Community-dwelling Patients Research Articles

The effectiveness and costs of intensive stroke rehabilitation and improvements in patient pathway in Finland: a retrospective benchmarking controlled trial.

To assess the effectiveness and costs of intensive stroke rehabilitation and improvements in patient pathway in the city of Lahti and in Päijät-Häme region compared with other parts in Finland. Retrospective benchmarking controlled trial. Three cohorts of Finnish community-dwelling patients (n = 94,749, n = 4,184, and n = 105,458) with ischaemic stroke between 2001 and 2019. This study is based on the PERFECT 2001-2019 database of ischaemic stroke patients. PERFECT indicators describe how the stroke patients recover. The difference-in-difference method was used in the main analysis. Improved stroke rehabilitation in Lahti increased the share of patients discharged home (p = 0.005) and decreased the length of first institutional episode (-4 days, p = 0.006), the share of patients institutionalized (-5.1%, p = 0.001), and the costs of first institutional episode (€-2,085, p < 0.001) compared with the rest of Finland. Discharges to home increased 6.6 percentage points (p = 0.021) in Lahti compared with rest of Päijät-Häme. After 2013, the costs of first institutional episode per patient in Päijät-Häme decreased significantly compared with the rest of Finland (p < 0.001). Investments in intensive stroke rehabilitation and patient pathway seem to provide both faster and better return to home for patients and reduced costs for the healthcare system.

Discontinuation of Alzheimer Disease Medications in Patients Receiving Home Care Medicine.

There is no consensus on how long antidementia medications should be administered to patients with Alzheimer disease (AD). To clarify this issue, we investigated the discontinuation of antidementia medications in Japanese home care settings, including community-dwelling and institutionalized patients. Using medical records from April 2017 to March 2022 at 3 clinics in Tokyo and Chiba prefectures, we selected patients with AD who started receiving home care medicine. Forty-nine patients discontinued antidementia medications during the observation period, there was no apparent deterioration in cognitive function or new occurrence of behavioral and psychological symptoms of dementia caused by the discontinuation of medications. More aggressive discontinuation of AD medications probably is recommended for patients with activities of daily living dysfunction, such as those receiving home care medicine.

A public health/hospital partnership to improve Emergency Department transitions of care for vulnerable older adults.

Community-dwelling older adults are at high risk for unmet social service needs. We describe a novel partnership embedding county services case managers in the Emergency Department (ED) to connect older adults to community services alongside their medical care. Setting: A medium-sized urban ED with 55,000 patient visits a year. Case managers from the Franklin County, Ohio Office on Aging (OA) were embedded within the ED. The OA team worked with the ED social work team to identify community-dwelling older patients, perform an in-person intake assessment, and initiate needed community services (including home-delivered meals, emergency response systems, house repairs, and transportation). Program logic model and development are reported in detail. From June to December 2023, there were 7284 ED visits for adults ≥60 years old. Referrals to the OA case manager ranged from 1 to 13 per day. The OA case managers performed 252 full intake assessments on unique patients. The population was 51% men. Only 11% (n = 28) were currently connected to OA services, and of those already connected 29% (n = 8) needed increased services. Of the remaining unconnected patients (n = 224), 8% (n = 20) were not county residents and the OA team connected them with other county OAs. Half 53% (n = 120) were accepting of services and had services from the OA or other community health programs initiated during the ED visit. The OA team made three new Adult Protective Services referrals and one referral to the long-term care ombudsman. The program did not increase ED length of stay or hospital admission rates. Embedding county service enrollment within a community ED is a cost neutral intervention that reached a population without previous services. Future plans include expansion of the program and evaluation of the program's ability to detect elder mistreatment and self-neglect.

Exploring the relationship between telehealth utilization and treatment burden among patients with chronic conditions: A cross-sectional study in Ontario, Canada.

