending ADCCs and living in one CCRC were recruited to a structured HT activity and other activities that took place in the ADCCs and CCRC. The activity took place over 10 weeks. The effects were assessed using Dementia Care Mapping (DCM) and questionnaires.

Results: Paired t-tests found that higher levels of mood and behavior were observed during HT activities compared to the other activities. Also, communication and function actions were higher in the HT activities as compared to the other activities.

Discussion and implications: This study adds to the growing evidence of the benefits of HT for PWD regardless of past experience in gardening/agriculture. HT seems to provide high therapeutic benefits and should be more prevalent in centers caring for PWD.

背景:痴呆症是一种渐进性疾病,随着病情的发展,许多家庭会通过活动和疗法寻求帮助。与其他一些疗法相比,园艺疗法(HT)广为大多数痴呆症患者所接受,因为它能让他们融入自然世界:目的:探讨在成人日间护理中心(ADCC)和持续护理退休社区(CCRC)为痴呆症患者提供的其他活动中,园艺疗法的情绪和沟通指标(即适当表达情绪、与他人沟通的能力)是否高于其他活动,以及园艺疗法对 "积极行动"(沟通行动和符合指导活动的行动)数量的影响与其他活动是否存在差异:研究设计:招募了51名参加ADCC和居住在一家CCRC的残疾人,让他们参加在ADCC和CCRC开展的结构化HT活动和其他活动。活动为期 10 周。活动效果通过痴呆症护理图谱(DCM)和调查问卷进行评估:结果:配对 t 检验发现,与其他活动相比,在 HT 活动中观察到的情绪和行为水平更高。此外,与其他活动相比,HT 活动中的交流和功能动作也更高:这项研究为越来越多的证据表明高温热身对残疾人的益处做出了补充,无论他们过去是否有园艺/农业方面的经验。高温热身似乎具有很高的治疗效果,应在残疾人护理中心更加普及。
{"title":"Horticultural therapy impact on people with dementia.","authors":"Adi Vitman-Schorr, Moran Chen, Ayelet Naveh, Tamar Hirshenzon Peiper, Orly Ganany Dagan","doi":"10.1186/s12877-024-05489-x","DOIUrl":"10.1186/s12877-024-05489-x","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a progressive disease, and as the disease progresses, many families seek help through activities and therapies. In contrast to some other therapies, horticultural therapy (HT) is widely accepted by most people with dementia (PWD) because it invites them to the natural world.</p><p><strong>Objectives: </strong>To explore whether HT emotional and communication measures (i.e. appropriate expression of emotions, ability to communicate with others) are higher than in other activities offered to PWD in adult day care centers (ADCC) and continuing care retirement community (CCRC), and whether there is a difference between the impact of HT on the number of \"positive actions\" (communication actions and actions that fit the guided activity) vs. the other activities.</p><p><strong>Research design and methods: </strong>Fifty-one PWD attending ADCCs and living in one CCRC were recruited to a structured HT activity and other activities that took place in the ADCCs and CCRC. The activity took place over 10 weeks. The effects were assessed using Dementia Care Mapping (DCM) and questionnaires.</p><p><strong>Results: </strong>Paired t-tests found that higher levels of mood and behavior were observed during HT activities compared to the other activities. Also, communication and function actions were higher in the HT activities as compared to the other activities.</p><p><strong>Discussion and implications: </strong>This study adds to the growing evidence of the benefits of HT for PWD regardless of past experience in gardening/agriculture. HT seems to provide high therapeutic benefits and should be more prevalent in centers caring for PWD.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High cotinine levels as an associated factor with frailty status in older adults: evidence from the NHANES study. 可替宁含量高是老年人体弱状况的一个相关因素:来自 NHANES 研究的证据。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12877-024-05482-4
Li Xu, Xuechun Lin, Tian Zhou, Yi Liu, Song Ge

Introduction: Smoking has been recognized as a contributing factor to frailty in older adults. Nevertheless, it remains uncertain whether the degree of smoking has a discernible impact on frailty among older smokers. This cross-sectional study was conducted to investigate the correlation between serum cotinine levels, a biomarker reflecting tobacco exposure, and the presence of frailty within a nationally representative cohort of older adults.

Method: A total of 1626 individuals aged ≥ 60 who identified as smokers were included in the analysis. Participants were selected based on self-reported current smoking status. According to the Fried Phenotype, frailty is assessed through five dimensions: unintentional weight loss, slow walking speed, weakness, self-reported exhaustion, and low physical activity. Participants with three or more of these conditions were categorized as frailty, those with at least one but less than three as pre-frailty, and those with none as robust. Multinomial logistic regression models were employed to explore the relationship between serum cotinine level quartiles, with the lowest quartile as the reference group, and the various frailty statuses, with robustness as the reference category. These models were adjusted for covariates, including age, sex, race/ethnicity, alcohol drinking, daily protein intake, systolic blood pressure, serum albumin level, depressive symptoms, and cognitive function. The data used for this analysis were sourced from the National Health and Nutrition Examination Survey for the years 2011 to 2014.

Results: The median age of the participants was 69.0 years. The majority were male (62.2%) and non-Hispanic White (49.0%). The distribution of frailty statuses among the participants revealed that the highest proportion had pre-frailty (50.7%), followed by robustness (41.1%), and frailty (8.2%). Multinomial logistic regression showed that participants in the 4th quartile of serum cotinine level exhibited a higher probability of pre-frailty versus robustness (Odds ratio [OR] 1.599, 95% confidence interval [CI] 1.017, 2.513, P = 0.042). Participants in the 3rd quartile of serum cotinine level had higher odds of frailty versus robustness (OR 2.403, 95% CI 1.125, 5.134, P = 0.024). Moreover, participants whose serum cotinine levels were higher than the literature cutoffs (≥ 15 ng/ml) were more likely to be pre-frail (Odds ratio [OR] 1.478, 95% confidence interval [CI] 1.017, 2.150, P = 0.035) or frail (Odds ratio [OR] 2.141, 95% confidence interval [CI] 1.054, 4.351, P = 0.041).

Conclusions: A higher serum cotinine level is linked to an elevated probability of pre-frailty and frailty among older smokers. Initiatives geared towards assisting older smokers in reducing or quitting their smoking habits might possibly play a crucial role in preventing pre-frailty and frailty.

