Frail Elderly People Research Articles

General motor function assessment scale – reliability of a Norwegian version

Purpose: The General Motor Function assessment scale (GMF) measures activity-related dependence, pain and insecurity among older people in frail health. The aim of the present study was to translate the GMF into a Norwegian version (N-GMF) and establish its reliability and clinical feasibility. Methods: The procedure used in translating the GMF was a forward and backward process, testing a convenience sample of 30 frail elderly people with it. The intra-rater reliability tests were performed by three physiotherapists, and the inter-reliability test was done by the same three plus nine independent colleagues. The statistical analyses were performed with a pairwise analysis for intra- and inter-rater reliability, using Cronbach’s α, Percentage Agreement (PA), Svensson’s rank transformable method and Cohen’s κ. Results: The Cronbach’s α coefficients for the different subscales of N-GMF were 0.68 for Dependency, 0.73 for Pain and 0.75 for Insecurity. Intra-rater reliability: The variation in the PA for the total score was 40–70% in Dependence, 30–40% in Pain and 30–60% in Insecurity. The Relative Rank Variant (RV) indicated a modest individual bias and an augmented rank-order agreement coefficient ra of 0.96, 0.96 and 0.99, respectively. The variation in the κ statistics was 0.27–0.62 for Dependence, 0.17–0.35 for Pain and 0.13–0.47 for Insecurity. Inter-rater reliability: The PA between different testers in Dependence, Pain and Insecurity was 74%, 89% and 74%, respectively. The augmented rank-order agreement coefficients were: for Dependence ra = 0.97; for Pain, ra = 0.99; and for Insecurity, ra = 0.99. Conclusion: The N-GMF is a fairly reliable instrument for use with frail elderly people, with intra-rater and inter-rater reliability moderate in Dependence and slight to fair in Pain and Insecurity. The clinical usefulness was stressed in regard to its main focus, the frail elderly, and for communication within a multidisciplinary team.Implications for RehabilitationThe Norwegian-General Motor Function Assessment Scale (N-GMF) is a reliable instrument.The N-GMF is an instrument for screening and assessment of activity-related dependence, pain and insecurity in frail older people.The N-GMF may be used as a tool of communication in a multidisciplinary team.

Problemas relacionados aos medicamentos em idosos fragilizados da Zona da Mata Mineira, Brasil

OBJETIVO: Identificar os principais problemas de saúde, o perfil de utilização de medicamentos e os problemas relacionados aos medicamentos (PRMs) envolvidos no tratamento de idosos fragilizados da Zona da Mata Mineira. MÉTODOS: Foram avaliados prontuários de 260 idosos atendidos pelo Centro Mais Vida, Juiz de Fora-MG, entre agosto e setembro de 2010. As doenças foram agrupadas de acordo com a Classificação Internacional de Doenças - 10ª revisão, os medicamentos de acordo com o Anatomical Therapeutic Chemical Classification System e os PRMs de acordo com o Método Dáder. RESULTADOS: Observou-se que 73,8% dos idosos eram do sexo feminino e 42,7% possuíam entre 60 e 69 anos. Foram constatadas 1.300 doenças, sendo 31,07% do aparelho circulatório, 19,85% endócrinas, nutricionais e metabólicas e 13,46% do sistema osteomuscular e tecido conjuntivo. Dos 1.737 medicamentos, os mais prevalentes foram os do sistema cardiovascular (42,8%), seguidos pelos do trato alimentar e metabolismo (23,7%) e pelos do sistema nervoso (18,2%). Do total de medicamentos, 53,9% apresentaram algum PRM, sendo o PRM 1 (não utilização da medicação necessária) o mais frequente (37,4%). CONCLUSÃO: Os resultados evidenciam a necessidade da revisão dos esquemas terapêuticos dos idosos, visando o uso racional e efetivo dos medicamentos. Os dados apontam, ainda, a necessidade de aprofundar estudos de avaliação de riscos de PRM nessa população.

