Loss Of Independence In Activities Research Articles

Frailty and behavioral and psychological symptoms of dementia: a single center study

AbstractBackgrounddementia is a clinical syndrome characterized by progressive cognitive decline and loss of independence in activities of daily living. Alongside the cognitive symptoms, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, causing considerable distress to both patients and caregiversMethodaim of this retrospective study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified in three clusters: “mood/apathy”, “psychosis” and “hyperactivity”. Using the Clinical Frailty Scale (CFS), patients were categorized as “severely frail”, “mild/moderately frail” and “robust” (CFS ≥ 7, 4‐6 and ≤ 3, respectively). In order to better understand the complex pattern of relationships between the different factors, we performed a network analysis.Result209 patients (71.3% women, mean age 83.24±4.98 years) with a clinical diagnosis of dementia were enrolled. The most represented group was the mild/moderately frail one (n = 155, 74%); lower numbers were seen in the robust (n = 18, 9%) and severely frail (n = 36, 17%) ones. Among the “severely frail” the percentage of BPSD was higher compared to the “mild/moderate” and “robust” groups. A significant correlation between frailty and “hyperactivity” cluster emerged, both at baseline and follow up visits (p<0.001, p = 0.022, p = 0.028 respectively). At the network analysis, the degree of frailty related to behavioral and psychological symptoms of the hyperactivity cluster, such as agitation and motor aberrant activity; the relationship was still positive although not so strong with other symptoms like apathy and hallucinations.Conclusionin this study an association between frailty and the number of neuropsychiatric symptoms of the “hyperactivity” cluster was found; however, whether the loss of independence is a possible cause of frailty or viceversa is still to be determined. The assessment of frailty may help identifying patients at risk of developing behavioral and psychological symptoms of dementia, and could provide the clinicians with a time‐window to target intervention in the earliest phases of both frail condition and BPSD.

SIOG2022-0108* - Trajectory of functional decline and loss of independence in activities of daily living (ADL) in older adults with advanced cancer receiving treatment

SIOG2022-0108* - Trajectory of functional decline and loss of independence in activities of daily living (ADL) in older adults with advanced cancer receiving treatment

Effect of life-space mobility on subjective well-being in aged home-based rehabilitation users with different levels of independence in activities of daily living.

[Purpose] The relationship between quality of life and life-space mobility in community-dwelling older adults has recently been reported. The present study aimed to elucidate this relationship in home-based rehabilitation users with limited life-space mobility and loss of independence in activities of daily living. [Participants and Methods] The study population comprised 33 home-based rehabilitation users. The participants were expected to have a wide range of the level of independence in activities of daily living; therefore, they were categorized into three groups according to the Barthel Index score: independent (95–100 points), moderately disabled (90–65 points), and severely disabled (60–0 points) groups. We examined the relationships among the Philadelphia Geriatric Center Morale Scale, Life-Space Assessment, and Barthel Index scores and age. [Results] We detected a strong positive correlation between the Philadelphia Geriatric Center Morale Scale and Life-Space Assessment scores in the independent group; however, no significant correlations were observed in the moderately and severely disabled groups. [Conclusion] Our findings suggest a relationship between subjective well-being and life-space mobility in home-based rehabilitation users who are mostly independent in activities of daily living. However, owing to the small sample size and characteristics of the scales used in this study, further studies are warranted to verify these results.

Abstract 10778: Long-Term Functional Outcomes in Older Adults After Hospitalization for Extracranial Hemorrhage