One in five Canadians lives with one or more chronic conditions. Patients with chronic conditions often experience a high treatment burden because of the work associated with managing care. Telehealth is considered a useful solution to reduce the treatment burden among patients with chronic conditions. However, telehealth can also increase the treatment burden by offloading responsibilities on patients. This cross-sectional study conducted in Ontario, Canada examines the association between telehealth utilization and treatment burden among patients with chronic conditions. This study aimed to explore whether and to what extent, telehealth use is associated with treatment burden among patients with chronic conditions. The secondary objective was to explore which sociodemographic variables are associated with patients' treatment burden. An online survey was administered to community-dwelling patients with one or more chronic conditions. The Treatment Burden Questionnaire (TBQ-15) was used to measure the patient's level of treatment burden, and a modified telehealth usage scale was developed and used to measure the frequency of telehealth use. Data was analyzed using descriptive statistics, correlations, analyses of variance, and hierarchical linear regression analysis. A total of 75 patients completed the survey. The participants' mean age was 64 (SD = 18.93) and 79% were female. The average reported treatment burden was 72.15 out of 150 (a higher score indicating a higher level of burden). When adjusted for demographic variables, a higher frequency of telehealth use was associated with experiencing a higher treatment burden, but the association was not statistically significant. Additionally, when adjusted for demographic variables, younger age, and the presence of an unpaid caregiver were positively related to a high treatment burden score. This finding demonstrates that some patient populations are more at risk of experiencing high treatment burden in the context of telehealth use; and hence, may require extra support to utilize telehealth technologies. The study highlights the need for further research to explore how to minimize the treatment burden among individuals with higher healthcare needs.

Doctor and patient perceptions of sarcopenia in community-based primary care clinics: a questionnaire survey.

Our study aims to examine perceptions of sarcopenia among doctors and patients for improved management strategies in the future. We analyzed nine matched items from separate surveys involving 80 community-based primary care doctors, recruited online (55%) and offline (45%), and 80 community-dwelling older patients who visited 6 of the 80 primary care clinics in South Korea. Doctors had a mean age of 58.3 ± 9.1 years, with 17.5% women; patients had a mean age of 74.1 ± 6.1 years, with 61.3% women. Twenty-eight patients (35.4%) had heard of sarcopenia, while only 19 doctors (23.8%) knew the diagnostic criteria of sarcopenia. Patients were more likely to believe they had sarcopenia than doctors assumed their patients had sarcopenia (patients, 35%; doctors, 16.9%; P = 0.0039). Patients desired more exercise and nutritional education than doctors reported they could provide (all P < 0.01). More patients preferred regular text messages for exercise or nutritional education (for exercise: patients 16.5%, doctors 5.8%, P = 0.0428; for nutrition: patients 17.1%, doctors 4.4%, P = 0.0154). Many patients were unaware of available community services for sarcopenia management (patients 48.8%, doctors 10.0%, P < 0.001). Both patients and doctors in community-based primary care clinics lacked awareness of sarcopenia. Significant discrepancies existed between the exercise and nutritional education patients desired and what doctors could provide. These findings can inform the development of sarcopenia management programs in primary care clinics.

Food insecurity and other barriers to adherence to a gluten-free diet in individuals with coeliac disease and non-coeliac gluten sensitivity in the Netherlands: a mixed-methods study

ObjectivesTo determine the prevalence of food insecurity among individuals with coeliac disease (CeD) and non-coeliac gluten sensitivity (NCGS) in the Netherlands and explore its association with diet quality and other...

Effectiveness of comprehensive geriatric assessment adapted to primary care when provided by a nurse or a general practitioner: the CEpiA cluster-randomised trial

BackgroundThe benefits of comprehensive geriatric assessment (CGA) are well established for hospital care but less so for primary care. Our primary objective was to assess the effect of two multifaceted interventions based on a CGA adapted for primary care on a composite criterion combining all-cause mortality, emergency department visits, unplanned hospital admissions, and institutionalisation.MethodsThis open-label, pragmatic, three-arm, cluster-randomised controlled trial involved 39 general practices in France. It included 634 patients aged 70 years or over with chronic health conditions and/or an unplanned hospital admission in the past 3 months, between 05/2016 and 08/2018. Interventions were in arm 1: a systematic nurse-led CGA; arm 2: a GP-led CGA, at the GP’s discretion; arm 3: standard care. The primary composite endpoint was assessed at 12 months. The secondary endpoints included: components of the composite endpoint, health-related quality of life (Duke Health Profile), functional status (Katz Activities of Daily Living Index) and medications (number) at 12 months. Pairwise comparisons between the experimental groups and the control were tested. The main analysis was performed on the intention-to-treat (ITT) population, after imputing missing information and adjusting for baseline imbalances by mixed effects regressions.ResultsFor the primary composite outcome, no statistically significant difference was found between arm 1 and the control (adjusted odds ratio [aOR] = 0.81 [95%CI 0.54–1.21], P = 0.31), whereas arm 2 and the control differed significantly (aOR = 0.60 [0.39–0.93], P = 0.022). A statistically lower risk of unplanned hospital admission in arm 2 vs control (aOR = 0.57 [0.36–0.92], P = 0.020)) was observed, while no statistically significant differences were found for the other components and between arm 1 and the control. None of the other secondary endpoints differed between arms.ConclusionsOur study led in community-dwelling older patients with chronic conditions found no significant effect of a CGA adapted for primary care on mortality, functional independence and quality of life, but suggests that a GP-led CGA may reduce the risk of unplanned hospital admission. Our study demonstrates the feasibility of incorporating CGA into clinical practice and highlights its potential benefits when applied on a case-by-case basis, guided by the GPs who develop the resulting PCP.Trial registrationNCT02664454.

