Group Of Older People Research Articles

Perceptions on Extending the Use of Technology after the COVID-19 Pandemic Resolves: A Qualitative Study with Older Adults.

The COVID-19 pandemic of the last two years has affected the lives of many individuals, especially the most vulnerable and at-risk population groups, e.g., older adults. While social distancing and isolation are shown to be effective at decreasing the transmission of the virus, these actions have also increased loneliness and social isolation. To combat social distancing from family and friends, older adults have turned to technology for help. In the health sector, these individuals also had a variety of options that strengthened eHealth care services. This study analyzed the technologies used during the COVID-19 pandemic by a group of older people, as well as explored their expectations of use after the pandemic period. Qualitative and ethnographic interviews were conducted with 10 Portuguese older adults, and data were collected over a period of seven months between 2020 and 2021. The research demonstrated that the use of current and new technologies in the post-pandemic future is likely to be related to overcoming: (i) insecurity regarding privacy issues; (ii) difficulties in using technologies due to the level of use of digital technology; and (iii) the human distancing and impersonal consequences of using these technologies.

Effect of Age on the Patterns of Traumatic Femoral Fractures: Seven Years of Experience at a Regional Tertiary Hospital

ObjectiveFemoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital.MethodsThe records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications.ResultsThe patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ 2 = 301.699, p < 0.001), osteoporosis (χ 2 = 375.463, p < 0.001), injury time of day (χ 2 = 114.913, p < 0.001), injury cause (χ 2 = 748.187, p < 0.001), injury location (χ 2 = 490.153, p < 0.001), fracture side (χ 2 = 57.000, p < 0.001), fracture site (χ 2 = 806.650, p < 0.001), associated injuries (χ 2 = 322.921, p < 0.001), coma after injury (χ 2 = 147.814, p < 0.001), non‐surgery‐related complications (χ 2 = 7.895, p = 0.019), and surgery‐related complications (χ 2 = 82.186, p < 0.001). The YA group had a significantly higher percentage of patients with surgery‐related complications than the OP group. The OP group had a higher frequency of non‐surgery‐related complications than the YA group and CH group. The most common non‐surgery‐related complications were pneumonia (7.1%) in the OP group and deep venous thrombosis (6.4%) in the YA group. Multivariable logistic regression showed that young adults, high‐energy injury, outdoors, coma after injury, and fracture sites except for the proximal region were independent risk factors for associated injuries. Older age, male, and fracture site except for the proximal region were independent risk factors for complications.ConclusionsTraumatic femoral fractures are mostly the result of low‐energy trauma and predominantly affect the proximal site of the femur among older people. A higher rate of shaft fractures, fractures occurring outdoors, and associated injuries were observed among young adults and children than among older people.

The impact of the absence of musical practice in a group of older people

The work that is presented collects a small sample of older people who participated in a choral group, whose activity was interrupted by covid19. The activities of this group gradually recovered, as the contagions decreased. A series of tests were carried out on a small sample after having resumed musical activity, during the month of March 2022. After the significant increase in infections at the end of December 2022, musical activities were paralyzed and it was measured again with the same tests to the small participating sample in January 2022. The results pointed to the relevant need for musical practice, since the evaluations were much lower in the post test.

Multidimensional analysis of frailty in older people of a Brazilian community: a cross-sectional study

In Brazil, the aging process takes place under unfavorable economic, social and health conditions. Therefore, a better understanding of the functionality patterns of different elderly populations becomes essential, especially in times of Covid-19. The objective of study is to assess the functionality of institutionalized and community older people. Cross-sectional study with 51 older people, divided into two groups: Institutionalized Older People Group (GII) and Community Older People Group (GIC), assessed by the Mini Mental State Examination, Clinical Functional Vulnerability Index-20 (IVCF-20), Barthel Scale, Lawton Scale and Tinneti Scale, descriptive analysis, multivariate multiple correspondence technique, multinomial and binomial logistic regression, with the R software were performed. The results showed: the quartiles: robust GIC (IVCF-20=6.75), independent (Lawton=21/Barthel=100). The fragile GII (IVCF-20=18), partially dependent (Lawton=13/Barthel=100). In GII association of frail older people and high risk of falls. In the GIC there is no association. The GIC showed more chances compared to the GII: 198.34 cognitively normal; 5.48 robust; more than 100,000 independents; and 14 low risk of falls. In this way, it is concluded that older people in the community have better functional performance than older people living in the two Long Term Care Institutions.