介绍:吸烟已被认为是导致老年人身体虚弱的一个因素。然而,吸烟程度是否会对老年吸烟者的虚弱程度产生明显影响,目前仍不确定。这项横断面研究旨在调查血清可替宁水平(一种反映烟草暴露的生物标志物)与具有全国代表性的老年人队列中是否存在虚弱之间的相关性:共有1626名年龄≥60岁的吸烟者被纳入分析。根据自我报告的当前吸烟状况选择参与者。根据弗里德表型(Fried Phenotype),虚弱可从五个方面进行评估:无意中体重减轻、行走速度慢、虚弱、自我报告的疲惫和体力活动少。有三个或三个以上上述情况的参与者被归类为虚弱,至少有一个但少于三个的参与者被归类为虚弱前期,没有上述情况的参与者被归类为稳健型。采用多项式逻辑回归模型来探讨血清可替宁水平四分位数(以最低四分位数为参照组)与各种虚弱状态(以体质强健为参照组)之间的关系。这些模型对年龄、性别、种族/民族、饮酒、每日蛋白质摄入量、收缩压、血清白蛋白水平、抑郁症状和认知功能等协变量进行了调整。分析所用数据来自 2011 年至 2014 年的全国健康与营养调查:参与者的年龄中位数为 69.0 岁。大多数参与者为男性(62.2%)和非西班牙裔白人(49.0%)。参与者的虚弱状态分布显示,虚弱前期的比例最高(50.7%),其次是健壮期(41.1%)和虚弱期(8.2%)。多项式逻辑回归显示,血清可替宁水平处于第四四分位数的参与者出现虚弱前期的概率高于健壮期(比值比 [OR] 1.599,95% 置信区间 [CI] 1.017,2.513,P = 0.042)。血清中可替宁水平处于第三四分位数的参与者体弱的几率高于健壮者(OR 2.403,95% 置信区间 [CI] 1.125,5.134,P = 0.024)。此外,血清中可替宁水平高于文献临界值(≥ 15 ng/ml)的参与者更有可能是虚弱前期(比值比 [OR] 1.478,95% 置信区间 [CI] 1.017,2.150,P = 0.035)或虚弱期(比值比 [OR] 2.141,95% 置信区间 [CI] 1.054,4.351,P = 0.041):结论:较高的血清可替宁水平与老年吸烟者出现虚弱前期和虚弱的概率升高有关。旨在帮助老年吸烟者减少或戒除吸烟习惯的措施可能会在预防前期虚弱和身体虚弱方面发挥重要作用。
{"title":"High cotinine levels as an associated factor with frailty status in older adults: evidence from the NHANES study.","authors":"Li Xu, Xuechun Lin, Tian Zhou, Yi Liu, Song Ge","doi":"10.1186/s12877-024-05482-4","DOIUrl":"10.1186/s12877-024-05482-4","url":null,"abstract":"<p><strong>Introduction: </strong>Smoking has been recognized as a contributing factor to frailty in older adults. Nevertheless, it remains uncertain whether the degree of smoking has a discernible impact on frailty among older smokers. This cross-sectional study was conducted to investigate the correlation between serum cotinine levels, a biomarker reflecting tobacco exposure, and the presence of frailty within a nationally representative cohort of older adults.</p><p><strong>Method: </strong>A total of 1626 individuals aged ≥ 60 who identified as smokers were included in the analysis. Participants were selected based on self-reported current smoking status. According to the Fried Phenotype, frailty is assessed through five dimensions: unintentional weight loss, slow walking speed, weakness, self-reported exhaustion, and low physical activity. Participants with three or more of these conditions were categorized as frailty, those with at least one but less than three as pre-frailty, and those with none as robust. Multinomial logistic regression models were employed to explore the relationship between serum cotinine level quartiles, with the lowest quartile as the reference group, and the various frailty statuses, with robustness as the reference category. These models were adjusted for covariates, including age, sex, race/ethnicity, alcohol drinking, daily protein intake, systolic blood pressure, serum albumin level, depressive symptoms, and cognitive function. The data used for this analysis were sourced from the National Health and Nutrition Examination Survey for the years 2011 to 2014.</p><p><strong>Results: </strong>The median age of the participants was 69.0 years. The majority were male (62.2%) and non-Hispanic White (49.0%). The distribution of frailty statuses among the participants revealed that the highest proportion had pre-frailty (50.7%), followed by robustness (41.1%), and frailty (8.2%). Multinomial logistic regression showed that participants in the 4<sup>th</sup> quartile of serum cotinine level exhibited a higher probability of pre-frailty versus robustness (Odds ratio [OR] 1.599, 95% confidence interval [CI] 1.017, 2.513, P = 0.042). Participants in the 3<sup>rd</sup> quartile of serum cotinine level had higher odds of frailty versus robustness (OR 2.403, 95% CI 1.125, 5.134, P = 0.024). Moreover, participants whose serum cotinine levels were higher than the literature cutoffs (≥ 15 ng/ml) were more likely to be pre-frail (Odds ratio [OR] 1.478, 95% confidence interval [CI] 1.017, 2.150, P = 0.035) or frail (Odds ratio [OR] 2.141, 95% confidence interval [CI] 1.054, 4.351, P = 0.041).</p><p><strong>Conclusions: </strong>A higher serum cotinine level is linked to an elevated probability of pre-frailty and frailty among older smokers. Initiatives geared towards assisting older smokers in reducing or quitting their smoking habits might possibly play a crucial role in preventing pre-frailty and frailty.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Low transthyretin concentration linked to adverse prognosis in elderly inpatients. 转甲状腺素浓度低与老年住院患者的不良预后有关。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12877-024-05467-3
Ting Wang, Zhi-Kai Yang, Yu-Hao Wan, Ke Chai, Ying-Ying Li, Yao Luo, Min Zeng, Ning Sun, Song Zou, Hua Wang

Background: To investigate the association between low transthyretin (prealbumin) concentration and mortality or readmission for all causes in elderly inpatients.

Methods: This analysis is based on a prospective cohort study conducted from September 2018 to April 2019 in ten wards of three tertiary referral hospitals in Beijing. Patients aged 65 years or older were enrolled, and their clinical data, laboratory test results, and auxiliary test results for patients were collected. A three-year follow-up was conducted with patients. Based on the 5th and 95th percentiles of transthyretin concentration, patients were split into three groups. The correlation between transthyretin concentration and the outcome of elderly hospitalized patients was investigated. The primary outcome of the research was death or readmission from all causes within three years.

Results: Among the 636 individuals in the study, 335 (52.7%) were males, with a median age of 74.7 years (interquartile range [IQR]: 69.3-80.1). During a median follow-up period of 1,099.0 days (IQR: 1,016.3-1,135.0), 363 individuals (57.0%) experienced all-cause mortality or readmission events. Patients with transthyretin concentrations at or below the 5th percentile had a significantly increased risk of all-cause mortality or readmission compared to those with concentrations between the 5th and 95th percentiles (hazard ratio [HR]: 2.25; 95% confidence interval [CI]: 1.55-3.26). Even after adjusting for potential confounders, low transthyretin concentration remained an independent risk factor for poor prognosis in elderly inpatients (HR: 1.84; 95% CI: 1.03-3.28). Since women have consistently lower baseline transthyretin levels than men, we performed gender-specific analysis. We found that low transthyretin concentration is an independent risk factor for adverse prognosis in elderly male inpatients (HR: 2.99; 95% CI: 1.35-6.62) but not in females.

Conclusions: Low transthyretin concentrations are associated with increased all-cause mortality or readmission in elderly inpatients, particularly among male patients.