Reliable and Sustainable Comprehensive Care for Frail Elderly People

Reliable and Sustainable Comprehensive Care for Frail Elderly People

The organisation of hospitals and the remuneration systems are not adapted to frail old patients giving them bad quality of care and the staff feelings of guilt and frustration

BackgroundIn the coming half-century, the population of old people will increase, especially in the oldest age groups. Therefore, the prevalence of multiple chronic conditions, and consequently, the need of health care including care in hospital, is rising. Materials and methodsThis article includes results from three mainly qualitative articles (interviews with frail old people, physicians, and an observational study in acute medical wards) and a cross-sectional survey of newly discharged elderly patients. ResultsHealth care does not take a holistic approach to patients with more complex diseases, such as frail old people. The remuneration system rewards high production of care in terms of numbers of investigations and operations, turnover of hospital beds, and easy accessibility to care. Frail old people do not feel welcome in hospital, with their complex diseases and a need of more time to recover. The staff providing care feels frustrated, and often guilty when taking care of old people. Discussion and conclusionTo improve quality of care of frail elderly, a model is suggested with the following main components: more hospital wards which can address the patients’ whole situation medically, functionally, and psychologically, i.e comprehensive geriatric assessment (CGA). Better identification of frail elderly people is necessary, together with a change in remuneration system, with a focus on the patients’ functional status and quality of life. More training in geriatrics is required for staff to feel confident when treating frail old people.

Concerns About the Use of New Oral Anticoagulants for Stroke Prevention in Elderly Patients with Atrial Fibrillation

The prevalence of atrial fibrillation (AF) and the embolic risk increase with age. Elderly AF patients are undertreated with vitamin K antagonists (VKA). The new oral anticoagulants (NOAC) dabigatran, rivaroxaban and apixaban have been shown to be non-inferior to VKA for stroke prevention in AF. We summarize the knowledge about primary and secondary stroke prevention by NOAC in AF patients >75 years of age. A literature search was carried out using the terms 'dabigatran', 'rivaroxaban', 'apixaban', 'elderly', 'octogenarians', 'atrial fibrillation' and 'anticoagulation' from 1998 to 2013. Randomized clinical trials, longitudinal studies, case series and case reports were included. Whereas studies investigating the use of VKA for stroke prevention in the 1990s were carried out by industry-independent institutions, all NOAC-investigating trials were sponsored by the manufacturers of the respective drugs. Frail elderly people were not represented in NOAC-investigating trials because of various exclusion criteria, and only one-third of patients were aged >75 years. A subgroup analysis from the dabigatran-investigating trial indicated that elderly patients might have a higher risk for extracranial bleeding complications with NOAC than with VKA. Further concerns about the use of NOAC in the elderly are the high prevalence of renal insufficiency in AF patients >75 years of age, the largely unknown risk of drug-drug and drug-food interactions, the lack of easily available laboratory monitoring tests of anticoagulant activity and the lack of an antidote. There is a need for independent studies comparing the efficacy and risk of side effects of NOAC with that of VKA in elderly AF patients.

The importance of oral health in (frail) elderly people – a review

Two important factors contribute to a higher chance of a deterioration of oral health status in frail and disabled elderly people. First, advances in oral health care and treatment have resulted in a reduced number of edentulous individuals and the proportion of adults who retain their teeth until late in life has increased substantially. Second, neglected self-care and/or professional care have led to reduced oral health care utilization. This review reports the consequences of having a poor oral health status and its impact on general health of frail elderly people and gives an overview of the important enabling and disabling factors regarding the provision of oral health care to frail older persons. Impaired cognitive and functional ability, medication-induced hyposalivation, reduced saliva buffer capacity and high saliva acidity, diabetes mellitus, the number of exposed root surfaces due to gingival recession, poor oral hygiene, high frequency of sugar consumption, and poor socio-economic conditions are the major predisposing conditions for the upsurge of caries in older population groups. Poor oral hygiene, tobacco smoking, and excessive alcohol consumption together with some systemic diseases, such as metabolic syndrome, rheumatoid arthritis, diabetes mellitus and post-menopausal osteoporosis are reported to be important risk factors for periodontal disease and later on peri-implantitis. Although during recent years increasing attention has been given to improving oral health care for frail old people, there is ample evidence showing that the oral health of elderly people, in particular of care home residents is (still) poor. The introduction of innovative care pathways to improve oral health care of elderly people by implementing new guidelines or health care models appears to be a complex process. Therefore, a poor oral health status might be regarded as a new geriatric giant in frail elderly people, which deserves urgent attention of scientists, health care providers and policymakers.