Adipokines Level and Cognitive Function-Disturbance in Homeostasis in Older People with Poorly Managed Hypertension: A Pilot Study.

Aim: To explore the network relationship between cognitive function, depressive symptom intensity, body composition, proxies of cognitive reserve, trophic factor, adipokines and myokines, physical performance and blood pressure in a group of older people with poorly managed hypertension (PMHTN) compared to a normotensive (NTN) group. Materials and methods: History of hypertension and blood pressure level were examined in older participants. Thirty-one subjects diagnosed with PMHTN (history of hypertension diagnosis and values of sBP or dBP over 140/90 mmHg) and eighteen NTN (lack of history of hypertension and sBP and dBP lower than 140/90 mmHg) participated. Participants completed physical and cognitive function assessments: including the Mini–Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and its two subtests Delayed Recall (DR) and Verbal Fluency (VF) and Trail Making Test Part B (TMT B). Factors associated with cognitive functioning: age, years of education, cognitive and travel activity were assessed using a questionnaire. Visceral fat was determined by bioimpedance testing and gait velocity and agility assessed using an Up and Go test. To summarize the strength and direction (negative or positive) of a relationship between two variables, Spearman’s rank correlation coefficient was used. Then, network graphs were created to illustrate the relationship between variables. Node strength (number of edges per node), neighbourhood connectivity (the average connectivity of all the neighbours of a node), stress (the number of shortest paths passing through each node) were compared in network from PMHTN group to network from NTN group. Results: Neighbourhood connectivity and stress were significantly higher in of the PMHTN network compared to NTN (6.03 ± 1.5 vs. 4.23 ± 2.5, p = 0.005 and 118.21 ± 137.6 vs. 56.87 ± 101.5, p = 0.02, accordingly). Conclusion: In older subjects with poorly managed hypertension, dyshomeostasis was observed, compared to normotensive subjects.

A comparison of the efficacy of textured insoles on balance performance in older people with versus without plantar callosities

BackgroundTextured insoles have been suggested to enhance foot sensation, which contributes to controlling upright balance. However, the interaction between plantar callosity and the textured surface has not been studied. Research questionFirstly, to compare the efficacy of textured insoles on balance performance and foot position sense between two groups of older people: one group had plantar callosity, and the other did not. Secondly, to investigate the efficacy of textured insoles within each study group. MethodsThirty older people with a history of falls (15 with plantar callosity and 15 without callosity) participated in this study. All participants underwent assessments of postural sway on a force plate, joint position sensation of the ankle with a slope box, and mobility using the "Timed Up and Go" test under three insole surface conditions: 1) smooth (control), 2) placebo and 3) textured surface. Two-way analyses of variance were used to compare the outcomes of the two groups and three conditions. ResultsOlder people with plantar callosity had worse ankle joint position sense and slower antero-posterior and mediolateral postural sway velocity than their peers who did not have plantar callosity. The textured insoles improved ankle joint position sense and mobility regardless of callus status in the plantar surface of older peoples’ feet. The insole-callosity interaction was not significant for any study outcome. SignificanceTextured insoles could be beneficial to older people with and without callosity as they have shown immediate improvements in ankle joint position sense and mobility.

Serious Leisure and Passion in University Programs for Seniors.