Introduction: Antiplatelet and anticoagulant medications often used to manage cardiovascular disease increase the risk of extracranial hemorrhage (ECH), such as gastrointestinal bleeding. There are few long-term data on the loss of function following ECH. This study’s goal was to measure the acute and persistent loss of independence in activities of daily living (ADLs) after ECH hospitalization. Methods: We used data from 1995-2015 from the Health and Retirement Study, a longitudinal, nationally representative survey of older Americans. We included subjects over age 65 who consented to Medicare linkage. We examined the association of ECH hospitalization with ability to perform all ADLs independently (walk across a room, dress, bathe, eat, toilet, get out of bed). To compare rates of ADL independence over time between those with ECH and a control group without ECH, we fit a logistic regression model that included an interaction term between ECH hospitalization and time and adjusted for comorbidities and sociodemographics. Results: In a cohort of 8950 with an average follow-up time of 7.3 years (65,335 person-years), 882 (10%) participants were hospitalized for ECH. Mean age was 78, and 59% were women. In the control group without ECH, the baseline rate of ADL independence declined by an average of 3.1% per year (average marginal effect [AME], 95% CI -3.1% to -3.3%). Assuming hospitalization for ECH at 5.2 years, the median time to ECH in this cohort, ECH was associated with an immediate decrease in ADL independence from 68% to 53% (AME -15%, 95% CI -11% to -18%). Following ECH, the average annual baseline rate of function loss did not change. Conclusions: In this nationally representative cohort, ECH hospitalization was associated with an immediate and pronounced decline in function that was equivalent to accelerating ADL disability by 5 years. After ECH, ADL independence continued to decline and did not recover to pre-ECH levels of independence over time.

Efficacy of robotic exoskeleton for gait rehabilitation in patients with subacute stroke : a systematic review.

Stroke is the most common cause of disability in Western Countries. It can lead to loss of mobility, capability to walk and ultimately loss of independence in activities of daily living (ADL). Several rehabilitative approaches have been proposed in these years. Robot-assisted gait rehabilitation (RAGT) plays a crucial role to perform a repetitive, intensive, and task-oriented treatment in stroke survivors. However, there are still few data on its role in subacute stroke patients. The aim of the present study was to assess the efficacy of RAGT for gait recovery in subacute stroke survivors. Systematic review with meta-analysis. The setting of the study included Units of Rehabilitation. The analyzed population was represented by subacute stroke patients. PubMed, Scopus, Web of Science, CENTRAL, and PEDro were systematically searched until January 18, 2021, to identify randomized controlled trials (RCTs) presenting: stroke survivors in subacute phase (≤6 months) as participants; exoskeleton robots devices as intervention; conventional rehabilitation as a comparator; gait assessment, through qualitative scales, quantitative gait scales or quantitative parameters, as outcome measures. We also performed a meta-analysis of the mean difference in the functional ambulation category (FAC) via the random effect method. Out of 3188 records, 14 RCTs were analyzed in this systematic review. The 14 studies have been published in the last 14 years (from 2006 to 2021) and included 576 stroke survivors, of which 306 received RAGT, and 270 underwent conventional rehabilitation. Lokomat robotic system was the most investigated robotic exoskeleton by the RCTs included (N.=9), albeit the meta-analysis demonstrated a non-significant difference of -0.09 in FAC (95% CI: -0.22.0.03) between Lokomat and conventional therapy. According to the PEDro scale, 11 (78.5%) were classified as good-quality studies, two as fair-quality studies (14.3%), and one as poor-quality study (7.1%). Taken together, these findings showed that RAGT might have a potential role in gait recovery in subacute stroke survivors. However, further RCTs comparing the efficacy of RAGT with conventional physical therapy are still warranted in the neurorehabilitation field. This systematic review provides information on the efficacy of RAGT in allowing subacute stroke patients to perform high-intensity gait training with a lower physical burden on PRM professionals.