Inhibidores de la bomba de protones: estudio de prescripción en una Unidad de Recuperación Funcional

IntroductionThe use of proton pump inhibitors (PPI) has increased exponentially since they were introduced. However concerns have been raised regarding the appropriateness of these prescriptions, and the potential side effects, particularly in frail elderly people, as well as the cost of this treatment. The aim of this study was to assess the extent and appropriateness of PPI prescribing in a group of patients over 65 years old admitted to the functional recovery unit of a medium-stay hospital. Materials and methodsA retrospective review of inpatient prescribing of PPI was carried out in a functional recovery unit in Hospital de la Fuenfría, selecting those older than 65 years, who were admitted during 2011. Data obtained from medical records included, prescription of a PPI before admission and at the time of discharge from hospital (both acute care hospital and Hospital de la Fuenfría), type of PPI, and indications for their prescription. ResultsInclusion criteria were met by 296 patients (mean age 78.8 years, 70.6% females). A total of 45.3, 79.1 and 75.5% of patients were on PPIs before admission, and at the time of being discharge from acute care hospital, and Hospital de la Fuenfría, respectively. A valid indication for therapy was not apparent in 62.7, 30.8 and 54.2% of them. Omeprazole was the most widely prescribed PPI. ConclusionsThere appears to be a widespread and inappropriate use of PPIs in hospital practice. Interventions are needed to curtail this inappropriate prescribing practice, avoiding side effects and drug interactions.

The Sociotechnical Challenge of Integrating Telehealth and Telecare into Health and Social Care for the Elderly

Telehealth and telecare have been heralded as major mechanisms by which frail elderly people can continue to live at home but numerous pilot studies have not led to the adoption of these technologies as mainstream contributors to the health and social care of people in the community. This paper reviews why dissemination has proved difficult and concludes that one problem is that these technologies require considerable organisational changes if they are to be effective: successful implementation is not just a technical design issue but is a sociotechnical design challenge. The paper reviews the plans of 25 health communities in England to introduce integrated health and social care for the elderly. It concludes that these plans when implemented will produce organisational environments conducive to the mainstream deployment of telehealth and telecare. However, the plans focus on different kinds of integrated care and each makes different demands on telehealth and telecare. Progress on getting mainstream benefits from telehealth and telecare will therefore depend on building a number of different sociotechnical systems geared to different forms of integrated care and incorporating different forms of telehealth and telecare.

The impact of protein supplementation on cognitive performance in frail elderly

Maintenance of cognitive abilities is important for elderly to stay independent. With the aging of the population, the call for modifiable factors is emerging. Dietary protein might improve cognitive performance; however, this has hardly been studied. Therefore, we studied the impact of 24-week dietary protein supplementation on cognitive performance in pre-frail and frail elderly people. Pre-frail and frail elderly subjects, according to the Fried criteria, randomly received a protein drink containing 15 g protein or a placebo drink twice a day. Cognitive performance was measured at baseline and after 24 weeks by means of a sensitive neuropsychological test battery. In addition, reaction time was assessed after both 12 and 24 weeks of intervention. Domain scores were calculated for the domains episodic memory, attention and working memory, information processing speed, and executive functioning. Analyses of covariance were used to determine differences between groups. Linear mixed models were used to determine differences in reaction time over time and per treatment. In total, 65 subjects (79 ± 8 years) with a median Mini-Mental State Examination score of 28 (interquartile range 26-30) were included. Reaction time improved more in the protein group (68 ms) than in the placebo group (18 ms, P = 0.03). Dietary protein had no significant effect on any of the cognitive domain scores. Protein supplementation might improve reaction time performance in pre-frail and frail elderly, but did not improve other cognitive functions.