Perseverance and persistence, effort, leisure career, permanent acquisitions, specific norms, and identification with the occupation are some of the hallmarks of the serious leisure perspective. The Dualistic Model of Passion (DMP) understands passion as a strong inclination towards an activity that a person loves, considers important, and in which they invest a great amount of time and energy. This article proposes to explore these two theoretical constructs that converge in their conceptual bases, in a group of older people who regularly participate in university training programs throughout life. The sample is made up of 157 persons over 60 years old enrolled in courses for the elderly at the University of Deusto (Bilbao, Spain). The quantitative findings revealed: (1) that there are no significant differences according to sociodemographic variables, (2) that learning throughout life in the case of older people can be converted into serious leisure, and (3) that the participants in training programs for seniors develop a harmonious passion for such activity.

Comparison of Clinical and Radiological Characteristics of Temporomandibular Joint Osteoarthritis in Older and Young people

Background and Objectives: The relatively high prevalence of temporomandibular joint (TMJ) osteoarthritis (OA) in older people increases the necessity to investigate the specific characteristics of TMJ-OA in this particular population. This study aimed to analyze the longitudinal changes in clinical and radiological characteristics of TMJ-OA in older people. Methods: We retrospectively analyzed the clinical features and cone-beam computed tomography (CBCT) images of 76 participants with TMJ-OA. Participants were classified into two groups according to age. The older people group included 33 participants over 50 years of age, and the control group included 43 participants in their 15-29 years. We analyzed the differences in clinical features and the distribution of destructive bony changes on CBCT images between groups. Results: The duration of pain was significantly shorter in the older people group (P = .046); however, the treatment duration was significantly longer in the older people group (P = .001). There was a significant difference in the distribution of destructive bony features between groups (P = .005). In the older people group, “three or more features” (36.3%) were the most common, whereas in the control group, “erosion” (44.2%) was the most common. After treatment, there was little improvement in the frequency of “erosion” in the older people group. There was a significant difference in the proportion of erosion after treatment between the groups (P = .033). Conclusion: In older people with TMJ-OA, active treatment to effectively induce condylar remodeling should be considered.

Comparison of Clinical and Radiological Characteristics of Temporomandibular Joint Osteoarthritis in Older and Young people

Background and Objectives: The relatively high prevalence of temporomandibular joint (TMJ) osteoarthritis (OA) in older people increases the necessity to investigate the specific characteristics of TMJ-OA in this particular population. This study aimed to analyze the longitudinal changes in clinical and radiological characteristics of TMJ-OA in older people. Methods: We retrospectively analyzed the clinical features and cone-beam computed tomography (CBCT) images of 76 participants with TMJ-OA. Participants were classified into two groups according to age. The older people group included 33 participants over 50 years of age, and the control group included 43 participants in their 15-29 years. We analyzed the differences in clinical features and the distribution of destructive bony changes on CBCT images between groups. Results: The duration of pain was significantly shorter in the older people group (P = .046); however, the treatment duration was significantly longer in the older people group (P = .001). There was a significant difference in the distribution of destructive bony features between groups (P = .005). In the older people group, “three or more features” (36.3%) were the most common, whereas in the control group, “erosion” (44.2%) was the most common. After treatment, there was little improvement in the frequency of “erosion” in the older people group. There was a significant difference in the proportion of erosion after treatment between the groups (P = .033). Conclusion: In older people with TMJ-OA, active treatment to effectively induce condylar remodeling should be considered.

Retrospective feelings of loneliness during the COVID-19 pandemic among residents of long-term care facilities

