Frail Elderly Persons Research Articles

We Still Can't Wait

The summer of 2021 Editor's Message, “Why We Can't Wait,” highlighted health disparities that the COVID-19 pandemic only increased. We called on clinicians to advocate for health equity and for researchers to investigate the effect of health disparities in rehabilitation. Rehabilitation Oncology announced a call for papers for a special issue in 2023 focusing on health disparities in cancer rehabilitation and sought original research examining gaps in access, quality, and affordability of rehabilitation as well as the effect of disparities on disability. It is now 2023. We may have emerged from the strict confines of the pandemic; we may be emerging from our stay-at-home lives and have moved toward full participation in society. We may be going to work and seeing patients in person, enjoying dinner out with our friends and families, and we might be thinking the pandemic is retreating in the distance. But this retreat is not enjoyed equally by all. It is not true for those still unable to access care or only can access care of lesser quality or quantity. Health disparities persist despite the attention brought by the pandemic. Although we had hoped to provide our readership with a special issue that focused on this critical issue, our call for papers was met with a feeble response. The Rehabilitation Oncology Editorial Board met to discuss why this may have happened. The reasons likely vary—from inability to access data to burnout (unable to deliver a manuscript within the time frame required). While some may have wished to contribute, busy schedules that have only seemed to continue and intensify post–COVID-19 did not allow some to be able to prioritize the importance of this solicitation. But ultimately, we believe the reason we cannot deliver for our clinician community is because there is a relative dearth of research focused on health disparities in cancer rehabilitation. Given the statistics—nearly 2 million people are diagnosed with cancer each year in the United States, more than 18 million are surviving cancer,1 and documented evidence that survival rates and quality of life are lower in underrepresented minority groups2—one wonders why is this? There is a bit of shame as well. We can and should be doing more and doing better. Burnout is real. Competing priorities are real. But ultimately, to those in underrepresented groups receiving a different care experience, it does not matter. Our profession is not stepping up to meet the needs of those in our community and we must do better. Please read the 3 pieces in this issue that do provide insight into health disparities—from our guest Letter to the Editor about the cancer experience to a systematic review focused on the disparities among the frail elderly persons with cancer when addressing pain, and an excellent perspective providing an example model of how to address disparities at the local community level. Clinicians, ask yourselves what you can do. Researchers, find ways to investigate barriers to care so that our profession can find ways to dismantle them. All of us have a responsibility to address this critical issue.

Trustful conversations: a qualitative interview study on older patients' experiences of the intervention Proactive healthcare in a Swedish primary care setting.

To explore older patients' experiences of the intervention Proactive healthcare for frail elderly persons. Previous research has indicated that continuity and good access to primary care can improve satisfaction in older people seeking care. However, little is known about the older patients' experiences in taking part of interventions aiming to enhance the care. Individual interviews were conducted with 24 older patients who participated in the intervention Proactive healthcare for frail elderly persons, selected from nine Swedish primary care centres. Interviews were analysed using qualitative content analysis. Older patients' experiences of the intervention involved five manifest categories: Ways of naming the elder care team, covering the older patients' lack of understanding regarding their connection to the team, and the need for clarity on this and on how the specialised care provided differed from conventional care; Availability, indicating how older patients associated easy access and a direct telephone number with a team nurse available at certain times with a sense of security; The importance of relations, covering how patients appreciated continuity in their personal and professional conversations with staff; A feeling of safety and trust, stressing the value of older persons attach to being given enough time, to be listened to and being recognised as people; and Finiteness of life, which refers to the difficulty of having end-of-life conversations and the need for experienced staff with personal knowledge of the patients. The latent theme Trustful conversations was created to give a deeper meaning to the content of the categories.Trustful conversations, created through good personal knowledge of patients and continuity of contact, engender a feeling of safety in older patients. Using elder care teams could result in a better quality of care, with increased satisfaction and feelings of security among patients, and a reduction in healthcare needs.