Multimorbidity in frail elderly people and the risk of death and readmission to a healthcare institute

Multimorbidity in frail elderly people and the risk of death and readmission to a healthcare institute

Preventing and Managing Indoor Falls with Home-Based Technologies in Mild and Moderate Alzheimer's Disease Patients: Pilot Study in a Community Dwelling

Background: Alzheimer's disease (AD) is known to increase the risk of falls. We aim to determine the effectiveness of home-based technologies coupled with teleassistance service (HBTec-TS) in older people with AD. Methods: A study of falls and the HBTec-TS system (with a light path combined with a teleassistance service) was conducted in the community. The 96 subjects, drawn from a random population of frail elderly people registered as receiving an allocation for lost autonomy from the county, were aged 65 or more and had mild-to-moderate AD with 1 year of follow-up; 49 were in the intervention group and 47 in the control group. Results: A total of 16 (32.7%) elderly people fell in the group with HBTec-TS versus 30 (63.8%) in the group without HBTec-TS. The use of HBTec-TS was significantly associated with a reduction in the number of indoor falls among elderly people with mild-to-moderate AD (OR = 0.37, 95% CI = 0.15-0.88, p = 0.0245). Conclusion: The use of the HBTec-TS significantly reduced the incidence of primary indoor falling needing GP intervention or attendance at an emergency room among elderly people with AD and mild-to-moderate dementia.

Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people

Serum 25-hydroxyvitamin D (25(OH)D) status has been associated with muscle mass, strength and physical performance in healthy elderly people. Yet, in pre-frail and frail elderly people this association has not been studied. The objective of this study was to explore the association between vitamin D intake and serum 25(OH)D status with muscle mass, strength and physical performance in a pre-frail and frail elderly population. This cross-sectional study included 127 pre-frail and frail elderly people in The Netherlands. Whole body and appendicular lean mass (ALM) (dual energy X-ray absorptiometry), leg strength (one repetition maximum), handgrip strength and physical performance (short physical performance battery) were measured, and blood samples were collected for the assessment of serum 25(OH)D status (liquid chromatography-tandem mass spectrometry). In addition, habitual dietary intake (3-day food records) and physical activity data (accelerometers) were collected. In total, 53% of the participants had a serum 25(OH)D level below 50 nmol/l. After adjustment for confounding factors, 25(OH)D status was associated with ALM (β=0.012, P=0.05) and with physical performance (β=0.020, P<0.05). Vitamin D intake was associated with physical performance (β=0.18, P<0.05) but not with ALM (P>0.05). In this frail elderly population, 25(OH)D status is low and suggests a modest association with reduced ALM and impaired physical performance. In addition, vitamin D intake tended to be associated with impaired physical performance. Our findings highlight the need for well-designed intervention trials to assess the impact of vitamin D supplementation on 25(OH)D status, muscle mass and physical performance in pre-frail and frail elderly people.

小規模介護施設を利用している在宅要介護高齢者の地域居住を支える「関係性を支えるケア」の方策--高齢者と地域の相互関係の構築に関する研究

小規模介護施設を利用している在宅要介護高齢者の地域居住を支える「関係性を支えるケア」の方策--高齢者と地域の相互関係の構築に関する研究

Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart

A rapidly increasing proportion of people in high-income countries are surviving into their tenth decade. Concern is widespread that the basis for this development is the survival of frail and disabled elderly people into very old age. To investigate this issue, we compared the cognitive and physical functioning of two cohorts of Danish nonagenarians, born 10 years apart. People in the first cohort were born in 1905 and assessed at age 93 years (n=2262); those in the second cohort were born in 1915 and assessed at age 95 years (n=1584). All cohort members were eligible irrespective of type of residence. Both cohorts were assessed by surveys that used the same design and assessment instrument, and had almost identical response rates (63%). Cognitive functioning was assessed by mini-mental state examination and a composite of five cognitive tests that are sensitive to age-related changes. Physical functioning was assessed by an activities of daily living score and by physical performance tests (grip strength, chair stand, and gait speed). The chance of surviving from birth to age 93 years was 28% higher in the 1915 cohort than in the 1905 cohort (6·50% vs 5·06%), and the chance of reaching 95 years was 32% higher in 1915 cohort (3·93% vs 2·98%). The 1915 cohort scored significantly better on the mini-mental state examination than did the 1905 cohort (22·8 [SD 5·6] vs 21·4 [6·0]; p<0·0001), with a substantially higher proportion of participants obtaining maximum scores (28-30 points; 277 [23%] vs 235 [13%]; p<0·0001). Similarly, the cognitive composite score was significantly better in the 1915 than in the 1905 cohort (0·49 [SD 3·6] vs 0·01 [SD 3·6]; p=0·0003). The cohorts did not differ consistently in the physical performance tests, but the 1915 cohort had significantly better activities of daily living scores than did the 1905 cohort (2·0 [SD 0·8] vs 1·8 [0·7]; p<0·0001). Despite being 2 years older at assessment, the 1915 cohort scored significantly better than the 1905 cohort on both the cognitive tests and the activities of daily living score, which suggests that more people are living to older ages with better overall functioning. Danish National Research Foundation; US National Institutes of Health-National Institute on Aging; Danish Agency for Science, Technology and Innovation; VELUX Foundation.