The novel coronavirus disease (COVID-19) has had an incisive effect on residents living in long-term care facilities (LTCFs). Local governments have introduced restrictive measures because of the danger posed by this virus. One increasing negative effect of these implementations among residents living in LTCFs is their subjective feelings of loneliness. This study assumed that these measures weighed heavily particularly on residents living in LTCFs, as this group of older people could not decide for themselves whether or how they should be implemented. Thus, this study investigated the retrospectively reported subjective loneliness of residents living in LTCFs. On a large-scale Swiss survey (N = 828; mean age: 87.78, 75% female), residents of 22 LTCFs filled out a questionnaire on their subjective feelings of loneliness during the pandemic. The retrospective loneliness scores of the residents living in LTCFs were found to exceed those reported in other studies focusing on community-dwelling older people. Multivariate regression analyses showed that females, individuals with lower values of joy in life and life satisfaction, and individuals who were not satisfied with the manner in which their care home coped with the COVID-19 measures significantly felt lonelier. Therefore, the subjective feelings of loneliness of residents in LTCFs should be monitored very carefully. As the measures have still not been completely lifted, residents of LTCFs are assumed to still experience social isolation and be at high risk of encountering prolonged feelings of loneliness, which can be detrimental to their mental health and well-being.

Factors Predicting Spiritual Well-Being among Dependent Older People

Spiritual well-being is a deep feeling within the mind that represents peacefulness and the inner strength of individuals, resulting from an understanding of the nature of life and acceptance of changes occurring to themselves. Spiritual well-being is; therefore, very important to dependent older people. The objectives of this study were to identify the levels of spiritual well-being of dependent older people, to examine the relationships between religious belief, religious practice, self-esteem, social support, depression, and spiritual well-being, and to examine the ability of those factors to predict spiritual well-being among dependent older people. The study sample were 395 of people aged 60 years and above who are dependent and live in three provinces in southern Thailand. Data were collected using questionnaires, including the Spiritual Well-Being Scale for Dependent Older People, Thai version of the Rosenberg Self-Esteem Scale, Thai version of the Multidimensional Scale of Perceived Social Support, Thai Geriatric Depression Scale, the Religious Practices Questionnaire, and the Buddhist Belief Questionnaire. Data were analyzed using descriptive statistics, Spearman’s rank correlation coefficient, and multiple regression analysis. The study results were as follows: 1) The spiritual well-being among dependent older people was at a moderate level (x̅ = 46.97, SD = 7.22). 2) Religious belief, religious practice, self-esteem, and social support significantly related positively to spiritual well-being (p &lt; 0.01), while depression significantly related negatively to spiritual well-being (p &lt; 0.01). 3) Religious belief, self-esteem, and social support together could explain 46.00 % of the variance in spiritual well-being. The results of this study can be used by nurses and health care providers to determine interventions for enhancing spiritual well-being in this particular group of older people.&#x0D; HIGHLIGHTS&#x0D; &#x0D; Spiritual well-being is one of the important dimensions of holistic care. Spiritual well-being has a positive effect on physical, mental and social health&#x0D; The conceptual framework is guided by the Buddhism Principles&#x0D; Religious belief, self-esteem, and social support together could explain 46.00 % of the variance in spiritual well-being&#x0D;

Emotion regulation profiles of development of depressive symptomatology: a longitudinal study.

Introduction:COVID-19 pandemic has had a psychological impact on the eldest population. The aim is to analyse whether there are differences depending on the emotional regulation profile shown by a group of older people 6 months before the pandemic and the depressive symptomatology of these people at the same time, during home confinement and 8 months later. Method:Longitudinal study, sample of people over 65, three evaluation measures: WAVE1 (6 months before COVID-19,N=305;M=73.63;58.9% women), WAVE2 (house confinement;N=151;M=73.14;59.6% women) and WAVE3 (8 months later;N=91;M=72.62;64.70% women). We measured depressive symptomatology (CES-D; Radloff, 1977) and nine emotional regulation strategies (CERQ-S; Garnefski et al., 2001; Carvajal et al., 2020), with which 3 clusters were preset (after dendogram inspection and K means analysis). Three mean difference analyses (one-factor ANOVA) were performed taking as factor profiles and as outcomes variables depression in each wave. Results:profile 1, people use adaptive cognitive-emotional regulation strategies; profile 2, those with low levels of strategies (adaptive and maladaptive); profile 3, high scores in maladaptive strategies. Statistically significant differences between profiles 1 and 3, in the pre-confinement depression variable (F'2,91=6.18;p=.00) and during confinement (F'2,91=4.02;p=.02). Profile 3 higher depressive symptomatology (x̄1=17.16;x̄2=16.80) than 1 (x̄1=8.41;x̄2=9.65). Differences between profile 1 and 2 and 3 in depression 8 months after confinement (F’2,91=4.02;p=.02). Profile 1 lower levels of depression (x̄3=98.00) than 2 (x̄3=15.78) and 3 (x̄3=14.20). Profiles explain 12.3%, 8.4% and 12.5% of the depression variance in each wave. Conclusions:a "protected profile" (1), a "medium-term vulnerable profile" (2) and a "vulnerable profile" (3) to the development of depressive symptomatology.

