Lower Activities Of Daily Living Scores Research Articles

Clinical and physiological risk factors contributing to the restricted mobility in older adults: a longitudinal analysis

BackgroundMobility limitations (e.g., using wheelchair) have been closely linked to diminished functional independence and quality of life in older adults. The regulation of mobility is pertaining to multiple neurophysiologic and sociodemographic factors. We here aimed to characterize the relationships of these factors to the risk of restricted mobility in older adults.MethodsIn this longitudinal study, 668 older adults with intact mobility at baseline completed the baseline assessments of clinical characteristics, cognitive function, sleep quality, activities of daily living (ADL), walking performance, beat-to-beat blood pressure, and structural MRI of the brain. Then 506 of them (mean age = 70.7 ± 7.5 years) responded to the follow-up interview on the mobility limitation (as defined by if using wheelchair, cane, or walkers, or being disabled and lying on the bed) after 18 ± 3.5 months. Logistic regression analyses were performed to examine the relationships between the baseline characteristics and the follow-up mobility restriction.ResultsAt baseline, compared to intact-mobility group (n = 475), restricted-mobility group (n = 31) were older, with lower score of ADL and the Montreal Cognitive Assessment (MoCA), greater score of Pittsburgh Sleep Quality Index (PSQI), poorer cardio- and cerebral vascular function, and slower walking speeds (ps < 0.05). The logistic regression analysis demonstrated that participants who were with history of falls, uncontrolled-hypertension, and/or greater Fazekas scale (odds ratios (ORs):1.3 ~ 13.9, 95% confidence intervals (CIs) = 1.1 ~ 328.2), walked slower, and/or with lower ADL score (ORs: 0.0026 ~ 0.9; 95%CI: 0.0001 ~ 0.99) at baseline, would have significantly greater risk of restricted mobility (p < 0.05; VIFs = 1.2 ~ 1.9).ConclusionsThese findings provide novel profile of potential risk factors, including vascular characteristics, psycho-cognitive and motor performance, for the development of restricted mobility in near future in older adults, ultimately helping the design of appropriate clinical and rehabilitative programs for mobility in this population.

Is patients’ activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

BackgroundProlonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients’ activities of daily living (ADL) score may be a proxy for home care workers’ standing time at work. The objective of the present study was to investigate the association between patients’ ADL self-care score, and workers standing time.MethodsThis cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients’ ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories.ResultsWe analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients.ConclusionOur findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers’ total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Home-based supportive and health care services based on functional ability in older adults in Iran.

Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Clinical Characteristics of Older Adults Living in Foster Families in the French West Indies: Baseline Screening of the KArukera Study of Aging in Foster Families (KASAF) Cohort.

Foster families for older adults could represent a transitional or alternative model to nursing homes. The aim of this study was to describe the clinical characteristics of older adults in foster families and to compare them with those of residents in nursing homes in French West Indies. This study is a cross-sectional analysis of the KArukera Study of Aging in Foster Families (KASAF) cohort. Sociodemographic and clinical characteristics were extracted. Dependency was assessed using the Activities of Daily Living (ADL) scale and cognition using the Mini-Mental State Examination (MMSE) scale. Age, gender, ADL, and MMSE scores were compared with nursing home residents from a twin study of KASAF (n = 332). A total of 107 older adults (mean age 81.8 years; 61.7% women) were recruited in 56 foster families between September 2020 and May 2021. In all, 25.5% had diabetes mellitus and 45.8% suffered from hypertension. The mean MMSE score was 9.3±10.1 and 76.0% had major cognitive impairment (MMSE score <18); 12.5% were diagnosed with Parkinson's disease, and 42.0% of the residents were confined to bed or in a wheelchair, with a mean ADL score of 1.5±1.8. Almost all the residents (96.3%) benefited from a medical follow-up by a nurse who visited once or twice a day. Compared to older adults living in nursing homes, those in foster families were more frequently women (61.7% vs 49.4%) and had lower ADL score (1.5 vs 2.4) and lower MMSE score (9.3 vs 11.3). The clinical profile of foster families' residents was quite similar to that of nursing home residents in terms of demographics, dementia, and dependency. Foster families might represent an interesting strategy to address the unmet clinical and social needs of dependent older adults, especially in countries where nursing homes are not sufficiently developed. NCT04545775.