Nursing Diagnoses, Planned Outcomes and Associated Interventions with Highly Complex Chronic Patients in Primary Care Settings: An Observational Study.

The information logged by nurses on electronic health records (EHRs) using standardised nursing languages can help us identify the characteristics of highly complex chronic patients (HCCP) by focusing on care in terms of patients' health needs. The aim of this study was to describe the profile of HCCPs using EHRs from primary care (PC) facilities, presenting patients' characteristics, functional status based on health patterns, NANDA-I nursing diagnoses, health goals based on Nursing Outcomes Classification (NOC), and care interventions using Nursing Interventions Classification (NIC). With an observational, descriptive, cross-sectional, epidemiological study design, this study was carried out with a sample of 51,374 individuals. The variables were grouped into sociodemographic variables, clinical variables, resources, functional status (health patterns), nursing diagnoses, outcomes, and interventions. A total of 57.4% of the participants were women, with a mean age of 73.3 (12.2), and 51% were frail or dependent. Prevalent conditions included high blood pressure (87.2%), hyperlipidaemia (80%), osteoarthritis (67.8%), and diabetes (56.1%). The participants were frequent users of healthcare services, with 12.1% admitted to hospital in the past year. Some 49.2% had one to four health patterns assessed, with more information on biological and functional aspects than on psychosocial aspects. The mean number of nursing diagnoses was 7.3 (5.2), NOC outcomes 5.1 (4.1), and NIC interventions 8.1 (6.9). Moderately and highly significant differences were observed between dysfunction in physical activity/exercise health pattern and age group, and between dysfunction in other health patterns and classification as a frail or dependent elderly person. Regarding the presence of certain nursing diagnoses, significant differences were observed by age group, classification of elderly person status, and presence of diseases. A total of 20 NIC interventions showed moderately or relatively strong associations for older age groups, higher levels of dependency, and chronic health conditions.

‘Do you have a future when you are 93?’ Frail older person’s perceptions about the future and end of life – a qualitative interview study in primary care

Objective To explore frail older persons’ perceptions of the future and the end of life. Design Qualitative content analysis of individual semi-structured interviews. Setting Nine primary health care centres in both small and middle-sized municipalities in Sweden that participated in the intervention project Proactive healthcare for frail elderly persons. Subjects/Patients The study includes 20 older persons (eight women and 12 men, aged 76–93 years). Main outcome measures Frail older persons’ perceptions of the future and end of life. Results The analysis uncovered two main categories: Dealing with the future and Approaching the end of life. Dealing with the future includes two subcategories: Plans and reflections and Distrust and delay. Approaching the end of life includes three subcategories: Practical issues, Worries and realism, and Keeping it away. Conclusion This study highlights the diverse ways older people perceive future and the end of life. The results make it possible to further understand the complex phenomenon of frail older persons’ perceptions on the future and the end of life. KEY POINTS The study found that older persons described their future as contradictory- with a broad spectrum of approaches, where some wanted to deal with these subjects and others wanted to ignore them. •Older persons that consciously planned for the future had tactics that often were related to goals that functioned as motivators to live longer. •Those who adopted a more passive approach did not think about what the future might hold in terms of losing autonomy and deteriorating health. •Older persons that approached end of life in a more proactive way wanted to plan practical arrangements around death but often found it hard to address this issue with relatives. •Those older persons that had a more passive approach to end of life preferred not to think about those issues, and some explicitly stated that they did not want to address the final period of life.

Oral Health and Undernutrition in the Frail Elderly Persons.