Loneliness, mental health and COVID-19 in the Spanish population

The study aim was to assess the effects of the health emergency and the stay-at-home restrictions on loneliness variables in the Spanish population during the initial stage of COVID-19. A cross-sectional study was conducted through an online survey of 3480 people. From March 14, 2020, screening tests were used to evaluate sociodemographic and COVID-19-related data on loneliness, social support, the presence of mental health symptoms, discrimination, and spiritual well-being. Descriptive analyses were conducted and linear regression models were constructed. A negative association was found between loneliness and being older, being partnered, having children, being a university graduate, being retired or still working, having stronger religious beliefs, believing that information provided about the pandemic was adequate, having social support, and having self-compassion. Actions that promote social support and further studies on loneliness in groups of older people are needed to prevent the pandemic having a stronger impact on mental health and well-being.

The Influence of Street Microenvironment on the Walking Activities of Older Adults: A Longitudinal Study Based on the Structural Equation Model and Manipulated Photos

There is growing evidence of an association between the built environment and walking activity, but knowledge of street microenvironmental factors and older adults’ walking is limited and inconsistent. We used a socio-ecological model as the theoretical framework for this study, aiming to investigate longitudinally the important influences of the street microenvironment on older people’s walking by manipulated street photographs and whether there are different groups of older people with different environmental preferences, and to determine the influence of environmental factors in the socio-ecological model. The clustering analysis method was used to divide the samples into four groups, and those four subgroups were put in a comparative analysis regarding their street environments by methods of semantic differential (SD). The preferences of various subgroups were checked by the variance analysis and post hoc tests, and the structural equation model (SEM) was applied to discuss the relations of correlation and influence among each factor. The results showed that “parking on the sidewalk” was rated the lowest in the pre-intervention photos, and “shaded” and “hedge” were rated the highest in the post-intervention photos, and the environmental requirements were different for the older, poorer and higher income and education subgroups. There was a significant positive relationship between residential status and architectural interventions as well as self-efficacy and physical condition. These findings suggest that when developing environmental interventions to promote walking among older adults, priority should be given to those factors that need to be improved most. In addition, attention should be paid to the differences in walking needs among different groups of older adults, with particular attention on the impact of self-selected living environments on street-level environmental interventions.

Статус гериатрической медицинской сестры в организации медико-социальной помощи

The article attempts to consider understanding the role of a geriatric nurse in solving problems related to the aging of the population and the expansion of the group of older people with increased requirements for social and medical care. The review includes materials published from 2015 to 2020.

Organization of primary medical care for patients with osteoporosis

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

BEFRIENding for Depression, Anxiety and Social support in older adults living in Australian residential aged care facilities (BEFRIENDAS): randomised controlled trial protocol