The Opportunity for “Design” to Influence the Ageing Process Itself

The unprecedented shift in the age composition of the world, which the JPA has often highlighted, will impact upon all aspects of society—how we live, how we work, how we play and consume, and importantly the environments within which we do this. For the world of design this brings not only the growing necessity of engaging with this demographic trend, but also the opportunities and advantages of doing so. There are, however, many myths surrounding this “grey burden”. The first misconception is that ageing populations herald a world of disabled frail elderly people requiring purpose-built geriatric care centres. Rather, we are heading for a future with fit, active, older adults, who will need to adapt their living and working environments to cope with their slow reduction in physical, sensory, and sometimes mental, capacity. Nowhere will this occur more than in the arena of domestic architecture and design—for it is here, in our homes, that most of us will spend the last decades of our lives. Current design interest, however, is still focusing on the “care” environment” with purpose built accommodation—sheltered housing and assisted living—comprising floor drainage suitable for a roll-in shower, wide staircases with handrails, and features which prevent falls, such as non-slip bathroom and kitchen floors. Driven by the growing need for long term eldercare in the community, both the UK and US, for example, will face a 30% increase in those over 80 during the next two decades, this has promoted the development of so-called hybrid homes—a combination of private living and community space. Retirement villages, like De Paul Manor Estate on Australia’s Gold Coast, the UK’s Westbury Fields in Bristol, and Wexford Creek Campus of Care, in Nanaimo, British Columbia, Canada, all combine housing, apartments and care facilities within the one complex. While good design within caring environments is important, it ignores the opportunity for innovative creative design for the growing segment of the population who will remain active and independent well into their 80’s, but will benefit from some Population Ageing (2013) 6:157–159 DOI 10.1007/s12062-013-9087-y

Prevalencia de quedas de idosos em situacao de fragilidade

To measure the prevalence in frail elderly people, their consequences and associated demographic factors. This was an epidemiological and cross-sectional study with a probabilistic sample composed of 240 elderly people (≥ 60 years) living in Ribeirão Preto, Sao Paulo state. Data were collected between November 2010 and February 2011, through a questionnaire that included socio-demographic data, fall assessment and the Edmonton Frailty Scale. Uni-variate and bivariate analyses were carried out. The mean age was 73.5 (± 8.4), with higher ages among women; 25% of the interviewees were aged 80 or older; 11.3% presented moderate frailty and 9.6% severe frailty. The prevalence of falls in frail elderly participants corresponded to 38.6%; higher levels were found among women and younger subjects (60 to 79 years old); 26.8% were victims of 1 to 2 falls, 27.1% of which occurred in the bedroom, 84.7% fell from their own height, 55.9% lost their balance, 54.2% suffered scratches and 78% were afraid of suffering a new fall. Higher fall prevalence levels were found in frail elderly 1,973 (1,094-3,556) compared to non-frail. We highlight the importance of addressing the health of frail elderly people, especially regarding the risk of falls, as well as of increasing investment in prevention strategies of these syndromes and in the formation of train like a virgin ed human resources to better care for this population.