PD37-09 PREVALENCE OF COGNITIVE IMPAIRMENT AND SPHINCTER MISUSE AMONG MEN WITH ARTIFICIAL URINARY SPHINCTERS

INTRODUCTION AND OBJECTIVE: As the population ages, a growing number of patients will suffer progressive cognitive decline, both normal and pathological. The association between cognitive impairment and loss of independence in activities of daily living is well documented and relates to both memory loss and functional decline in abilities like manual dexterity. These deficits can be particularly problematic for patients with artificial urinary sphincters (AUS). We aimed to define the prevalence of cognitive impairment and sphincter misuse among our institutional cohort of AUS patients. METHODS: Men who had undergone primary AUS placement or revision surgery at our institution from 2004-2019 were invited to participate in telephone surveys. Patients answered questions regarding current urinary symptoms, quality of life, medical history, AUS use, and urologic follow-up. Validated telephone mini-mental status exams (T-MMSE) were completed to assess cognitive function. Patients were categorized by degree of cognitive impairment and analyzed using appropriate statistical comparison tests. RESULTS: A total of 142 unique patients were identified; 74 participated in the study (61% response rate, excluding 20 deceased patients). Median age and follow-up since AUS implantation were 76 [69, 81] and 7 [4, 11] years, respectively. Some degree of cognitive impairment was seen in 18 (24%) patients: 13 (18%) mild, 2 (3%) moderate, and 3 (4%) severe. Table 1 compares patient characteristics, revision and continence rates, and sphincter usage patterns in those with normal versus impaired cognition. Twenty-three (31%) patients reported they did not cycle their device with every void, and 11 (15%) reported they were no longer using their AUS. Notably, 50% of patients with impaired cognition were not cycling their device with every void compared to 25% among those with normal cognition. Over half of all patients with impaired cognition had not seen a urologist in the last year. CONCLUSIONS: Our study revealed significant rates of cognitive impairment and sphincter misuse among men with artificial urinary sphincters. These data suggest there may be a role for monitoring cognitive function and long-term follow-up in these patients. Further prospective study of cognitive decline and related outcomes in AUS patients is warranted.Source of Funding: No source of funding

NOVEL DATA AND APPROACHES TO THE STUDY OF HEALTH AND AGING IN NSHAP

The National Social Life, Health, and Aging Project (NSHAP) is a longitudinal, population-based study that seeks to improve an understanding of the well-being of older, community-dwelling Americans. It accomplishes this by affording researchers a wide range of high quality measures that enable examining interactions among physical health and illness, medication use, cognitive function, emotional health, sensory function, health behaviors, social connectedness, sexuality, and relationship quality. The panelists in this symposium use NSHAP data to shed light on previously un- or underexplored aspects of health during aging. Kaufman et al. use interviewer ratings of respondents’ skin shade along with respondents’ individual experiences of discrimination, neighborhood racial composition, and other factors to characterize heterogeneity in the racial experience and how heterogeneity relates to health inequities. Riley integrates information on respondents’ residential region at birth and in older age to show that older adults who left the South are less healthy than those who stay in the South, and that social embeddedness helps to explain the health benefits for those who stay. Huang et al. take advantage of rich structural and functional social connectedness data to show that self-reported hearing impairment is associated with depth but not breadth of social connections. Huisingh-Scheetz et al. capitalizes on performance measures of gait speed and chair stands obtained at each wave to examine whether repeated measures improve the ability to predict loss of independence in activities of daily living. Discussant will discuss the importance, strengths, and weaknesses of these papers, and consider implications for future research.

DISTRIBUTION, PREDICTORS, AND CLINICAL RELEVANCE OF 5-YEAR CHANGE IN FRAILTY MEASURES

Implementing frailty assessment into routine clinical practice is a priority. Gait speed and performance on 5 repeated chair stands are two measures of frailty. We face a number of clinical implementation challenges: (1) We lack normative data for U.S. older adults and (2) The clinical relevance of change in frailty measures is unclear. The National Social Life, Health and Aging Project dataset allows an examination of the distribution of 3-meter gait and 5-repeated chair stands times as well as 5-year change in these measures in a nationally-representative, community-dwelling older adult sample. Dr. Huisingh-Scheetz will describe demographic predictors of change in these measures as well as determine whether baseline plus 5-year change in these measures predicts loss of independence in activities of daily living (ADLs).

Quantifying physical functional trajectory in hospitalized older adults using body worn inertial sensors

Acute medical illness requiring hospitalization usually is a critical event in the trajectory leading to disability in older adults. Functional decline frequently occurs during hospitalization, resulting in a loss of Independence in activities of daily living after discharge. The aim of the study was to assess the functional decline in different ADLs of hospitalized elderly patients in an Acute Care for Elderly (ACE) unit incorporating a body-worn inertial sensor and accompanying custom algorithms. 38 hospitalized older adults (age ≥ 75) were included. The patients completed different functional tasks, including a balance test, Gait Velocity Test (GVT), verbal and arithmetic dual-task gait, and a sit-to-stand ability test at admission and discharge. Movement-related parameters were acquired from a unique tri-axial inertial sensor unit. Maximal muscle strength and muscle power output endpoints were also assessed. The results indicated that significant improvements (p < 0.05) were found at discharge compared with the admission values for gait variability and spatiotemporal parameters in the 4- and 6-meter GVT. These significant gains were also obtained in the verbal GVT. In contrast, a significant reduction was found in the functional status measured with the Barthel Index scale. Regarding to the sit-to-stand ability, lower peak power was observed in the sit-to-stand phase of the task at discharge. In conclusion, inertial sensor unit and our custom, validated, algorithms represent a feasible tool for measuring and monitoring functional trajectory during hospitalization in older adults and they are sensitive to detect differences in movement pattern parameters in different ADLs such as walking and the ability to stand from a seated position.