The neutrophil-lymphocyte ratio predicts all-cause and cardiovascular mortality among United States adults with COPD: results from NHANES 1999-2018.

Neutrophil-to-lymphocyte ratio (NLR) is considered a biomarker of systemic inflammation and immune activation. However, its relationship with the risk of mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to investigate the association between NLR and the risk of all-cause and cardiovascular mortality in patients with COPD. Data were collected from the National Health and Nutrition Examination Survey (NHANES) from January 1999 to December 2018. The calculation method of NLR involves dividing the neutrophil count by the lymphocyte count in the total blood cell count. The optimal NLR threshold associated with survival outcomes was determined using the maximally selected rank statistics method (MSRSM). The relationship between NLR and the risk of all-cause mortality and cardiovascular mortality in COPD was investigated using a weighted multivariable Cox regression model. Additionally, restricted cubic spline (RCS) was employed to discuss the potential relationship between NLR patients in different groups and the risk of mortality. In this study, 716 adults with COPD were included using the maximally selected rank statistics method, among whom 208 had higher NLR (≥2.56) and 508 had lower NLR (<2.56). During a median follow-up of 111.5 months, 162 COPD patients died from all causes, and 49 patients died from cardiovascular diseases. After adjusting for demographic, socioeconomic status, and lifestyle factors, the risk of all-cause mortality (HR = 2.07, 95%CI: 1.46-2.94) and cardiovascular mortality (HR = 3.03, 95%CI: 1.63-5.65) in patients with higher NLR was increased by 2-3 times compared to those with lower NLR. Kaplan-Meier analysis revealed significantly lower survival rates in patients with higher NLR for all-cause mortality and cardiovascular mortality (p < 0.05). Restricted cubic spline analysis showed a linear correlation between NLR and the risk of all-cause mortality and cardiovascular mortality. NLR has a high value in independently predicting long-term all-cause and cardiovascular mortality risks in community-dwelling COPD patients. Therefore, NLR can serve as a cost-effective and widely available indicator for assessing the prognosis of COPD patients.

An organisation working mainly reactively instead of proactively: a qualitative study of how frail users of home care services and their next of kin experience crises

BackgroundFrail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services.MethodsA qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data.ResultsOur findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication—a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant’s experience of insufficient communication and the lack of a holistic approach from the service, but also in the user’s sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis.ConclusionsOur findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach.

Cognitive function in dyslipidemia patients: exploring the impact of statins.

Evidence regarding the relationship between the use of statins and cognitive outcomes presents varying findings. This study aims to analyze the relationship between sustained statin use and cognitive performance in dyslipidemia patients. This study presents findings from the Beijing Ageing Brain Rejuvenation Initiative (BABRI) study, in which a cohort of community-dwelling dyslipidemia patients (Entire sample, N = 1,062, aged 50-86) was recruited. Participants were divided into two groups based on their sustained use statins (Statins group, N = 677) or not use any lipid-lowering agents (Untreated group, N = 385). Furthermore, the entire sample was stratified by age into the middle-aged sample (N = 451) and the older people sample (N = 611), following a similar categorization based on statin application. ANCOVA was used to evaluate the relationship between sustained statin use and cognitive function. Overall, in the total sample, the statins group demonstrated better cognition in overall cognition, memory, visuospatial ability, attention, executive function, and language domains compared to the untreated group. Moreover, the statins group only showed better performance in attention among the middle-aged sample. In the older people sample, statins group exhibited superior cognitive performance across various cognitive domains compared to untreated group. Among dyslipidemia patients in Beijing community, sustained statin users exhibited superior cognitive function across all domains compared to untreated individuals, with particularly noticeable improvements among those aged 65 and above. These findings underscore the protective effect of statins on cognitive function in dyslipidemia patients, highlighting significant benefits for the older people population.