Although many studies associate a poor state of oral health with the risk of undernutrition in both the autonomous and dependent elderly, very few of them consider the frail elderly person. However, the identification of the frail elderly is one of major issues of modern geriatrics. It is at this stage that preventive strategies are the most effective against the risks of dependency. The main objective of our study is to explore the nature of the association between oral health and undernutrition in the frail elderly patient, and to identify the associated factors. We have used the data of an observational transversal monocentric study, conducted among a population of patients hospitalized for frailty assessment at the Geriatric Frailty Clinic (G.F.C.) for Assessment of Frailty and Prevention of Disability. The enrolment site is the Cité de la Santé, at Toulouse University Hospital. Data were collected from January 25, 2016 February 2, 2018. The data collected sociodemographic characteristics, oral health (Oral Health Assessment Tool), nutritional status (Mini Nutritional Assessment), Body Mass Index, and weight loss according to Fried), frailty (Fried criteria), functional status (Mini Mental State Examination, Activity of Daily Living, Instrumental Activity of Daily Living, Geriatric Depression Scale-15), and behavior (tobacco and alcohol). We included 1,155 subjects with an average age of 81.9 years, including 65% women. Bivariate analysis indicated a statistically significant association (p<0.05) between a pathological state of oral health and undernutrition, particularly with regard to decay of natural teeth, pathologies of the tongue, gums and tissues, dry mouth, lack of oral cleanliness and presence of dental pain. Multivariate analysis adjusted for socio-demographic, behavioral and functional data confirmed some of these associations, notably between the item gum/mucous membrane and the decrease of the score (p<0.01); this same item and weight loss according to Fried (p<0.01), and the item tongue and weight loss (p<0.05). A statistically significant association appeared between the state of oral health and frailty (item tongue (p<0.01)). Our study shows a statistically significant association between a pathological state of oral health and nutrition disorders in the frail elderly person. This result confirms the hypothesis postulating that a poor state of oral health would be associated with nutritional disorders among the frail elderly. Our analysis also shows a statistically significant association between a deteriorated state of oral health and frailty. Tongue diseases here increase the risk of frailty for the patient. Our results are, however, limited and do not allow for an analysis of causal effect. It would be useful to complete our study by more refined analyses of risk factors, conducted on a larger sample, and with a follow-up patients over time. We show here the importance of targeting the frail population in order to screen for oral disease and refer patients for dental care. Ensuring oral health care of frail patients seems indispensable if they are to maintain not only a healthy nutritional state, but also a satisfactory general state of health, thus allowing for successful aging.

17.C. Workshop: I-Care Lab: Puglia scaling up in integrated care for the future of digital health and social system

Abstract Background Healthcare systems around the world are under great pressure to drive forward transformation in order to meet the evolving needs of their populations. Ageing and chronicity are the main challenges to be tackled. In many countries care is too often fragmented and has clear deficiencies in quality, inducing low responsiveness of the healthcare system and low satisfaction with healthcare services. To address these challenges, the transformation towards integrated care has the potential to address deficiencies in order to obtain accessible, quality, effective and sustainable health care. Objectives The objectives of this workshop are to present 3 innovative projects undertaken by Puglia Region, by means of its Strategic Regional Agency for Health and Social Care AReSS, within the framework of the I-CARE LAB, a think tank and beta site for integrated care focused on the production of evidence-based knowledge and systematic approaches to exploitation and scaling up of good practices. The workshop will present the results of the research that has taken place around the above-mentioned projects and to gather feedback from the participants on their opinions and perspectives about integrate care models, policies, tools and practices. Results The featured projects are based on the collaboration with national and international partners interested in developing tools and approaches to stimulate changes towards more sustainable health and care systems, and in supporting scalability and transferability of good practices in Europe. The knowledge transfer among these institutions represents the added value that can establish a common language and framework of integrated care. The showcased projects focus on vulnerable populations for which integrated care might be most beneficial, e.g., chronically ill, frail elderly, and multi-morbid persons; the projects have identified and described an impressive number of promising practices; there are several plans to evaluate these in the coming years, and other plans to facilitate the wider-spread implementation and scaling up of such programs. During this session, 3 of such projects will present their findings, approaches and connections: SCIROCCO Exchange (assessment of integrated care interventions), FooDia-NET (patient engagement and literacy), EURIPHI (innovation procurement). Conclusions The workshop will be a 90-minute session with 3 presentations with ample time for audience interaction (30-minutes). Three individual members of the above-mentioned projects will be responsible for conducting the workshop (the chair, and 3 people making 3 presentations). The session will be chaired by the AReSS Puglia CEO, who will introduce the workshop. A set of presentations will follow, covering the different session topics corresponded to the 3 projects of the Puglia I-Care Lab. Participants will be asked to actively join in the discussion on the further projects enhancement. Key messages The first impact of the proposed workshop consists of stimulating knowledge and discussion about emerging tools and approaches in Europe towards more sustainable health and care systems. The second expected impact is to create awareness and to support scalability and transferability of good practices in Europe and abroad.