Acute regression in young people with Down Syndrome

Objective: To study the acute regression in young people with Down Syndrome (DS) Methods: We did a retrospective study of DS patients who presented an acute regression in our center from 1984 to 2016. Inclusion criteria were: ages from 10–30 years, significant and acute loss of activities of daily living and baseline skills within 6 months, perceived decline in cognition and significant loss of speech, unexplained decompensation in behavioral functioning and mood, no history of autism spectrum disorder, seizure disorder or significant psychopathology. Results: We found 30 DS patients aged 10–22 years with more girls (58%) than boys. Regression occured regardless of the level of intellectual disability (mild, moderate and severe).The acute regression was characterized by a marked loss of activity with psychiatric symptoms in all cases (catatonia, depression, delusions, stereotypies, etc...) with partial or total loss of independence in activities of daily living (dressing, toilet, meals and continence), language impairment (silence, whispered voice, etc;) sleep disturbance and loss of academic skills. A medical evaluation, laboratory testing and research of comorbidities were down in most of patients without finding a cause except than all patients experienced severe emotional stress prior to regression. Partial or total recovery was observed in one third of them with different types of treatment. Conclusion: This retrospective study highlights the challenges involved in diagnosting, evaluating and treating patients with DS who have experienced this acute and unexplained clinical deterioration. Neurobiological and genetics hypothesis are discussed as well as therapeutic approach. European collaboration among healthcare providers is necessary to improving outcomes of these patients.

Acute Regression in Young People with Down Syndrome.

Adolescents and young adults with Down syndrome (DS) can present a rapid regression with loss of independence and daily skills. Causes of regression are unknown and treatment is most of the time symptomatic. We did a retrospective cohort study of regression cases: patients were born between 1959 and 2000, and were followed from 1984 to now. We found 30 DS patients aged 11 to 30 years old with history of regression. Regression occurred regardless of the cognitive level (severe, moderate, or mild intellectual disability (ID)). Patients presented psychiatric symptoms (catatonia, depression, delusions, stereotypies, etc.), partial or total loss of independence in activities of daily living (dressing, toilet, meals, and continence), language impairment (silence, whispered voice, etc.), and loss of academic skills. All patients experienced severe emotional stress prior to regression, which may be considered the trigger. Partial or total recovery was observed for about 50% of them. In our cohort, girls were more frequently affected than boys (64%). Neurobiological hypotheses are discussed as well as preventative and therapeutic approaches.

Unravelling the potential mechanisms behind hospitalization-associated disability in older patients; the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) cohort study protocol.

BackgroundOver 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the protocol for the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, which aims to unravel the potential mechanisms behind HAD from admission to three months post-discharge.Methods/designThe Hospital-ADL study is a multicenter, observational, prospective cohort study aiming to recruit 400 patients aged ≥70 years that are acutely hospitalized at departments of Internal Medicine, Cardiology or Geriatrics, involving six hospitals in the Netherlands. Eligible are patients hospitalized for at least 48 h, without major cognitive impairment (Mini Mental State Examination score ≥15), who have a life expectancy of more than three months, and without disablement in all six ADLs. The study will assess possible cognitive, behavioral, psychosocial, physical, and biological factors of HAD. Data will be collected through: 1] medical and demographical data; 2] personal interviews, which includes assessment of cognitive impairment, behavioral and psychosocial functioning, physical functioning, and health care utilization; 3] physical performance tests, which includes gait speed, hand grip strength, balance, bioelectrical impedance analysis (BIA), and an activity tracker (Fitbit Flex), and; 4] analyses of blood samples to assess inflammatory and metabolic markers. The primary endpoint is additional disabilities in ADLs three months post-hospital discharge compared to ADL function two weeks prior to hospital admission. Secondary outcomes are health care utilization, health-related quality of life (HRQoL), physical performance tests, and mortality. There will be at least five data collection points; within 48 h after admission (H1), at discharge (H3), and at one (P1; home visit), two (P2; by telephone) and three months (P3; home visit) post-discharge. If the patient is admitted for more than five days, additional measurements will be planned during hospitalization on Monday, Wednesday, and Friday (H2).DiscussionThe Hospital-ADL study will provide information on cognitive, behavioral, psychosocial, physical, and biological factors associated with HAD and will be collected during and following hospitalization. These data may inform new interventions to prevent or restore hospitalization-associated disability.