Assessment of Activities of Daily Living (ADL)Scale Can be Used to Predict Overall Survival after CAR-T Cell Therapy in Elderly Patient(over 70 years of age) with Refractory/Relapsed B-Cell Lymphoma

Background:The advent of chimeric antigen receptor (CAR) T-cell therapy has changed the treatment landscape for refractory/relapsed B-cell lymphoma (r/r B-NHL). However, there are limited data on outcomes in older patients (age≥65 years) treated with CAR -T-cell therapy, particularly in patients older than 70 years. Objectives:Our objective was to evaluate the efficacy of CAR -T-cell therapy in elderly patients with r/r B-NHL, including response rates, progression-free survival (PFS), and overall survival (OS), as well as factors affecting survival. Methods:As of April 1, 2023, a total of 80 patients with r/r B-NHL in the age group 65-70 years (n=57) or older than 70 years (n=23) were included. Diagnoses included DLBCL NOS (n=58) ,HGBCL(n=6) ,TFL(n=6), Richter(n=4) and Other(n=6). Baseline characteristics are described in Table 1.All patients were heavily pretreated. 71/80 (88.75%) patients were at stage III-IV. The median IPI score was 3 (range 1-5). 8/96 (10%) patients failure of prior autologous hematopoietic stem cell transplantation (HSCT). The median assessment score of ADL scale was 95 for both the 65-70 and &amp;gt; 70 age groups, and 47.5% of patients received bridging therapy(BT) prior to CAR -T cell therapy. There were no significant differences in baseline data between age groups. Prior to the study, CD19/CD22 antigen expression in tumor tissue was confirmed by pathology, and the target was selected according to antigen expression. The kinetics and function of CAR -T cells were monitored by quantitative PCR and flow cytometry. Efficacy was assessed by PET-CT every 3 months after CAR -T therapy. All p-values were two-sided values. Survival curves were calculated by the Kaplan-Meier method. Results: The number of patients who chose a CD19 target or a CD19/CD22 dual target for CAR -T therapy was 67/80 (%) and 13/80 (%), respectively. The median CAR -T cells infused dose in the 65-70 and &amp;gt; 70 age groups was 1.3 (range, 0.0485-9.5) and 1.6 (range, 0.088-3.91) (×106/Kg), respectively (P=0.9618).(Table 2).There were no differences between the 2 age groups in the occurrence of cytokine release syndrome (CRS) grade 3 or higher(P=0.6221). The proportion of patients using glucocorticoid therapy for CRS was higher in the age group &amp;gt; 70 years than in the age group 65-70 years, but there was no statistically significant difference (P=0.0957). A response occurred in 35/57 (61.4%) of patients in the 65-70 years age group and in 14/23 (60.7%) of patients in the &amp;gt; 70 years age group (P=0.9646), with a complete response in 21/57 (36.8%) and 8/23 (34.8%), respectively (P=0.8623). At a median follow-up of 8.05 months (95% CI: 10.27-15.20), 12-month overall survival(OS) was 54.6% (95%CI: 39.3%-67.6%) vs 72.1% (95%CI:43.9%-87.8%) at ages 65-70 vs &amp;gt; 70,12-month progression-free survival (PFS) was 32.8% (95%CI: 19.8%-46.5%) vs 32.9% (95%CI: 13.5%-54%), and there was no significant difference in OS (p=0.0623) and PFS(p=0.6327) by age group. In contrast, patients aged &amp;gt; 70 with ADL &amp;lt; 95 showed significantly shorter 12-m OS (0) compared to patients aged 65-70 with ADL≥95(55.2%,95%CI:35.5%-71.1%) or ADL &amp;lt; 95(40.5%, 95%CI: 14.2%-59.9%), or &amp;gt; 70 with ADL≥95(85.6%, 95%CI:52.5%-96.3%), respectively (Figure 1: P= 0.0069). The three negative factors comprising the prognostic tool OS: low ADL scores (P=0.0124), high IPI scores (P=0.0029), and presence of extranodal lesions (P=0.0143). Conclusions: Our data suggest that the safety and efficacy of CAR -T-cell therapy in &amp;gt; 70-year-old patients is not significantly different from that in 65-70-year-olds. Elderly patients with ADL scores below 95 have poor survival after CAR -T therapy, especially those over 70 years of age. However, studies on curative approaches and long-term follow-up are needed.