Technological Services in Shared Housing: Needs Elicitation Method from Home to Living Lab

Housing under a shared housing organisation enables frail elderly persons to live in a semi autonomous way, thanks to cooperation between residents and an assistant. The social organization of this new type of housing also has an impact on the social participation of users. This article is based on a pilot study and deals with the benefits of digital technologies and “ambient intelligence” used to answer the needs of such a way of living.The pilot study was carried out in a house shared by 6 co-tenants. The qualitative method used first consisted in a characterisation of the 6 inhabitants. This was followed by semi-structured interviews about their sensed needs, and a focus group, with 5 of the 6 co-tenants, in order to gain an initial consensus about needs.This result was confronted to the demands of the assistants, collected through interviews. A usage scenario was developed in a smart home (Maison Intelligente de Blagnac). This scenario was performed by three of the inhabitants and followed by a second focus group and a narrative interview with the assistants and the designers of the shared house. This article reports the method which was carried out and the needs expressed by the co-tenants.

Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation

BackgroundAlmost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme.MethodsIn this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme.ResultsA part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme.ConclusionThis study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients.

Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons.

To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons. Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia. The participants were 3475 independent Japanese elderly persons (≥65years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis. The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR=1.35; 95% CI=1.08-1.68), chewing ability (AOR=1.70; 95% CI=1.32-2.18), oral dryness (AOR=1.94; 95% CI=1.48-2.54), physical function (AOR=2.19; 95% CI=1.66-2.90), cognitive function (AOR=1.68; 95% CI=1.34-2.12) and depressive mood (AOR=1.82; 95% CI=1.41-2.35). Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65years.

Societal costs of informal care of community-dwelling frail elderly people.

Aims: The aims of this study are to describe informal care activities and to estimate the societal cost of informal care of community-dwelling frail elderly people in Sweden. Methods: This study was performed within the frame of the TREEE project that included 408 frail elderly patients. At index hospitalisation (baseline), primary informal caregivers of the patients were provided with a questionnaire on informal care during a period of three months. Questions concerning other (secondary) informal caregivers were also included. A rough estimate of the total cost of informal care of frail elderly people in Sweden was obtained by combining data from this study with published data and official statistics. Results: In total, 176 informal caregivers responded, and 89% had provided informal care. The informal caregivers (primary and secondary) provided care for an average of 245 hours over three months. Taking care of the home was the dominating activity. In total, the mean cost of informal care was estimated to approximately 18,000 SEK (€1878) over three months, corresponding to an annual cost of approximately 72,000 SEK (€7477) per frail elderly person. The total annual societal costs of informal care of community dwelling frail elderly people aged 75 years and older in Sweden was estimated to be approximately 11,000 million SEK (€1150 million). Conclusions: The care of frail elderly people provided by informal caregivers is extensive and represents a great economic value. Although our calculations are associated with uncertainty, the size indicates that supporting informal caregivers should be a priority for society.