Neural correlates of working memory training in HIV patients: study protocol for a randomized controlled trial.

BackgroundPotent combined antiretroviral therapy decreased the incidence and severity of HIV-associated neurocognitive disorders (HAND); however, no specific effective pharmacotherapy exists for HAND. Patients with HIV commonly have deficits in working memory and attention, which may negatively impact many other cognitive domains, leading to HAND. Since HAND may lead to loss of independence in activities of daily living and negative emotional well-being, and incur a high economic burden, effective treatments for HAND are urgently needed. This study aims to determine whether adaptive working memory training might improve cognitive functions and neural network efficiency and possibly decrease neuroinflammation. This study also aims to assess whether subjects with the LMX1A-rs4657412 TT(AA) genotype show greater training effects from working memory training than TC(AG) or CC(GG)-carriers.Methods/Design60 HIV-infected and 60 seronegative control participants will be randomized to a double-blind active-controlled study, using adaptive versus non-adaptive Cogmed Working Memory Training® (CWMT), 20–25 sessions over 5–8 weeks. Each subject will be assessed with near- and far-transfer cognitive tasks, self-reported mood and executive function questionnaires, and blood-oxygenation level-dependent functional MRI during working memory (n-back) and visual attention (ball tracking) tasks, at baseline, 1-month, and 6-months after CWMT. Furthermore, genotyping for LMX1A-rs4657412 will be performed to identify whether subjects with the TT(AA)-genotype show greater gain or neural efficiency after CWMT than those with other genotypes. Lastly, cerebrospinal fluid will be obtained before and after CWMT to explore changes in levels of inflammatory proteins (cytokines and chemokines) and monoamines.DiscussionImproving working memory in HIV patients, using CWMT, might slow the progression or delay the onset of HAND. Observation of decreased brain activation or normalized neural networks, using fMRI, after CWMT would lead to a better understanding of how neural networks are modulated by CWMT. Moreover, validating the greater training gain in subjects with the LMX1A-TT(AA) genotype could lead to a personalized approach for future working memory training studies. Demonstrating and understanding the neural correlates of the efficacy of CWMT in HIV patients could lead to a safe adjunctive therapy for HAND, and possibly other brain disorders.Trial registrationClinicalTrial.gov, NCT02602418.

Potential impact of abrupt opioid therapy discontinuation in the management of chronic pain: A pilot study on patient perspective

This survey highlights the perspective of patients with chronic pain when confronted with the possibility of abrupt opioid discontinuation. Anonymous and self-administered survey. Pain Clinic in an urban academic hospital setting. Patients with chronic pain of at least 6 months, and age 18 years or older. The perceived impact of abrupt opioid discontinuation on mood, daily functioning, and potential for opioid misuse. When patients were asked how they would feel if told their opioids would be discontinued, the responses were neglected (scale mean, 7.1), angry (6.3), helpless (6.7), and upset (7.0) on a scale of 0-10. The majority predicted loss of independence in activities of daily living (scale mean, 7.5), inability to enjoy their lives (7.4), and inability to work (7.8). A group of 19 patients (11.6 percent) reported that they would obtain opioids from friends or family, and 7 (4.4 percent) would obtain them illegally. These patients reported higher scores of neglect, anger, suspicion, helplessness, and upset (p = 0.000-0.019) and were more likely to have previously obtained opioids illegally (p = 0.008-0.023). The most common nonopioid strategies tried by patients were lumbar epidural (71.5 percent), physical therapy (78.9 percent), and exercise (83.5 percent). The strategies considered to be effective as opioid replacement therapy were lumbar epidural (42.3 percent), exercise (43.2 percent), and massage (42.0 percent). These data suggest that opioid therapy discontinuation is an emotionally distressing experience for most patients, and the transition to nonopioid treatments is a complex process that will require patient participation to achieve optimal care.