背景:研究老年住院患者转甲状腺素(前白蛋白)浓度低与死亡率或因各种原因再次入院之间的关系:研究老年住院患者转甲状腺素(前白蛋白)低浓度与死亡率或因各种原因再入院之间的关系:本分析基于 2018 年 9 月至 2019 年 4 月在北京三家三级转诊医院的十个病房进行的前瞻性队列研究。入组 65 岁及以上患者,收集患者的临床数据、实验室检查结果和辅助检查结果。对患者进行了为期三年的随访。根据转甲状腺素浓度的第5百分位数和第95百分位数,将患者分为三组。研究了转甲状腺素浓度与老年住院患者预后之间的相关性。研究的主要结果是三年内因各种原因死亡或再次入院:在参与研究的 636 人中,335 人(52.7%)为男性,中位年龄为 74.7 岁(四分位距[IQR]:69.3-80.1)。在中位 1099.0 天(IQR:1,016.3-1,135.0)的随访期间,363 人(57.0%)经历了全因死亡或再入院事件。与转甲状腺素浓度介于第 5 和第 95 百分位数之间的患者相比,转甲状腺素浓度处于或低于第 5 百分位数的患者发生全因死亡或再入院的风险显著增加(危险比 [HR]:2.25;95% 置信区间 [CI]:1.55-3.26)。即使调整了潜在的混杂因素,转甲状腺素浓度低仍然是老年住院患者预后不良的独立风险因素(HR:1.84;95% CI:1.03-3.28)。由于女性的转甲状腺素基线水平一直低于男性,因此我们进行了性别分析。我们发现,转甲状腺素浓度低是老年男性住院患者不良预后的一个独立风险因素(HR:2.99;95% CI:1.35-6.62),但在女性患者中并非如此:结论:转甲状腺素浓度低与老年住院患者全因死亡率或再入院率升高有关,尤其是男性患者。
{"title":"Low transthyretin concentration linked to adverse prognosis in elderly inpatients.","authors":"Ting Wang, Zhi-Kai Yang, Yu-Hao Wan, Ke Chai, Ying-Ying Li, Yao Luo, Min Zeng, Ning Sun, Song Zou, Hua Wang","doi":"10.1186/s12877-024-05467-3","DOIUrl":"10.1186/s12877-024-05467-3","url":null,"abstract":"<p><strong>Background: </strong>To investigate the association between low transthyretin (prealbumin) concentration and mortality or readmission for all causes in elderly inpatients.</p><p><strong>Methods: </strong>This analysis is based on a prospective cohort study conducted from September 2018 to April 2019 in ten wards of three tertiary referral hospitals in Beijing. Patients aged 65 years or older were enrolled, and their clinical data, laboratory test results, and auxiliary test results for patients were collected. A three-year follow-up was conducted with patients. Based on the 5th and 95th percentiles of transthyretin concentration, patients were split into three groups. The correlation between transthyretin concentration and the outcome of elderly hospitalized patients was investigated. The primary outcome of the research was death or readmission from all causes within three years.</p><p><strong>Results: </strong>Among the 636 individuals in the study, 335 (52.7%) were males, with a median age of 74.7 years (interquartile range [IQR]: 69.3-80.1). During a median follow-up period of 1,099.0 days (IQR: 1,016.3-1,135.0), 363 individuals (57.0%) experienced all-cause mortality or readmission events. Patients with transthyretin concentrations at or below the 5th percentile had a significantly increased risk of all-cause mortality or readmission compared to those with concentrations between the 5th and 95th percentiles (hazard ratio [HR]: 2.25; 95% confidence interval [CI]: 1.55-3.26). Even after adjusting for potential confounders, low transthyretin concentration remained an independent risk factor for poor prognosis in elderly inpatients (HR: 1.84; 95% CI: 1.03-3.28). Since women have consistently lower baseline transthyretin levels than men, we performed gender-specific analysis. We found that low transthyretin concentration is an independent risk factor for adverse prognosis in elderly male inpatients (HR: 2.99; 95% CI: 1.35-6.62) but not in females.</p><p><strong>Conclusions: </strong>Low transthyretin concentrations are associated with increased all-cause mortality or readmission in elderly inpatients, particularly among male patients.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unveiling a hidden burden: exploring sarcopenia in hospitalized older patients through concordance and cluster analysis. 揭开隐性负担的面纱:通过一致性和聚类分析探讨住院老年患者的肌少症。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12877-024-05322-5
Luis Carlos Venegas-Sanabria, Miguel German Borda, Luisa Fernanda Murcia-Soriano, Diana Marcela Ramos-Caballero, Alejandra Tordecilla-Sanders, Gabriela Garcia-Laguna, Olga Vargas-Pinilla

Background: Sarcopenia has been shown to be an important condition with the ability to predict negative health outcomes, especially in hospitalized older adults; hence, its accurate identification has an important role in the prognosis of older patients.

Aim: The prevalence of sarcopenia among hospitalized older adults was assessed by employing three distinct diagnostic methods.

Methods: Older adults who were hospitalized were recruited. Bioelectrical impedance analysis was used to assess muscle mass and body composition. Sarcopenia was diagnosed via the European and Asian criteria and via a modified approach in which the Colombian cutoff points for handgrip and gait speed were used. Finally, a cluster analysis was performed to classify the population.

Results: The prevalence rates of sarcopenia and severe sarcopenia ranged from 7.3 to 31.6%. The agreement between approaches revealed substantial or almost perfect agreement in 30% of the sarcopenia comparisons and 46.6% of the severe sarcopenia comparisons. The cluster analysis defined three different clusters. The first cluster was associated with increased age, BMI and body fat and poorer functional status and muscle. The second cluster was the healthiest, with high functional status and muscle mass. The third cluster had intermediate characteristics.

Discussion: This study highlights the requirements for standardized diagnostic criteria and precise body composition assessment tools in acute geriatric units and highlights the heterogeneity of older adults. Accurate assessment and well-defined diagnostic criteria will facilitate the implementation of appropriate management and interventions.

Conclusion: Sarcopenia is highly prevalent in hospitalized older adults, but the adjusted criteria and the inclusion of other parameters must be considered in the assessment.

背景:目的:采用三种不同的诊断方法评估肌肉疏松症在住院老年人中的患病率:方法:招募住院的老年人。生物电阻抗分析用于评估肌肉质量和身体成分。根据欧洲和亚洲的标准,并采用哥伦比亚的手握力和步速临界点,对 "肌肉疏松症 "进行诊断。最后,对人群进行了聚类分析:结果:肌肉疏松症和严重肌肉疏松症的患病率从 7.3% 到 31.6% 不等。在30%的肌肉疏松症对比和46.6%的严重肌肉疏松症对比中,各种方法之间的一致性显示出基本一致或几乎完全一致。聚类分析确定了三个不同的聚类。第一个聚类与年龄、体重指数和体脂增加以及功能状态和肌肉较差有关。第二组最健康,功能状态和肌肉质量较高。第三组具有中间特征:本研究强调了急诊老年病科对标准化诊断标准和精确身体成分评估工具的要求,并突出了老年人的异质性。准确的评估和定义明确的诊断标准将有助于实施适当的管理和干预措施:结论:"肌少症 "在住院老年人中发病率很高,但在评估时必须考虑调整标准和纳入其他参数。
{"title":"Unveiling a hidden burden: exploring sarcopenia in hospitalized older patients through concordance and cluster analysis.","authors":"Luis Carlos Venegas-Sanabria, Miguel German Borda, Luisa Fernanda Murcia-Soriano, Diana Marcela Ramos-Caballero, Alejandra Tordecilla-Sanders, Gabriela Garcia-Laguna, Olga Vargas-Pinilla","doi":"10.1186/s12877-024-05322-5","DOIUrl":"10.1186/s12877-024-05322-5","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia has been shown to be an important condition with the ability to predict negative health outcomes, especially in hospitalized older adults; hence, its accurate identification has an important role in the prognosis of older patients.</p><p><strong>Aim: </strong>The prevalence of sarcopenia among hospitalized older adults was assessed by employing three distinct diagnostic methods.</p><p><strong>Methods: </strong>Older adults who were hospitalized were recruited. Bioelectrical impedance analysis was used to assess muscle mass and body composition. Sarcopenia was diagnosed via the European and Asian criteria and via a modified approach in which the Colombian cutoff points for handgrip and gait speed were used. Finally, a cluster analysis was performed to classify the population.</p><p><strong>Results: </strong>The prevalence rates of sarcopenia and severe sarcopenia ranged from 7.3 to 31.6%. The agreement between approaches revealed substantial or almost perfect agreement in 30% of the sarcopenia comparisons and 46.6% of the severe sarcopenia comparisons. The cluster analysis defined three different clusters. The first cluster was associated with increased age, BMI and body fat and poorer functional status and muscle. The second cluster was the healthiest, with high functional status and muscle mass. The third cluster had intermediate characteristics.</p><p><strong>Discussion: </strong>This study highlights the requirements for standardized diagnostic criteria and precise body composition assessment tools in acute geriatric units and highlights the heterogeneity of older adults. Accurate assessment and well-defined diagnostic criteria will facilitate the implementation of appropriate management and interventions.</p><p><strong>Conclusion: </strong>Sarcopenia is highly prevalent in hospitalized older adults, but the adjusted criteria and the inclusion of other parameters must be considered in the assessment.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Analgesic regimens administered to older adults receiving skilled nursing facility care following hip fracture: a proof-of-concept federated analysis. 髋部骨折后接受专业护理机构护理的老年人的镇痛方案:概念验证联合分析。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12877-024-05486-0
Andrew R Zullo, Melissa R Riester, Kaleen N Hayes, Yuan Zhang, Sarah D Berry, Emmanuelle Belanger, Meghan A Cupp, Francesca L Beaudoin