End of life care for frail older patients in family practice (ELFOP) – protocol of a longitudinal qualitative study on needs, appropriateness and utilisation of services

BackgroundFrail elderly people represent a major patient group in family practice. Little is known about the patients’ needs, and how their needs evolve over time with increasing frailty towards the end of life. This study will address end-of-life care needs, service utilisation, and experiences of frail elderly patients and their informal caregivers, with regard to family practice. This paper aims to introduce the research protocol.Methods/DesignThe study uses a multiple perspective approach qualitative design. The first study part consists of serial six-monthly in-depth interviews with 30 community-dwelling elderly patients (≥70 years) with moderate to severe frailty and their key informal caregivers, over a period of 18 months. Additionally, semi-structured interviews with the patients’ family physician will be conducted. The serial interviews will be analysed with grounded theory and narrative approaches. Special attention will be paid to the comparison of distinct views of the patients’, informal caregivers’, and family physicians’ as well as on chronological aspects. In the second study part, five focus groups with experts in family medicine, geriatrics, palliative medicine, and nursing will be conducted. Finally, the implications for family practice and health care policy will be discussed in an expert workshop.DiscussionTo our knowledge, this is the first prospective, longitudinal qualitative study on the needs of elderly patients with advanced frailty towards the end of life in German family practice, which integrates the perspectives of patients, informal caregivers, family physicians and other health professionals. The study will contribute to the understanding of the clinical, psychosocial and information needs of patients and their caregivers, and of respective changes of experiences and needs along the illness/frailty trajectory including the last phase of life. It will provide an empirical basis for improving patient-centred care for this increasingly relevant target group.

Application of Pole Walking to Day Service Centers for Use by Community-dwelling Frail Elderly People

In an aging society, it is important to provide community-dwelling frail elderly with ongoing social services to maintain and improve their physical function. The purpose of this study was to investigate the effects of physical fitness, posture, and quality of life (QoL) on community-dwelling elderly using pole walking at a day service center. Participants were recruited from day service users, and a control group and intervention (pole walking) group were randomly selected. Pole walking group members were allowed to use poles during walking and ambulation in the daily routine of a day service center for 3 months. Thirty-five and 22 participants in the control and pole walking groups, respectively, were measured for physical fitness, posture, and QoL at the baseline and at the final session, and the measurements were compared to pre- and postintervention levels in both groups. In the control group, a timed up and go test after 3 months was performed significantly slower than at baseline ( p < 0.05, power = 0.13, effect size = 0.13). The Physical Component Summary score of the MOS 8-item Short Form Health Survey was significantly increased compared to the score at baseline ( p < 0.01, power = 0.64, effect size = 0.47) in the pole walking group. The effects of 3 months of pole walking on community-dwelling elderly day service users showed improved Physical Component Summary scores of higher QoL. However, there was no significant effect of physical functions due to the intervention.

동영상을 이용한 근력 강화 운동이 허약 여성노인의 악력, 균형, 이동능력에 미치는 영향

PURPOSE: The purpose of this study was to investigate characteristics of the effects of a video strength exercise on grip strength, balance, timed up and go in the frail elderly women. METHODS: Subjects were thirty frail elderly people selected by the screening tool and they were divided into exercise group and control group. The video strength exercise was carried out for three time a week for 12 weeks. Data was analyzed with independent t-test between exercise and control group and paired t-test between before and after. RESULTS: There were not significant differences between exercise and control group. However, there were significant effects between before and after in exercise group. The grip strength and one-leg stand with eyes open were significant improved and timed up and go was significant decreases. CONCLUSION: These results indicate that the video strength exercise for the frail elderly was very effective on improving grip strength and one-leg stand and timed up and go.

Surgery in elderly people: Preoperative, operative and postoperative care to assist healing

Surgery for elderly women is likely to increase steadily as the population of elderly people increases globally. Although increasing age increases perioperative morbidity and mortality, the functional age and physiologic reserve rather than chronological age is more important in preventing complications. Preparation for surgery, with special attention to functional capacity and activity, mental status, and existing comorbid conditions, can improve outcomes. Perioperative management must be tailored to physiologic changes of ageing, which affect respiratory, cardiac and renal function, as well as guidelines for preventing infection and thrombotic events. Of particular note is the enhanced effect of narcotic medications in elderly people, which affects intraoperative and postoperative management of pain. Prevention of postoperative delirium is accomplished through preoperative and postoperative planning. Discharge planning, particularly for frail elderly people, must start before surgery.