Systematic Review of the Effects of Exercise on Activities of Daily Living in People With Alzheimer’s Disease

OBJECTIVE. Alzheimer's disease (AD) results in a loss of independence in activities of daily living (ADLs), which in turn affects the quality of life of affected people and places a burden on caretakers. Limited research has examined the influence of physical training (aerobic, balance, and strength training) on ADL performance of people with AD. METHOD. Six randomized controlled trials (total of 446 participants) fit the inclusion criteria. For each study, we calculated effect sizes for primary and secondary outcomes. RESULTS. Average effect size (95% confidence interval) for exercise on the primary outcome (ADL performance) was 0.80 (p < .001). Exercise had a moderate impact on the secondary outcome of physical function (effect size = 0.53, p = .004). CONCLUSION. Occupational therapy intervention that includes aerobic and strengthening exercises may help improve independence in ADLs and improve physical performance in people with AD. Additional research is needed to identify specific components of intervention and optimal dosage to develop clinical guidelines.

The role of citicoline in neuroprotection and neurorepair in ischemic stroke.

Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living. Therefore, over the past several years, research has been directed to limit the brain lesions produced by acute ischemia (neuroprotection) and to increase the recovery, plasticity and neuroregenerative processes that complement rehabilitation and enhance the possibility of recovery and return to normal functions (neurorepair). Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke. Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients’ functional recovery. Prolonged citicoline administration at optimal doses has been demonstrated to be remarkably well tolerated and to enhance endogenous mechanisms of neurogenesis and neurorepair contributing to physical therapy and rehabilitation.

Memory loss during lenalidomide treatment: a report on two cases

BackgroundThere are many reports of cognitive dysfunction in patients receiving chemotherapy or targeted therapies. Many antineoplastic agents may be involved in the condition also known as “chemo brain” or “chemo fog”.Case presentationTwo male patients (aged 41 and 70) with multiple myeloma developed severe, rapidly progressing cognitive impairment (mostly involving episodic memory) and loss of independence in activities of daily living during lenalidomide-based treatment. On withdrawal of the drug, one patient recovered normal cognitive function and independence in activities of daily living, whereas mild cognitive impairment persisted in the other patient. The Naranjo Adverse Drug Reaction Probability Scale score was 6 out of 13 for the first patient and 5 out of 13 for the second, suggesting a probable causal relationship between the adverse event and lenalidomide administration.ConclusionLenalidomide may induce particular cognitive disorders (notably episodic memory impairments) in some patients. The drug’s putative neurotoxicity is probably promoted by specific risk factors (such as previous chemotherapy, prior mild cognitive impairment, age and the presence of cerebrovascular lesions).

Abstract 2: The Changing Face of Cardiac Surgery: Frailty, Age, and Adverse Outcomes Create a Mandate for Shared Decision Making

OBJECTIVES The literature shows that comprehension of risks, benefits, and alternatives of treatment options is poor among patients referred for cardiac interventions. We have previously demonstrated that frail, elderly patients undergoing cardiac surgery require complex procedures and are at markedly increased risk of postoperative death and prolonged institutional care. An effective informed consent process is critical in this population. We sought to determine the proportion of frail, elderly patients referred for cardiac surgery over time and their associated outcomes. METHODS Patient demographics and utilization rates from 2001 to 2010 were examined at a single cardiac surgery center. Patients were stratified by age (≤70, 71-79, 80+) and frailty (defined as any loss of independence in activities of daily living (Katz Index), ambulation, or a documented history of dementia; frailty data available since 2006). We examined case complexity (CABG, Valve, combined CABG+Valve) and in-hospital outcomes: major adverse cardiac events (MACE, defined as one or more of mortality, stroke, infection or renal failure), as well as ICU stay &gt;7 days, and discharge (DC) to an institution. RESULTS In the past decade the proportion of patients 80+ has increased from 7% (75/1005) to 13% (105/824) while the proportion &lt;70 has decreased from 63% (632/1005) to 57% (466/824) (p&lt;0.0005). Isolated CABG surgery declined from (79% (789/1005) to 60% (497/824) while CABG+Valve cases increased from 9% (91/1005) to 12% (104/824) (p&lt;0.05). CABG+Valve surgery was performed on 26% (228/893) of patients 80+ vs. 6% (348/5614) of patients &lt;70 (p&lt;0.0005). In the past five years the proportion of frail patients referred for surgery has increased from 3.8% (33/871) to 9.3% (77/824). Adverse outcomes were significantly higher for frail patients (p&lt;0.0001) as shown in figure 1, as well as for older patients (p&lt;0.0001). CONCLUSIONS We have identified increasing rates of elderly and frail patients with high-risk profiles referred for cardiac surgery. These patients experience higher rates of mortality and prolonged institutional care. We suggest this vulnerable patient population may benefit from the institution of a formalized shared decision making process to effectively communicate risks, benefits and alternatives to the planned procedure.