Frailty and cognitive performance in older adults living in the community: a cross-sectional study

Abstract Background Cognitive impairment and frailty are important problems affecting the elderly population. Frail elderly present worse overall cognitive performance. Objective The aim of this study was to investigate general and domain-specific cognitive performance among non-frail, pre-frail, and frail elderly persons. Methods This is a cross-sectional study in which 267 elderly persons living in Sao Carlos, SP were divided into three groups according to the frailty criteria defined by Fried et al. Cognitive performance was evaluated with a battery of cognitive tests covering domains such as memory, attention, language, and executive functioning. A multinomial logistic regression analysis adjusted for age, gender, and education was performed to evaluate the association between performance in cognitive domains and levels of frailty. Results Frailty was significantly associated with lower scores on the global cognitive test (RRR = 0.86; IC 95% 0.78-0.96; p < 0.01), word list memory (RRR = 0.92; IC 95% 0.86-0.99; p = 0.02), and figure list recognition (RRR = 0.78; IC 95% 0.62-0.99; p = 0.04). Pre-frailty was associated with lower scores on the word list memory (RRR = 0.92; IC 95% 0.86-1.00; p = 0.04) and naming test (RRR = 0.82; IC 95% 0.69-0.99; p = 0.03). Discussion Frailty syndrome can influence general cognition and specific domains such as memory and language. Prospective studies will be fundamental to evaluate the causal relation between frailty and cognition.

FRAILTY MEDIATES SENILITY IN MEXICAN AMERICANS

The latent construct “d” (for “dementia”) offers a continuously distributed transdiagnostic dementia severity metric. Age is significantly associated with “d”. We test whether frailty mediates age’s effect on 6 year prospective change in dementia severity in Mexican-Americans (MA), using data from the Hispanic Established Population for Epidemiological Studies in the Elderly (HEPESE). Age was regressed onto the 6yr prospective slope of change in “d” in N = 880 [mean age = 77.4 (6.1) at wave 3]. Change in “d” was estimated by a latent growth curve (LGC) indicated by latent cognitive measures across three HEPESE waves (i.e., 3, 5 and 6). “Frailty” was assessed by a modified version of Fried et al.’s construct observed at wave 5, and was tested as a mediator of age’s association with change in “d”. The mediation effect was estimated by MacKinnon’s method. “d” at each wave, and the LGC of change in “d” all had acceptable model fit (e.g. RMSEA <.05). Age was significantly associated with change in “d”. 51% of their association was explained by frailty. Frailty mediates the majority of age’s association with dementia severity. Not only does this support the existence of a cognitive “frailty” syndrome in MA, it also implicates an effect of frailty on intelligence (as “d” is derived from Spearman’s general intelligence factor “g”). Their association may be mediated by blood-based serum biomarkers, including somatomedins, which may offer targets for the treatment and /or prevention of senility in frail elderly persons.

QUALITATIVE FINDINGS AND THEMES IN REIMAGINING LTC: RESULTS ROUND 1 AND 2 OF THE NATIONAL DELPHI STUDY

From Round 1 we developed programmatic building blocks, which we classified as: housing suggestions; services suggestions; housing and/or technology heavy suggestions; policy or regulation suggestions;new philosophical approaches; and long-range social engineering. Besides the quantitatively ratings of the importance of each building block, respondents explained what they liked and disliked about each.. They frequently commented that environments rich in design features, amenities and activities would not be practical for low-income people. Respondents felt that some ideas would not be suitable for people with dementia because they would be insufficiently protected. Principles that seemed to be incompatible could be highly endorses; e.g., the principle that we prioritize people staying in their own homes and a principle that frail elderly persons living along should relocate to group residential settings to avoid social isolation. This paper concludes with a list of areas for further discussion by work groups.

Respiratory syncytial virus (RSV): a scourge from infancy to old age

Respiratory syncytial virus (RSV) is the most common single cause of respiratory hospitalisation of infants and is the second largest cause of lower respiratory infection mortality worldwide. In adults, RSV...

Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden

IntroductionThe provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and...

Effects of health care interventions on quality of life among frail elderly: a systematized review.