BackgroundThis protocol describes an ongoing study of the impact of befriending on depression, anxiety and loneliness in older people living in residential aged care facilities in Australia. While systematic reviews of befriending have indicated positive benefits of befriending for people in a range of ages and settings, there have been no randomised controlled trials (RCTs) of befriending for older people living in residential aged care with depression and no studies of the cost effectiveness of befriending in residential aged care facilities (RACFs) in Australia.Methods and analysisWe are conducting a single blind pragmatic RCT comparing two groups of older people living in RACFs, one receiving an intervention consisting of weekly befriending for 4 months from a trained volunteer and the other receiving treatment as usual. Participants undergo eligibility screening for depression (GDS-15 ≥ 4) and cognitive impairment (GPCog ≥ 4) and assessments at three measurement time points: baseline prior to randomisation, 2 months post-baseline and 4 months post-baseline. The primary outcome measure is depression, and secondary outcome measures are anxiety, loneliness, social isolation and quality of life. The economic evaluation will take the form of a cost-utility analysis based on the outcome of quality of life. The primary and secondary outcomes will be analysed using negative binomial and logistic regressions utilizing the Generalised Estimating Equations approach.DiscussionTo our knowledge, this is the first RCT evaluating the effectiveness of befriending on older people with depression living in residential aged care. It is expected that the befriending intervention will reduce the severity of depression symptoms experienced by older people living in residential aged care. If the intervention proves effective it may be incorporated into volunteer training programs and adopted as a way of supporting older people’s mental health.Trial registrationTrial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number: ACTRN12619000676112, registered 06/05/2019 – retrospectively registered.

Development of a Core Outcome Set for clinical trials aimed at improving antimicrobial stewardship in care homes

Abstract Introduction Diverse outcomes reported in clinical trials to improve antimicrobial stewardship (AMS) in care homes has hindered evidence synthesis [1]. We previously reported that a number of outcomes for care home AMS which may be important to healthcare professionals and relatives of care home residents had not been measured in previous trials [2]. It is essential to generate a set of important outcomes (a core outcome set – COS) for future studies of AMS interventions in care homes. Aim To develop a COS for use in clinical trials aimed at improving AMS in care homes. Methods A refined inventory of outcomes for AMS interventions in care homes, compiled from a previous study [2], was presented in a three-round international Delphi consensus survey, followed by an online consensus exercise. Stakeholders engaged in AMS in care homes (e.g. healthcare professionals, representatives of care home residents) were invited to participate, having been identified through the research team’s contacts and knowledge of relevant organisations. A 9-point Likert scale was used during the consensus procedures and an outcome was included in the COS if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3. Less stringent criteria for inclusion were also applied if the final COS comprised fewer than three outcomes. Subsequently, a suitable outcome measurement instrument (OMI) was selected for each outcome in the COS using the following steps: finding existing OMIs in the literature and consulting with experts, assessing the quality of OMIs, and selecting one OMI for each core outcome via a two-round international Delphi consensus exercise. Consent was obtained from all participants taking part in all consensus procedures. Results The initial inventory of 14 outcomes was presented to 82 international Delphi panellists from 17 countries in the first round who also suggested three additional outcomes. These 17 outcomes were rated again in two further rounds, with consensus achieved for ten outcomes. A subsequent online consensus exercise with twelve participants from Northern Ireland, including the research team, reached consensus to include five outcomes in the COS (Table 1). Regarding selection of OMIs for the COS, 17 OMIs were identified through literature searches and experts’ suggestions. Based on quality assessment, three OMIs - ‘Number of antimicrobial courses started per 1000 resident-days’, ‘Rate of antimicrobial days of therapy per 1000 resident-days’, and ‘Van Buul algorithms to evaluate appropriateness of initiating or withholding antibiotics’ - were selected for a two-round Delphi exercise with 59 participants from 16 countries. Consensus was reached to select two OMIs for the COS, as presented in Table 1. Conclusion This is the first study to develop a COS for use in clinical trials aimed at improving AMS in care homes. Although we recruited few representatives from advocacy groups for older people, care home staff and managers, there was common agreement for inclusion of a number of outcomes. This COS represents the minimum that should be used in research and trialists may consider exploring other outcomes as reported in previous studies.