Background: Although a majority of patients in the U.S. receive post-acute care in skilled nursing facilities (SNFs) following hip fracture, large-sample observational studies of analgesic prescribing and use in SNFs have not been possible due to limitations in available data sources. We conducted a proof-of-concept federated analysis of electronic health records (EHRs) from 11 SNF chains to describe analgesic use during hip fracture post-acute care.

Methods: We included residents with a diagnosis of hip fracture between January 1, 2018 and June 30, 2021 who had at least one administration of an analgesic. Use of analgesics was ascertained from EHR medication orders and medication administration records. We quantified the proportion of residents receiving analgesic regimens based on the medications that were administered up to 100 days after hip fracture diagnosis. Plots visualizing trends in analgesic use were stratified by multiple resident characteristics including age and Alzheimer's Disease and Related Dementias (ADRD) diagnosis.

Results: The study included 23,706 residents (mean age 80.5 years, 68.6% female, 87.7% White). Most (~ 60%) residents received opioids + APAP. Monotherapy with APAP or opioids was also common. The most prevalent regimens were oxycodone + APAP (20.1%), hydrocodone + APAP (15.8%), APAP only (15.1%), tramadol + APAP (10.4%), and oxycodone only (4.3%). During the study period, use of APAP-only increased, opioids-only decreased, and opioids + APAP remained stable. Use of APAP-only appeared to be more prevalent among individuals aged > 75 years (versus ≤ 75 years) and those with ADRD (versus without).

Conclusions: We successfully leveraged federated SNF EHR data to describe analgesic use among residents receiving hip fracture post-acute care.

背景:虽然美国大多数患者在髋部骨折后都会在专业护理机构(SNF)接受急性期后护理,但由于现有数据源的限制,还无法对 SNF 的镇痛剂处方和使用情况进行大样本观察研究。我们对 11 家连锁 SNF 的电子健康记录(EHR)进行了概念验证联合分析,以描述髋部骨折后护理期间镇痛药的使用情况:我们纳入了 2018 年 1 月 1 日至 2021 年 6 月 30 日期间诊断为髋部骨折且至少使用过一次镇痛药的住院患者。镇痛药的使用情况通过电子病历(EHR)用药单和用药管理记录确定。我们根据髋部骨折确诊后 100 天内的用药情况,量化了接受镇痛治疗的住院患者比例。根据居民的多种特征(包括年龄和阿尔茨海默病及相关痴呆症(ADRD)诊断)对镇痛剂使用趋势进行了分层:研究包括 23706 名住院患者(平均年龄 80.5 岁,68.6% 为女性,87.7% 为白人)。大多数居民(约 60%)接受了阿片类药物 + APAP 治疗。使用 APAP 或阿片类药物的单一疗法也很常见。最普遍的治疗方案是羟考酮+APAP(20.1%)、氢可酮+APAP(15.8%)、仅APAP(15.1%)、曲马多+APAP(10.4%)和仅羟考酮(4.3%)。在研究期间,仅使用 APAP 的情况有所增加,仅使用阿片类药物的情况有所减少,而阿片类药物 + APAP 的情况保持稳定。在年龄大于 75 岁(相对于小于 75 岁)和患有 ADRD(相对于无 ADRD)的人群中,仅使用 APAP 似乎更为普遍:我们成功地利用了联合 SNF 电子病历数据来描述接受髋部骨折后期护理的住院患者的镇痛药使用情况。
{"title":"Analgesic regimens administered to older adults receiving skilled nursing facility care following hip fracture: a proof-of-concept federated analysis.","authors":"Andrew R Zullo, Melissa R Riester, Kaleen N Hayes, Yuan Zhang, Sarah D Berry, Emmanuelle Belanger, Meghan A Cupp, Francesca L Beaudoin","doi":"10.1186/s12877-024-05486-0","DOIUrl":"10.1186/s12877-024-05486-0","url":null,"abstract":"<p><strong>Background: </strong>Although a majority of patients in the U.S. receive post-acute care in skilled nursing facilities (SNFs) following hip fracture, large-sample observational studies of analgesic prescribing and use in SNFs have not been possible due to limitations in available data sources. We conducted a proof-of-concept federated analysis of electronic health records (EHRs) from 11 SNF chains to describe analgesic use during hip fracture post-acute care.</p><p><strong>Methods: </strong>We included residents with a diagnosis of hip fracture between January 1, 2018 and June 30, 2021 who had at least one administration of an analgesic. Use of analgesics was ascertained from EHR medication orders and medication administration records. We quantified the proportion of residents receiving analgesic regimens based on the medications that were administered up to 100 days after hip fracture diagnosis. Plots visualizing trends in analgesic use were stratified by multiple resident characteristics including age and Alzheimer's Disease and Related Dementias (ADRD) diagnosis.</p><p><strong>Results: </strong>The study included 23,706 residents (mean age 80.5 years, 68.6% female, 87.7% White). Most (~ 60%) residents received opioids + APAP. Monotherapy with APAP or opioids was also common. The most prevalent regimens were oxycodone + APAP (20.1%), hydrocodone + APAP (15.8%), APAP only (15.1%), tramadol + APAP (10.4%), and oxycodone only (4.3%). During the study period, use of APAP-only increased, opioids-only decreased, and opioids + APAP remained stable. Use of APAP-only appeared to be more prevalent among individuals aged > 75 years (versus ≤ 75 years) and those with ADRD (versus without).</p><p><strong>Conclusions: </strong>We successfully leveraged federated SNF EHR data to describe analgesic use among residents receiving hip fracture post-acute care.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"The stay here is, of course, not appropriate for an old person": the perspective of healthcare providers on older patients in the emergency department. "在这里住院当然不适合老年人":医疗服务提供者对急诊科老年病人的看法。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-29 DOI: 10.1186/s12877-024-05429-9
Johannes Deutschbein, Andreas Wagenknecht, Gabriela Gilles, Martin Möckel, Liane Schenk

Background: In aging societies, emergency departments (ED) face an increasing number of older, geriatric patients. Research shows that older emergency patients have a greater burden of comorbidities and a higher risk of adverse events. It has been questioned whether contemporary ED structures can meet the specific needs and characteristics of older patients. Little is known about how professional health care providers perceive and experience ED care for older patients. This study aimed to get insight into the perspective of healthcare providers working with older ED patients and to explore the challenges they experience in their daily work.

Methods: The study used a qualitative research design with a social-constructivist perspective and a Grounded Theory based methodology. Data were collected through qualitative interviews with N = 25 healthcare providers from different urban EDs in Berlin, Germany, and adjacent healthcare institutions. Following the Ground Theory approach, categories and central themes were identified, analyzed, and interpreted to gain a comprehensive understanding of the healthcare provider perspective.