Distinct impulsivity profiles in subtypes of violence among community-dwelling patients with severe mental disorders: a longitudinal study

BackgroundAlthough only a few patients with severe mental disorders (SMD) can commit violent behaviour in the community, violent behaviour aggravates the stigma towards patients with SMD. Understanding the subtypes of violent behaviour may be beneficial for preventing violent behaviour among patients with SMD, but it has rarely been studied.MethodsThis longitudinal study investigated 1914 patients with SMD in the community at baseline, and the follow-up period ranged from February 2021 to August 2021. The Barratt Impulsiveness Scale Version-11, the Buss-Perry Aggression Questionnaire, the Impulsive/Premeditated Aggression Scale, the Personality Diagnostic Questionnaire and the MacArthur Community Violence Instrument were used at baseline. The Modified Overt Aggression Scale was used to assess the occurrence of violent behaviour (outcome) during the follow-up period. Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Latent class analysis was used to characterise the subtypes of patients with SMD who engaged in violent behaviour at follow-up.ResultsWe found that 7.2% of patients with SMD presented violent behaviour within six months in the community. Younger age (OR = 0.98, 95% CI = 0.96-1.00, p = 0.016) and no economic source (OR = 1.60, 95% CI = 1.10–2.33, p = 0.014) were risk factors for violent behaviour. Patients with SMD who engaged in violent behaviour could be classified into three subtypes: one class characterised by a history of violence and impulsivity, another class characterised by high levels of aggression and motor impulsivity, and the last class characterised by median cognitive impulsivity.ConclusionsSocio-demographic factors were risk factors for violent behaviour among patients with SMD, which could eliminate the discrimination toward this group. Impulsivity played a vital role in identifying the three subtypes of patients with SMD who engaged in violent behaviour. These findings may be helpful for the development of a personalised violence risk management plan for patients with SMD who commit violent behaviour in the community.

Association between cognitive insight and anxiety among community-dwelling schizophrenia patients: the chain mediating effects of family cohesion and chronotype.

To investigate the effect of cognitive insight on anxiety in community-dwelling schizophrenia patients and to construct a chain mediating model to determine the underlying mechanisms of the relationship between cognitive insight and anxiety through family cohesion and chronotype. The Beck Cognitive Insight Scale, the Chinese version of the Family Adaptability and Cohesion Scale, the Morningness-Eveningness Scale, and the Generalized Anxiety Disorder Scale were used to assess cognitive insight, family cohesion, chronotype, and anxiety in a sample of 785 individuals with schizophrenia living in the community. Spearman correlation analysis, multiple linear regression and Bootstrap methods were employed to analyze the four variables. Residential region, current employment status, and family economic status impacted anxiety among community-dwelling schizophrenia patients. All variables were associated with each other, but self-certainty was not significantly associated with anxiety. Cognitive insight and self-reflection had direct effects on anxiety, as well as indirect effects on anxiety through the partial mediating effect of chronotype, the suppressing effect of family cohesion, and the chain mediating effect of family cohesion and chronotype. Family cohesion and chronotype can mediate the relationship between cognitive insight and anxiety. Improving family functioning, promoting emotional relationships within families, and correcting non-circadian sleep patterns can reduce anxiety in community-dwelling schizophrenia patients, with important implications for improving adverse mental health outcomes.

Causes and predictors of recurrent unplanned hospital admissions in heart failure patients: a cohort study.

Despite progress in therapy, heart failure (HF) inflicts a heavy burden of hospital admissions. In this study, we identified among 1360 community-dwelling HF patients (mean age 70.7 ± 11.3 years, 72.5% men) subgroups sharing similar profiles of unplanned hospital admissions, based on the admission causes and frequency of each cause. Hospital discharge summaries were reviewed for the main admission cause. Patient subgroups were identified via cluster analysis. We investigated baseline predictors associated with these subgroups, using multinomial logistic models. During 3421 patient-years, there were 5192 hospital admissions, of which 4252 (82%) were unplanned. We identified five patient subgroups (clusters 1-5) with distinctive hospitalization profiles. HF accounted for approximately one-third of admissions in the first patient cluster (23% of the patient sample). In contrast, patients in the second cluster (39% of the patient sample) were hospitalized for various reasons, with no single prominent admission cause identified. The other three clusters, comprising 16% of the patient sample, accounted for 42% of all unplanned hospitalizations. While patients in the third cluster were hospitalized mainly due to ischemic heart disease and arrhythmia, patients in the fourth and fifth clusters shared a high burden of recurrent HF admissions. The five patient clusters differed by baseline predictors, including age, functional capacity, comorbidity burden, hemoglobin, and cause of HF. HF patients differ significantly in the causes and overall burden of unplanned hospitalizations. The patient subgroups identified and predictors for these subgroups may guide personalized interventions to reduce the burden of unplanned hospitalizations among HF patients. Trial registration: ClinicalTrials.gov, NCT00533013. Registered 20 September 2007. https://clinicaltrials.gov/study/NCT00533013 .