IntroductionMany health care interventions have been developed that aim to improve or maintain the quality of life for frail elderly. A clear overview of these health care interventions for frail elderly and their effects on quality of life is missing.PurposeTo provide a systematic overview of the effect of health care interventions on quality of life of frail elderly.MethodsA systematic search was conducted in Embase, Medline (OvidSP), Cochrane Central, Cinahl, PsycInfo and Web of Science, up to and including November 2017. Studies describing health care interventions for frail elderly were included if the effect of the intervention on quality of life was described. The effects of the interventions on quality of life were described in an overview of the included studies.ResultsIn total 4,853 potentially relevant articles were screened for relevance, of which 19 intervention studies met the inclusion criteria. The studies were very heterogeneous in the design: measurement of frailty, health care intervention and outcome measurement differ. Health care interventions described were: multidisciplinary treatment, exercise programs, testosterone gel, nurse home visits and acupuncture. Seven of the nineteen intervention studies, describing different health care interventions, reported a statistically significant effect on subdomains of quality of life, two studies reported a statistically significant effect of the intervention on the overall quality of life score. Ten studies reported no statistically significant difference between the intervention and control groups.ConclusionReported effects of health care interventions on frail elderly persons’ quality of life are inconsistent, with most of the studies reporting no differences between the intervention and control groups. As the number of frail elderly persons in the population will continue to grow, it will be important to continue the search for effective health care interventions. Alignment of studies in design and outcome measurements is needed.

Management of Frailty at Individual Level: Narrative Review of Physical Activity from the European Perspective of Joint Action on Frailty - JA Advantage.

IntroductionThis paper aimed to review the effect of physical activity and exercise in frail older persons. As the process which leads to frailty and disability can be slowed down or even completely reversed, it can be appropriate for early interventions.MethodologyA literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published from 2002 to 2017. From 620,043 initial hits, 25 publications were selected.ResultsPhysical activity and exercise in frail elderly are effective and relatively safe and may reverse frailty.ConclusionDifferent exercise interventions in frail elderly persons can increase strength and power, improve balance and reduce fall incidence resulting in greater quality of life. From this perspective, physical exercise interventions should become daily routine in frail elderly persons.

Outcome of interventions in elderly persons classified according to the Fried frailty phenotype: an integrative review

Abstract Objective: To analyze the interventions carried out with elderly persons classified according to the Fried frailty phenotype criteria and the outcomes obtained. Method: The PubMed, Embase, Scopus, CINAHL, PEDro, SciELO, BVS and Web of Science portals were used, and a manual search was applied to identify the interventions implemented in elderly persons aged over 60 years, which were able to modify the scores of the frailty phenotype criteria and other outcomes. Results: The final sample totaled 14 randomized clinical trials published between 2001 and 2018. The combined interventions of exercise, orientation and nutritional supplementation with or without cognitive training presented better outcomes for the frailty criteria and other clinical outcomes in pre-frail and frail elderly persons living in the community and in long-term care facilities. Conclusion: The implementation of combined interventions sustains frailty as a reversible and multifactorial syndrome.

Design and Evaluation of a Connected Insole to Support Healthy Aging of Frail Patients at Home

The main objective of this work is to develop a technological solution to support active aging of frail older individuals. In this perspective, we designed a connected insole in order to encourage frail elderly persons to become more active in their daily life. The project presented in this paper, funded by the French National Research Agency, aims to design and evaluate an original solution to follow and encourage walking activity. The evaluation is performed in two stages: adjusting tests in a living-lab with nine healthy elderly, then clinical evaluation of three frail patients followed over one month. We designed a noninvasive wireless insole, which automatically measures gait parameters and transmits information to a remote terminal via a secure Internet connection. The first laboratory tests of this technological solution showed good reliability measurements as well as good user acceptability. The average distance error obtained on volunteers is 3.2% and the accuracy of the average walking speed is 96.8% thanks to design of a calibration system based on a personalized stride length measurement. Finally, the introduction of an induction charging instead of a button cell makes the system perfectly autonomous. In this paper, we present the specifications of the solution, the design of the connected insole, the methods used to measure desired parameters, the results of the living-lab tests, and the work in progress.

Comprehensive geriatric assessment in Swedish acute geriatric settings.

Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly person's medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA. The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up. The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education. Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.