Results: The interviews revealed a significant and increasing relevance of geriatric ED patients for healthcare providers. However, there was no shared definition of 'the geriatric patient'. Most interviewees found ED structures to be inadequate for older patients. They described specific challenges, such as information gathering and safety risks in the ED, as well as an increased use of resources (both time and personnel) when caring for older patients. In addition, specific problems in the collaboration with other professions and institutions were addressed, namely nursing homes, hospital wards, consultations, and the hospital social service.

Conclusion: Healthcare providers experience a structural mismatch between contemporary EDs and the specific needs of geriatric patients. They are aware of the vulnerabilities of geriatric patients and try to compensate for inherent structural shortcomings. Such structures and limited resources often cause practical, organizational, and ethical problems. There is a great need to develop, implement, and evaluate systematic approaches and care concepts that address the specifics of ED care for geriatric patients.

背景:在老龄化社会中,急诊科(ED)面临着越来越多的老年患者。研究表明,老年急诊患者的合并症负担更重,发生不良事件的风险更高。现代急诊科的结构能否满足老年患者的特殊需求和特点一直是个问题。对于专业医护人员如何看待和体验急诊室对老年患者的护理,人们知之甚少。本研究旨在深入了解为急诊室老年患者提供服务的医护人员的观点,并探讨他们在日常工作中遇到的挑战:本研究采用社会建构主义视角的定性研究设计和基于基础理论的方法。通过对来自德国柏林不同城市急诊室和邻近医疗机构的 N = 25 名医疗服务提供者进行定性访谈收集数据。按照基础理论的方法,确定了类别和中心主题,并对其进行了分析和解释,以全面了解医疗服务提供者的观点:结果:访谈显示,老年急诊室患者对医疗服务提供者的重要性与日俱增。然而,"老年病人 "并没有一个共同的定义。大多数受访者认为急诊室的结构不适合老年患者。他们描述了一些具体的挑战,例如急诊室的信息收集和安全风险,以及在护理老年患者时资源(时间和人员)使用的增加。此外,他们还提到了与其他专业和机构(即疗养院、医院病房、会诊和医院社会服务机构)合作的具体问题:结论:医疗服务提供者经历了当代急诊室与老年病人特殊需求之间的结构性不匹配。他们意识到老年病人的脆弱性,并试图弥补固有的结构缺陷。这种结构和有限的资源往往会造成实际、组织和伦理方面的问题。因此,亟需开发、实施和评估针对老年病人急诊室护理特殊性的系统方法和护理理念。
{"title":"\"The stay here is, of course, not appropriate for an old person\": the perspective of healthcare providers on older patients in the emergency department.","authors":"Johannes Deutschbein, Andreas Wagenknecht, Gabriela Gilles, Martin Möckel, Liane Schenk","doi":"10.1186/s12877-024-05429-9","DOIUrl":"10.1186/s12877-024-05429-9","url":null,"abstract":"<p><strong>Background: </strong>In aging societies, emergency departments (ED) face an increasing number of older, geriatric patients. Research shows that older emergency patients have a greater burden of comorbidities and a higher risk of adverse events. It has been questioned whether contemporary ED structures can meet the specific needs and characteristics of older patients. Little is known about how professional health care providers perceive and experience ED care for older patients. This study aimed to get insight into the perspective of healthcare providers working with older ED patients and to explore the challenges they experience in their daily work.</p><p><strong>Methods: </strong>The study used a qualitative research design with a social-constructivist perspective and a Grounded Theory based methodology. Data were collected through qualitative interviews with N = 25 healthcare providers from different urban EDs in Berlin, Germany, and adjacent healthcare institutions. Following the Ground Theory approach, categories and central themes were identified, analyzed, and interpreted to gain a comprehensive understanding of the healthcare provider perspective.</p><p><strong>Results: </strong>The interviews revealed a significant and increasing relevance of geriatric ED patients for healthcare providers. However, there was no shared definition of 'the geriatric patient'. Most interviewees found ED structures to be inadequate for older patients. They described specific challenges, such as information gathering and safety risks in the ED, as well as an increased use of resources (both time and personnel) when caring for older patients. In addition, specific problems in the collaboration with other professions and institutions were addressed, namely nursing homes, hospital wards, consultations, and the hospital social service.</p><p><strong>Conclusion: </strong>Healthcare providers experience a structural mismatch between contemporary EDs and the specific needs of geriatric patients. They are aware of the vulnerabilities of geriatric patients and try to compensate for inherent structural shortcomings. Such structures and limited resources often cause practical, organizational, and ethical problems. There is a great need to develop, implement, and evaluate systematic approaches and care concepts that address the specifics of ED care for geriatric patients.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cognitive impairment among older persons with chronic illness attending primary care and its association with cardiovascular risk using the Framingham risk score. 接受初级保健的慢性病老年人的认知障碍及其与使用弗雷明汉风险评分的心血管风险的关系。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-29 DOI: 10.1186/s12877-024-05505-0
Nimelesh Balanthiren, Mohd Fairuz Ali, Aznida Firzah Abdul Aziz

Background: Dementia is a major public health burden, particularly among the older persons with significant implications for individuals, caregivers, and society. Identifying mild cognitive impairment early can facilitate timely intervention and care.This cross-sectional study aims to investigate the association between Framingham risk score (FRS), a widely used tool for cardiovascular disease (CVD) risk prediction, and cognitive impairment among older persons with chronic illness in Malaysia.

Methods: A total of 289 participants aged 60 years and above with chronic illness were recruited from Klinik Primer Hospital Tuanku Chanselor Muhriz via simple random sampling via computer generator. The Montreal Cognitive Assessment Bahasa Malaysia version (MoCA-BM) was used to assess cognitive function and the FRS was calculated on the basis of CVD risk factors.

Results: The prevalence of cognitive impairment among the participants was found to be 19.7%. Multiple Logistic Regression revealed that age (AOR 1.101, 95% CI = 1.041,1.163, p < 0.001), systolic blood pressure (AOR 1.048, 95%CI = 1.024, 1.072, p < 0.001) diabetes (AOR 2.655, 95% CI = 1.194, 5.906, p = 0.017) increased the odds of having cognitive impairment among older persons with chronic illness whereas secondary education ( AOR 0.087, 95% CI = 0.008, 0.963, p = 0.047) and higher education ( AOR 0.037, 95% CI = 0.002, 0.833, p = 0.038) reduced the likelihood of having cognitive impairment. Individuals with higher FRS were more likely to have cognitive impairment (AOR 1.099, 95% CI = 1.049, 1.172, p < 0.001). The optimal cutoff point for the FRS to determine cognitive impairment is 30 for males with a sensitivity and specificity of 84.4% and 51.2% while the optimal cut off point for females is 18.5 with a sensitivity and specificity of 76% and 63.1% respectively.

Conclusions: These findings suggest that the FRS which was originally designed for CVD risk assessment may also serve as a valuable predictive tool for cognitive impairment among older persons with chronic illness. Integrating FRS into routine primary care assessments could enhance the early identification of individuals at risk and enable appropriate cognitive screenings and interventions. Further research such as a longitudinal cohort study in a larger and more diverse population is warranted to validate the association of CVD risks with the development of dementia.