Effect of home-based and remotely supervised combined exercise and cognitive intervention on older adults with mild cognitive impairment (COGITO): study protocol for a randomised controlled trial

IntroductionMild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the...

Age-related effects on absolute and relative isokinetic knee extensor strength in community-dwelling older men and women at a French geriatric day hospital.

Isokinetic knee extensor strength is poorly evaluated in geriatric day hospitals (GDHs), despite its potential functional significance compared to grip strength. This study aimed to investigate age-related effects on absolute and relative isokinetic knee extensor peak torque (KEPT) data in community-dwelling older GDH patients. A total of 472 French GDH patients (179 men and 293 women, aged 75-94 years) participated in this study. Absolute and relative KEPT were measured at six distinct angular velocities between 0.52 and 3.14 rad/s. In addition, comfortable gait speed and grip strength were assessed. Participants were stratified by sex and age using 5-year intervals. One-way ANOVAs were used to examine age-related effects on KEPT values. Multiple linear regression models were employed to investigate the associations between gait speed and both mean KEPT values and grip strength, with separate models conducted on absolute and relative values. The recruited GDH patients presented lower absolute and relative KEPT values in comparison with established reference values for healthy community-dwelling older individuals, with men being consistently stronger than women. Notably, there was a significant decline in both absolute and relative KEPT values beyond the age of 85 for both sexes. Importantly, the multiple linear regression analyses conducted revealed a significant positive relationship between gait speed and mean KEPT values, surpassing the association with grip strength. These findings underscore the clinical importance of assessing isokinetic knee extensor strength in community-dwelling older GDH patients, particularly for tailoring personalized physical activity interventions.

Social support and sleep quality in people with schizophrenia living in the community: the mediating roles of anxiety and depression symptoms.

Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living, and social participation, but the relationship between social support and sleep quality remains unknown. This study aims to investigate the mediating effects of anxiety and depression in the relationship between social support and sleep among community-dwelling patients with schizophrenia. Purposive sampling was used to collect face-to-face data from 1,107 community-dwelling patients with schizophrenia in Chengdu, Sichuan Province, China, between April and July 2023. The Athens Insomnia Scale (AIS) was used to assess sleep quality; the Generalized Anxiety Disorder 7-item scale (GAD-7) was utilized to evaluate anxiety symptoms; and the Patient Health Questionnaire-9 (PHQ-9) was employed to assess depressive symptoms. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 6 (Serial multiple mediator model) of the SPSS PROCESS macro. Among the 1,107 participants, the proportions of people with schizophrenia experiencing anxiety, depressive symptoms, and poor sleep quality were 22.8, 37.7, and 42.1%, respectively. Mediation analyses indicated that although social support had no direct effect on sleep quality, anxiety and depressive symptoms fully mediated the relationship between social support and sleep quality. Patients with schizophrenia experience low levels of social support and poor sleep quality. To enhance the sleep quality of individuals with schizophrenia, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. Implementing diverse intervention measures to strengthen social support and improve symptoms of anxiety and depression should be considered. This approach may potentially lead to an improvement in sleep quality among individuals with schizophrenia.

Comparing patient- and proxy-reported health-related quality of life of frail older patients at the emergency department