Medical specialist undertreatment in nursing home residents-Prevalence and extrapolation

HintergrundBisherige Studien deuten darauf hin, dass Pflegebedürftige eine geringere fachärztliche Versorgung aufweisen als Nichtpflegebedürftige. Insbesondere im stationären Setting ist die fachärztliche Versorgungsintensität gering. Aus den bestehenden quantitativen Versorgungsunterschieden lässt sich bislang jedoch nicht ableiten, inwieweit von einer Unterversorgung bei Pflegebedürftigen ausgegangen werden muss. Für die Versorgungsbereiche Sehfähigkeit, Hörfähigkeit, Mundgesundheit und Parkinson-Syndrom wird geprüft, inwieweit Heimbewohner fachärztlich unterversorgt sind.Material und MethodenIn 44 Pflegeheimen in Bremen und Niedersachsen wurde der Gesundheitszustand von 409 Pflegebedürftigen mittels standardisierter Assessments und Befragungen erhoben; zusätzlich wurden Diagnosen und die medizinische Versorgung aus der Pflegedokumentation ausgewertet. Ärzteteams beurteilten auf dieser Grundlage für jeden Pflegebedürftigen, inwieweit eine bedarfsgerechte fachärztliche Versorgung vorlag oder nicht.ErgebnisseGemäß ärztlichem Urteil zeigt sich bei 45 % (Sehfähigkeit), 19 % (Parkinson-Syndrom), 16 % (Mundgesundheit) und 15 % (Hörfähigkeit) der Bewohner mit entsprechendem Versorgungsbedarf eine fachärztliche Unterversorgung. Bei 27 % aller Bewohner zeigt sich in mindestens einem der 4 Versorgungsbereiche eine fachärztliche Unterversorgung. Hochgerechnet entspricht dies bis zu 205.000 fachärztlich unterversorgten Pflegeheimbewohnern in Deutschland.DiskussionDie Studie liefert für ausgewählte Versorgungsbereiche die ersten empirischen Belege über das Ausmaß fachärztlicher Unterversorgung von Pflegeheimbewohnern. Daher erscheint es notwendig, entsprechende Interventionen zur Reduktion der Unterversorgung zu entwickeln und zu erproben.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00391-021-01865-z) enthält eine detaillierte Erklärung zur Methodik der Datenerhebung sowie 6 Tabellen mit weiterführenden Analysen. Beitrag und Zusatzmaterial stehen Ihnen im elektronischen Volltextarchiv auf https://www.springermedizin.de/link/10.1007/10.1007/s0391-021-01865-z zur Verfügung. Sie finden das Video am Beitragsende unter „Supplementary Material“.

Prognostic models for 1-year survival of NPC after radiotherapy in different ages

Previous studies have shown that approximately 10% of nasopharyngeal cancer (NPC) patients die within a year of disease onset, and that age is an independent predictor. However, no predictive model has been developed. We aimed to establish novel prognostic models to predict the 1-year cancer-specific survival (CSS) of young, middle-aged, and older patients with NPC after radiotherapy. The data of 2822 NPC patients who underwent radiotherapy between 2004 and 2015 were reviewed from the surveillance, epidemiology, and end results database. We divided them into young, middle-aged, and older people groups according to age (< 44years, 45-59years, and ≥ 60years, respectively). Multivariate analyses were performed, and prognostic models were constructed. Multivariate analyses indicated that age, ethnicity, histological subtype, T, and M stage were independent predictors of 1-year CSS in the older people group. In contrast, ethnicity and age were not found to have predictive value in the young and middle-aged groups, respectively. Accordingly, three prognostic models with excellent predictive values were established for the three groups (C-indices: 0.791 [95% CI 0.722-0.859], 0.763 [95% CI 0.721-0.806] and 0.723 [95% CI 0.683-0.763], respectively). These predictive values are higher than those of the eighth edition American joint committee cancer tumor-node-metastasis (TNM) classification system. Three prognostic models for predicting the 1-year CSS of young, middle-aged, and older NPC patients after radiotherapy showed better predictive power than the TNM classification system. These models may guide treatment strategies and clinical decision-making in different cohorts.