背景:痴呆症是一项重大的公共卫生负担,尤其是在老年人中,对个人、照顾者和社会都有重大影响。这项横断面研究旨在调查马来西亚患有慢性疾病的老年人中,弗雷明汉风险评分(FRS)与认知障碍之间的关系:通过计算机生成器进行简单随机抽样,从Klinik Primer医院(Tuanku Chanselor Muhriz)招募了289名60岁及以上的慢性病患者。评估认知功能时使用了蒙特利尔认知评估马来语版(MoCA-BM),并根据心血管疾病风险因素计算了FRS:结果:参与者中认知功能障碍的发生率为 19.7%。多重逻辑回归显示,年龄(AOR 1.101,95% CI = 1.041,1.163,P 结论:这些结果表明,FRS(心血管疾病危险因素)是评估认知功能的重要指标:这些研究结果表明,最初设计用于心血管疾病风险评估的 FRS 也可以作为预测患有慢性疾病的老年人认知功能障碍的重要工具。将 FRS 纳入常规初级保健评估可加强对高危人群的早期识别,并进行适当的认知筛查和干预。为了验证心血管疾病风险与痴呆症发展之间的联系,有必要开展进一步的研究,如在更大范围和更多样化的人群中开展纵向队列研究。
{"title":"Cognitive impairment among older persons with chronic illness attending primary care and its association with cardiovascular risk using the Framingham risk score.","authors":"Nimelesh Balanthiren, Mohd Fairuz Ali, Aznida Firzah Abdul Aziz","doi":"10.1186/s12877-024-05505-0","DOIUrl":"10.1186/s12877-024-05505-0","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a major public health burden, particularly among the older persons with significant implications for individuals, caregivers, and society. Identifying mild cognitive impairment early can facilitate timely intervention and care.This cross-sectional study aims to investigate the association between Framingham risk score (FRS), a widely used tool for cardiovascular disease (CVD) risk prediction, and cognitive impairment among older persons with chronic illness in Malaysia.</p><p><strong>Methods: </strong>A total of 289 participants aged 60 years and above with chronic illness were recruited from Klinik Primer Hospital Tuanku Chanselor Muhriz via simple random sampling via computer generator. The Montreal Cognitive Assessment Bahasa Malaysia version (MoCA-BM) was used to assess cognitive function and the FRS was calculated on the basis of CVD risk factors.</p><p><strong>Results: </strong>The prevalence of cognitive impairment among the participants was found to be 19.7%. Multiple Logistic Regression revealed that age (AOR 1.101, 95% CI = 1.041,1.163, p < 0.001), systolic blood pressure (AOR 1.048, 95%CI = 1.024, 1.072, p < 0.001) diabetes (AOR 2.655, 95% CI = 1.194, 5.906, p = 0.017) increased the odds of having cognitive impairment among older persons with chronic illness whereas secondary education ( AOR 0.087, 95% CI = 0.008, 0.963, p = 0.047) and higher education ( AOR 0.037, 95% CI = 0.002, 0.833, p = 0.038) reduced the likelihood of having cognitive impairment. Individuals with higher FRS were more likely to have cognitive impairment (AOR 1.099, 95% CI = 1.049, 1.172, p < 0.001). The optimal cutoff point for the FRS to determine cognitive impairment is 30 for males with a sensitivity and specificity of 84.4% and 51.2% while the optimal cut off point for females is 18.5 with a sensitivity and specificity of 76% and 63.1% respectively.</p><p><strong>Conclusions: </strong>These findings suggest that the FRS which was originally designed for CVD risk assessment may also serve as a valuable predictive tool for cognitive impairment among older persons with chronic illness. Integrating FRS into routine primary care assessments could enhance the early identification of individuals at risk and enable appropriate cognitive screenings and interventions. Further research such as a longitudinal cohort study in a larger and more diverse population is warranted to validate the association of CVD risks with the development of dementia.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Healthcare workers' experience of screening older adults in emergency care settings: a qualitative descriptive study using the Theoretical Domains Framework. 医护人员在急诊环境中筛查老年人的经验:使用理论领域框架进行的定性描述性研究。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-28 DOI: 10.1186/s12877-024-05410-6
Louise Barry, Aoife Leahy, Margaret O'Connor, Damien Ryan, Gillian Corey, Sylvia Murphy Tighe, Rose Galvin, Pauline Meskell

Background: In emergency care settings, screening for disease or risk factors for poor health outcomes among older adults can identify those in need of specialist and early intervention. The aim of this study was to identify barriers and facilitators to implementing older person-centred screening in emergency care settings in the Mid-West of Ireland.

Methods: This study employed a qualitative descriptive design underpinned by the theoretical domains framework (TDF). This design informs implementation strategy by establishing a theoretical foundation for focused objectives. One on one semi-structured interviews were conducted with a purposive sample of healthcare workers (HCWs) to explore their screening experiences with older adults in emergency care settings. Information power guided sample size calculation. In data analysis, verbatim interview transcripts were deductively mapped to TDF constructs forming meta-themes that revealed specific barriers and facilitators to person-centred screening for older individuals. These findings will directly inform implementation strategies.

Results: Three themes were identified; Preconditions to Implementing Older Person-Centred Screening; Knowledge and Skills Required to Implement Older Person-centred Screening and Motivation to Deliver Older Person-Centred Screening. Overall, screening in emergency care settings is a complicated process which is ideally undertaken by knowledgeable and skilled practitioners with a keen awareness of team dynamics and environmental challenges in acute care settings. These practitioners serve as champions and sources of specialist knowledge and practice. Less experienced clinicians seek supervision and support to undertake screening competently and confidently. Education on frailty and aged related syndromes facilitates screening uptake. Recognition of the value of screening is a clear motivator and leadership is vital to sustain screening practices.

Conclusions: Screening serves as an entry point for specialist intervention, necessitating a specialist multidisciplinary team (MDT) approach for effective implementation in emergency care settings. Strengthening screening practices for older adults who attend emergency care settings involves employing audit, supervision and tailored supports. Skilled and experienced practitioners play a key role in mentoring and supporting the broader MDT in screening engagement. Long-term and sustainable implementation relies on utilising existing managerial, practice development and educational resources to underpin screening practices. Communication between Emergency Department (ED) staff, the specialist team and wider geriatric team is vital to ensure a cohesive approach to delivering older person-centred care in the ED.