‘Primum non nocere’—first, do no harm

British Journal of Healthcare AssistantsVol. 6, No. 11 Conference Preview‘Primum non nocere’—first, do no harmLinda NazarkoLinda NazarkoSearch for more papers by this authorLinda NazarkoPublished Online:16 Aug 2013https://doi.org/10.12968/bjha.2012.6.11.527AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bhatia N, Daga MK, Garg S, Prakash SK (2010) Urinary catheterization in medical wards. J Global Infect Dis 2(2): 83–90 Crossref, Google ScholarCovinsky KE, Palmer RM, Fortinsky RHet al. (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51(4): 451–8 Crossref, Google ScholarHealth Protection Agency (HPA) (2012) English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011: preliminary data. http://bit.ly/KBRtdc (accessed 29 October 2012) Google ScholarFakih MG, Pena ME, Shemes Set al. (2010) Effect of establishing guidelines on appropriate urinary catheter placement. Acad Emerg Med 17(3): 337–40 Crossref, Google ScholarHoogerduijn JG, Schuurmans MJ, Duijnstee MSet al. (2007) A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs 16(1): 46–57 Crossref, Google ScholarNational Patient Safety Agency (NPSA) (2007) Slips, trips and falls data update. http://bit.ly/Rix92X (accessed 29 October 2012) Google ScholarNational Patient Safety Agency (NPSA) (2010) Bedrails Safer Practice Notice. http://bit.ly/xh0juG (accessed 29 October 2012) Google ScholarNazarko L (2010) Effective evidence-based catheter management: an update. Br J Nurs 19(15): 948–53 Link, Google ScholarNHS Midlands and East (2012) Five simple steps to prevent and treat pressure ulcers. www.stopthepressure.com/sskin/ (accessed 29 October 2012) Google ScholarPhillips L, Buttery J (2009) Exploring pressure ulcer prevalence and preventative care. Nurs Times 105(16): 34–6 Google ScholarRothfeld AF, Stickley A (2010) A program to limit urinary catheter use at an acute care hospital. Am J Infect Control 38(7): 568–71 Crossref, Google ScholarSchwendimann R, Bühler H, De Geest S, Milisen K (2008) Characteristics of hospital inpatient falls across clinical departments. Gerontology 54(6): 342–8 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 November 2012Volume 6Issue 11ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 16 August 2013 Published in print 1 November 2012 Information© MA Healthcare LimitedPDF download

Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study

This study aims to describe the changes in sense of coherence (SOC) over time and relate these changes to negative life events among very old people. Prospective and longitudinal study. 190 old women and men participated, of whom 56 could be included in the 5-year follow-up. The mean SOC score from the first and second data collection were compared using a paired sample t-test. The relationship between the index of negative life events and the changes on SOC score between the two data collections was investigate using linear regression. Antonovsky's SOC scale and an index of negative life events including severe physical and mental diseases, various losses as losses of spouses, cognitive and functional ability. For the whole group of subjects (n = 56), the SOC scores was higher (70.1 vs. 73.7, p = 0.029) at the second point measure. The most common negative life events at follow-up were loss of independence in activities in daily living and decrease in cognitive function. A significant correlation between the index of negative life events and changes in SOC over 5 years was found (p = 0.025). The more negative life events, the more decrease in SOC. We concluded that there is a risk of decreased SOC and thereby quality of life when negative life events accumulate among very old people. Nursing interventions might play an important role for maintaining and perhaps strengthening SOC among old people exposed to negative life events.