PurposeTo examine agreement between patient- and proxy-reported Health-Related Quality of Life (HRQoL) scores, and their associations with clinical measures and patient demographics.MethodsWe examined the patient-proxy agreement in HRQoL within a cohort of community-dwelling frail older patients (Clinical Frailty Scale [CFS] score 4–6) planned for discharge from the Emergency Department (ED) of a 1700-bed tertiary hospital in Singapore. Patients were recruited as part of the Emergency Department Interventions for Frailty (EDIFY) program, a quasi-experimental study evaluating the effectiveness of a multicomponent frailty intervention (MFI) in maintaining or improving functional outcomes. HRQoL was measured using the EuroQoL five-dimensional questionnaire (EQ-5D-5L) for patients and proxies. We analysed a sample of dyadic-reported HRQoL to explore the inter-rater agreement using intraclass correlation coefficients (ICC), and the influencing factors of concordance.ResultsWe recruited 140 participants with 23 pairs of patient-proxy dyads having concurrent EQ-5D reported. There was poor inter-rater agreement between patient- and proxy-reported EQ-5D (ICC 0.18) with proxies perceiving poorer average HRQoL than patients. On the domain level, there was poor agreement in self-care and pain domains (ICC − 0.07 and 0.20), where proxies perceived more problems than patients. In multivariate regressions, lower frailty scores were associated with poorer agreement in EQ-5D scores (p < 0.05).ConclusionIn conclusion, our findings demonstrate differences between patient- and proxy-reported HRQoL outcomes among frail older patients, with significant discordance observed among patients who are “less frail”. Hence, proxy-reported responses should be interpreted with care especially when the abovementioned characteristics are present in an older patient.

Effects of physical exercise intervention on improving physical functioning and quality of life among geriatric population: A systematic review of randomized controlled trials.

To assess the effectiveness of exercise intervention on elderly population's physical functioning and quality of life. The systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines, and comprised research on Cochrane Library, PubMed, Physiotherapy Evidence Database and Web of Science for randomised controlled trials published in the English language from January 2012 to December 2021. The trials included comprised individuals of either gender aged ≥60 years who were either community-dwelling elderly or patients living in residential facilities who could walk independently with or without assistive devices. Key words used for the search included age, exercise, physical function, quality of life and cognition. A 10-point scale from the Physiotherapy Evidence Database was used for methodological evaluation. Of the 1050 studies initially found, 14(1.33%) were analysed in detail. All 14(100%) included multi-component exercise interventions, like aerobic, strength and balance, 4(28.6%) trials included cognition and quality of life as well. Only 1(7.14%) trial showed little or no improvement in terms of quality of life. Of the 2(14.3%) studies that reported the effects of exercise on falls, 1(50%) found positive impact of exercise interventions, while 1(50%) showed no improvement on the risk of fall and psychosocial factors related to fall. Overall, 9(64.3%) trials investigated the effects of exercise training on several aspects of mobility, and showed marked improvement in mobility. Also, 8(57.14%) trials studied the effect of exercise intervention on balance performance, and 1(12.5%) of them showed no effect on balance. Of the 9(64.3%) trials investigating the effects of exercise intervention on muscle strength, 5(55.5%) reported increase in muscle strength. Multi-component exercises were found to have a positive impact on functional and psychosocial health of geriatric population.

Promoting serious illness conversations in primary care through telehealth among persons living with cognitive impairment.

serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI. Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina. Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available). SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR. Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes. Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits. These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.

Comparison of psychometric properties of the dual-task timed up-and-go test (cognitive) and the 3-m walk backward test in community-dwelling stroke patients

ABSTRACT Background There is a need for practical, easy-to-use and accurately assessing balance tools in stroke patients. Objectives This study aimed to compare the psychometric properties of the dual-task Timed Up-and-Go test (cognitive) (DTUG) and the 3-m walk backward test (3MBWT) in stroke patients. Methods This study evaluated the practicality, validity, and reliability of the DTUG and the 3MBWT. The test-retest method was used for reliability. The Modified Four Square Step Test (MFSST), the Timed Up-and-Go (TUG), and Berg Balance Scale (BBS) were administered for concurrent validity. A cutoff value was calculated to discriminate between fallers and non-fallers. Results The mean practicality times of the tests were 63.58 ± 47.32 sec for DTUG and 37.42 ± 24.036 sec for 3MBWT. Intraclass correlation coefficient of the DTUG and 3MBWT were 0.977, 0.964, respectively which showed excellent test – retest reliability. The DTUG demonstrated strong/very strong correlations with the MFSST (r = 0.724, p < 0.001), TUG (r = 0.909, p < 0.001), and BBS (r = –0.740, p < 0.001). The 3MBWT showed strong correlations with the MFSST (r = 0.835, p < 0.001), the TUG (r = 0.799, p < 0.001), and the BBS (r = –0.740, p < 0.001). The cutoff point was 36.945 s for DTUG and 14.605 s for 3MBWT. Conclusions The 3MBWT was a more practical test than the DTUG; however, the DTUG was more discriminative than the 3MBWT in identifying fallers after stroke. Clinical Trial Registration Number NCT05211349 URL https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000BRKZ&selectaction=Edit&uid=U0005GRO&ts=2&cx=z21bhg