背景:在急诊护理环境中,对老年人的疾病或不良健康后果的风险因素进行筛查,可以识别出那些需要专家及早干预的老年人。本研究旨在确定在爱尔兰中西部的急诊护理机构中实施以老年人为中心的筛查的障碍和促进因素:本研究采用了以理论领域框架(TDF)为基础的定性描述设计。这种设计通过为重点目标建立理论基础,为实施策略提供信息。研究人员有目的性地对医护人员(HCWs)进行了一对一半结构式访谈,以探讨他们在急诊护理环境中对老年人进行筛查的经验。在计算样本大小时,以信息功率为指导。在数据分析过程中,逐字记录的访谈记录被演绎映射到 TDF 结构,形成元主题,揭示了以人为本的老年人筛查的具体障碍和促进因素。这些发现将直接为实施策略提供参考:结果:确定了三个主题:实施以老年人为中心的筛查的先决条件;实施以老年人为中心的筛查所需的知识和技能;实施以老年人为中心的筛查的动机。总体而言,急诊护理环境中的筛查是一个复杂的过程,最好由知识丰富、技能娴熟、对团队动态和急诊护理环境中的环境挑战有敏锐认识的从业人员来进行。这些从业人员是专业知识和实践的倡导者和来源。经验较少的临床医生则应寻求监督和支持,以胜任并自信地开展筛查工作。关于虚弱和老年相关综合征的教育有助于筛查的开展。对筛查价值的认可是一个明确的激励因素,而领导力对于维持筛查实践至关重要:结论:筛查是专家干预的切入点,需要专业的多学科团队(MDT)方法才能在急诊环境中有效实施。加强对急诊环境中老年人的筛查工作包括审计、监督和有针对性的支持。技术娴熟、经验丰富的从业人员在指导和支持更广泛的 MDT 参与筛查方面发挥着关键作用。长期和可持续的实施有赖于利用现有的管理、实践发展和教育资源来支持筛查实践。急诊科(ED)工作人员、专家团队和更广泛的老年医学团队之间的沟通对于确保在急诊科提供以老年人为中心的护理服务至关重要。
{"title":"Healthcare workers' experience of screening older adults in emergency care settings: a qualitative descriptive study using the Theoretical Domains Framework.","authors":"Louise Barry, Aoife Leahy, Margaret O'Connor, Damien Ryan, Gillian Corey, Sylvia Murphy Tighe, Rose Galvin, Pauline Meskell","doi":"10.1186/s12877-024-05410-6","DOIUrl":"10.1186/s12877-024-05410-6","url":null,"abstract":"<p><strong>Background: </strong>In emergency care settings, screening for disease or risk factors for poor health outcomes among older adults can identify those in need of specialist and early intervention. The aim of this study was to identify barriers and facilitators to implementing older person-centred screening in emergency care settings in the Mid-West of Ireland.</p><p><strong>Methods: </strong>This study employed a qualitative descriptive design underpinned by the theoretical domains framework (TDF). This design informs implementation strategy by establishing a theoretical foundation for focused objectives. One on one semi-structured interviews were conducted with a purposive sample of healthcare workers (HCWs) to explore their screening experiences with older adults in emergency care settings. Information power guided sample size calculation. In data analysis, verbatim interview transcripts were deductively mapped to TDF constructs forming meta-themes that revealed specific barriers and facilitators to person-centred screening for older individuals. These findings will directly inform implementation strategies.</p><p><strong>Results: </strong>Three themes were identified; Preconditions to Implementing Older Person-Centred Screening; Knowledge and Skills Required to Implement Older Person-centred Screening and Motivation to Deliver Older Person-Centred Screening. Overall, screening in emergency care settings is a complicated process which is ideally undertaken by knowledgeable and skilled practitioners with a keen awareness of team dynamics and environmental challenges in acute care settings. These practitioners serve as champions and sources of specialist knowledge and practice. Less experienced clinicians seek supervision and support to undertake screening competently and confidently. Education on frailty and aged related syndromes facilitates screening uptake. Recognition of the value of screening is a clear motivator and leadership is vital to sustain screening practices.</p><p><strong>Conclusions: </strong>Screening serves as an entry point for specialist intervention, necessitating a specialist multidisciplinary team (MDT) approach for effective implementation in emergency care settings. Strengthening screening practices for older adults who attend emergency care settings involves employing audit, supervision and tailored supports. Skilled and experienced practitioners play a key role in mentoring and supporting the broader MDT in screening engagement. Long-term and sustainable implementation relies on utilising existing managerial, practice development and educational resources to underpin screening practices. Communication between Emergency Department (ED) staff, the specialist team and wider geriatric team is vital to ensure a cohesive approach to delivering older person-centred care in the ED.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The impact of patient-facility language discordance on potentially inappropriate prescribing of antipsychotics in long-term care home in Ontario, Canada: a retrospective population health cohort study. 加拿大安大略省长期护理院中患者与护理机构语言不一致对可能不适当开具抗精神病药物处方的影响:一项回顾性人群健康队列研究》(The impact of patient-facility language discordance on potentially inappropriate prescribing of antipsychotics in long-term care home in Ontario, Canada)。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-28 DOI: 10.1186/s12877-024-05446-8
Michael Reaume, Cayden Peixoto, Michael Pugliese, Peter Tanuseputro, Ricardo Batista, Claire E Kendall, Josette-Renée Landry, Denis Prud'homme, Marie-Hélène Chomienne, Barbara Farrell, Lise M Bjerre

Background: Appropriate use of medication is a key indicator of the quality of care provided in long-term care (LTC). The objective of this study was to determine whether resident-facility language concordance/discordance is associated with the odds of potentially inappropriate prescribing of antipsychotics (PIP-AP) in LTC.

Methods: We conducted a population-based, retrospective cohort study of LTC residents in Ontario, Canada from 2010 to 2019. We obtained resident language from standardized resident assessments, and derived facility language by determining the proportion of residents belonging to each linguistic group within individual LTC homes. Using linked administrative databases, we identified all instances of PIP-AP during a 1-year follow-up period. PIP-AP was defined using the STOPP-START criteria, which have previously been shown to predict adverse clinical events such as emergency department (ED) visits and hospitalizations. The association between linguistic factors and PIP-AP was assessed using adjusted multivariable logistic regression analysis.

Results: We identified 198,729 LTC residents consisting of 162,814 Anglophones (81.9%), 6,230 Francophones (3.1%), and 29,685 Allophones (14.9%). The odds of PIP-AP of were higher for both Francophones (aOR 1.15, 95% CI 1.08-1.23) and Allophones (aOR 1.11, 95% CI 1.08-1.15) when compared to Anglophones. When compared to English LTC homes, French LTC homes had greater odds of PIP-AP (aOR 1.12, 95% CI 1.05-1.20), while Allophone homes had lower odds of PIP-AP (aOR 0.82, 95% CI 0.77-0.86). Residents living in language-discordant LTC homes had higher odds of PIP-AP when compared to LTC residents living in language-concordant LTC homes (aOR 1.07, 95% CI 1.04-1.10).

Conclusion: This study identified linguistic factors related to the odds of PIP-AP in LTC, suggesting that the linguistic environment may have an impact on the quality of care provided to residents.

背景:合理用药是衡量长期护理(LTC)护理质量的一个关键指标。本研究的目的是确定居民与医疗机构之间语言的一致性/不一致性是否与长期护理机构可能不适当地开具抗精神病药物处方(PIP-AP)的几率有关:我们对加拿大安大略省 2010 年至 2019 年的 LTC 居民进行了一项基于人群的回顾性队列研究。我们从标准化居民评估中获得了居民的语言,并通过确定各家 LTC 机构中属于各语言群体的居民比例得出了机构的语言。我们利用关联的行政数据库,确定了 1 年随访期内 PIP-AP 的所有情况。PIP-AP 的定义采用 STOPP-START 标准,该标准曾被证明可预测不良临床事件,如急诊室就诊和住院。通过调整后的多变量逻辑回归分析评估了语言因素与 PIP-AP 之间的关系:我们确定了 198,729 名 LTC 居民,其中包括 162,814 名英语居民(81.9%)、6,230 名法语居民(3.1%)和 29,685 名全英语居民(14.9%)。与讲英语者相比,讲法语者(aOR 1.15,95% CI 1.08-1.23)和讲全英语者(aOR 1.11,95% CI 1.08-1.15)发生 PIP-AP 的几率更高。与英语国家的长者护理院相比,法语国家的长者护理院发生 PIP-AP 的几率更高(aOR 1.12,95% CI 1.05-1.20),而英语国家的长者护理院发生 PIP-AP 的几率较低(aOR 0.82,95% CI 0.77-0.86)。与居住在语言不一致的长者护理院的长者相比,居住在语言一致的长者护理院的长者发生 PIP-AP 的几率更高(aOR 1.07,95% CI 1.04-1.10):本研究发现了与长者护理院中 PIP-AP 发生几率相关的语言因素,这表明语言环境可能会对为院友提供的护理质量产生影响。
{"title":"The impact of patient-facility language discordance on potentially inappropriate prescribing of antipsychotics in long-term care home in Ontario, Canada: a retrospective population health cohort study.","authors":"Michael Reaume, Cayden Peixoto, Michael Pugliese, Peter Tanuseputro, Ricardo Batista, Claire E Kendall, Josette-Renée Landry, Denis Prud'homme, Marie-Hélène Chomienne, Barbara Farrell, Lise M Bjerre","doi":"10.1186/s12877-024-05446-8","DOIUrl":"10.1186/s12877-024-05446-8","url":null,"abstract":"<p><strong>Background: </strong>Appropriate use of medication is a key indicator of the quality of care provided in long-term care (LTC). The objective of this study was to determine whether resident-facility language concordance/discordance is associated with the odds of potentially inappropriate prescribing of antipsychotics (PIP-AP) in LTC.</p><p><strong>Methods: </strong>We conducted a population-based, retrospective cohort study of LTC residents in Ontario, Canada from 2010 to 2019. We obtained resident language from standardized resident assessments, and derived facility language by determining the proportion of residents belonging to each linguistic group within individual LTC homes. Using linked administrative databases, we identified all instances of PIP-AP during a 1-year follow-up period. PIP-AP was defined using the STOPP-START criteria, which have previously been shown to predict adverse clinical events such as emergency department (ED) visits and hospitalizations. The association between linguistic factors and PIP-AP was assessed using adjusted multivariable logistic regression analysis.</p><p><strong>Results: </strong>We identified 198,729 LTC residents consisting of 162,814 Anglophones (81.9%), 6,230 Francophones (3.1%), and 29,685 Allophones (14.9%). The odds of PIP-AP of were higher for both Francophones (aOR 1.15, 95% CI 1.08-1.23) and Allophones (aOR 1.11, 95% CI 1.08-1.15) when compared to Anglophones. When compared to English LTC homes, French LTC homes had greater odds of PIP-AP (aOR 1.12, 95% CI 1.05-1.20), while Allophone homes had lower odds of PIP-AP (aOR 0.82, 95% CI 0.77-0.86). Residents living in language-discordant LTC homes had higher odds of PIP-AP when compared to LTC residents living in language-concordant LTC homes (aOR 1.07, 95% CI 1.04-1.10).</p><p><strong>Conclusion: </strong>This study identified linguistic factors related to the odds of PIP-AP in LTC, suggesting that the linguistic environment may have an impact on the quality of care provided to residents.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The relationship between oropharyngeal dysphagia and dehydration in older adults. 老年人口咽吞咽困难与脱水之间的关系。
IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-26 DOI: 10.1186/s12877-024-05492-2
Müberra Tanrıverdi, Cihan Heybeli, Ömer Faruk Çalım, Merve Durna, Orhan Özturan, Pinar Soysal

Background: Relationship between dysphagia and dehydration has not been studied widely. The aim of this study is to determine the frequency of dysphagia and dehydration in geriatric outpatient clinic, to evaluate the relationship between these two conditions.

Methods: The cross-sectional study included 1345 patients. Plasma osmolarity (Posm) was calculated using the following formula: [1.86 x (Na + K) + 1.15 x glucose + urea + 14]. Overt dehydration was defined as a calculated Posm of > 300 mmol/L. Eating Assessment Tool (EAT-10) score of ≥ 3 was accepted as dysphagia. Associations between dehydration and dysphagia was evaluated.

Results: Mean age was 78 ± 8 years, and 71% were females. Dysphagia was observed in 27% of patients. Dysphagia was associated with a higher number of drug exposure, dependency on basic activities of daily living and geriatric depression (p < 0.05). Overt dehydration was found in 29% of patients with dysphagia, and 21% of patients with no dysphagia (p = 0.002); and dysphagia was significantly associated with overt dehydration mmol/L (OR 1.49, 95% CI 1.13-1.96, p = 0.005) after adjustments for age and sex. In another model, EAT-10 score was found as one of the independent predictors of overt dehydration (OR1.03, 95% CI 1.00-1.06, p = 0.38), along with diabetes mellitus (OR 2.32, 95% CI 1.72-3.15, p < 0.001), chronic kidney disease (OR 3.05, 95% CI 2.24-4.15, p < 0.001), and MNA score (OR 0.97, 95% CI 0.94-1.00, p = 0.031).

Conclusion: EAT-10 scale was independently associated with overt dehydration among older adults, as MNA score was. Correction of both dysphagia and malnutrition might improve overt dehydration to a better extent than correction either of these factors alone. Future studies are needed to test cause and effect relationships.

背景:吞咽困难和脱水之间的关系尚未得到广泛研究。本研究旨在确定老年门诊中吞咽困难和脱水的频率,评估这两种情况之间的关系:横断面研究包括 1345 名患者。血浆渗透压(Posm)用以下公式计算:[1.86 x (Na + K) + 1.15 x 葡萄糖 + 尿素 + 14]。计算得出的 Posm > 300 mmol/L 即为严重脱水。进食评估工具(EAT-10)评分≥3分为吞咽困难。评估脱水与吞咽困难之间的关联:平均年龄为 78 ± 8 岁,71% 为女性。27%的患者出现吞咽困难。吞咽困难与较高的药物接触次数、基本日常生活依赖性和老年抑郁症有关(p 结论:EAT-10 量表与吞咽困难有独立相关性:与 MNA 评分一样,EAT-10 量表也与老年人明显脱水有关。同时纠正吞咽困难和营养不良可能比单独纠正其中一个因素更好地改善明显脱水。今后还需要开展研究来检验因果关系。
{"title":"The relationship between oropharyngeal dysphagia and dehydration in older adults.","authors":"Müberra Tanrıverdi, Cihan Heybeli, Ömer Faruk Çalım, Merve Durna, Orhan Özturan, Pinar Soysal","doi":"10.1186/s12877-024-05492-2","DOIUrl":"10.1186/s12877-024-05492-2","url":null,"abstract":"<p><strong>Background: </strong>Relationship between dysphagia and dehydration has not been studied widely. The aim of this study is to determine the frequency of dysphagia and dehydration in geriatric outpatient clinic, to evaluate the relationship between these two conditions.</p><p><strong>Methods: </strong>The cross-sectional study included 1345 patients. Plasma osmolarity (Posm) was calculated using the following formula: [1.86 x (Na + K) + 1.15 x glucose + urea + 14]. Overt dehydration was defined as a calculated Posm of > 300 mmol/L. Eating Assessment Tool (EAT-10) score of ≥ 3 was accepted as dysphagia. Associations between dehydration and dysphagia was evaluated.</p><p><strong>Results: </strong>Mean age was 78 ± 8 years, and 71% were females. Dysphagia was observed in 27% of patients. Dysphagia was associated with a higher number of drug exposure, dependency on basic activities of daily living and geriatric depression (p < 0.05). Overt dehydration was found in 29% of patients with dysphagia, and 21% of patients with no dysphagia (p = 0.002); and dysphagia was significantly associated with overt dehydration mmol/L (OR 1.49, 95% CI 1.13-1.96, p = 0.005) after adjustments for age and sex. In another model, EAT-10 score was found as one of the independent predictors of overt dehydration (OR1.03, 95% CI 1.00-1.06, p = 0.38), along with diabetes mellitus (OR 2.32, 95% CI 1.72-3.15, p < 0.001), chronic kidney disease (OR 3.05, 95% CI 2.24-4.15, p < 0.001), and MNA score (OR 0.97, 95% CI 0.94-1.00, p = 0.031).</p><p><strong>Conclusion: </strong>EAT-10 scale was independently associated with overt dehydration among older adults, as MNA score was. Correction of both dysphagia and malnutrition might improve overt dehydration to a better extent than correction either of these factors alone. Future studies are needed to test cause and effect relationships.</p>","PeriodicalId":9056,"journal":{"name":"BMC Geriatrics","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
BMC Geriatrics
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1