ORIHIME II Study: Background, Treatment Status, and Outcomes of Patients with Acquired Hemophilia A with Low Activities of Daily Living Scores or Undergoing Rehabilitation - a Japanese Health Claims Database Analysis

Background: Acquired hemophilia A (AHA) is a rare disease in which autoantibodies (inhibitors) develop against blood coagulation factor (F)VIII, resulting in significantly reduced FVIII activity, with onset of bleeding symptoms such as sudden subcutaneous hemorrhage and muscular hemorrhage. The database-based study, 'Obtain Real-World Insights of Acquired Hemophilia A Patients in Japan' (the ORIHIME study) first reported data on rehabilitation and activities of daily living (ADL) scores for patients with AHA in Japan, which had previously been scarce (Ogawa et al. Blood 2021). The need to clarify the clinical experience of patients undergoing rehabilitation and patients with low ADL scores, who are considered to have relatively poor treatment and prognosis among AHA patients, has become apparent. This study evaluated the association between patient background, medication use, and outcomes among patients with AHA who underwent rehabilitation or had low ADL scores between April 1, 2008, and October 31, 2021. Methods: The study was conducted using the Medical Data Vision Co., Ltd. database. Patients with a diagnosis of AHA who were hospitalized and were administered immunosuppressants following admission were included. The primary endpoint examined the association of actual rehabilitation practices and total ADL score (measured using the Barthel Index) at discharge with patient background, medication use, and clinical outcomes. Total ADL score was calculated by adding together the scores for each of the following activities: eating, transferring (e.g. from bed to chair and back), ambulating, toilet use, bathing, mobility, stairs, dressing, and control of bladder and bowel movement. A score of 85 or higher corresponds with 'independence with minimal assistance' in the Barthel Index, therefore, in this analysis, participants are categorized by scores of <85 and ≥85 (Sulter et al. Stroke 1999). The risk of infection due to immunosuppressive therapy was a secondary endpoint. Results: Overall, 427 patients were included in this study. The mean (standard deviation [SD]) age of the patients was 76.3 (11.3) years, and 264 (61.8%) were male. A total of 249 patients underwent rehabilitation following admission to hospital. The median (range) time to the start of rehabilitation from the date of admission to hospital was 10.0 (1.0-133.0) days, and a high proportion of patients had a period of <2 weeks between admission to hospital and the start of rehabilitation (n=142/249 [57.0%]). Hemostatic agents used during rehabilitation were bypassing agents in 44 cases, FVIII in two cases, and tranexamic acid in 50 cases. Of the patients who received hemostatic agents, 36/44 (81.8%) patients who received bypassing agents, 2/2 (100.0%) patients who received FVIII, and 38/50 (76.0%) patients who received tranexamic acid started rehabilitation <2 weeks after the date of admission (Table 1). The ADL score at discharge was ≥85 points in 192 patients (45.0%) and <85 points in 186 patients (43.6%). Most patients with an ADL score at discharge of ≥85 (n=144/192 [75.0%]) were discharged from the hospital to home (attending outpatient visits at the same hospital), and for patients with ADL scores of <85 at discharge, the highest proportion of patients were transferred to other hospitals (n=92/186 [49.5%]; Table 2). Conclusions: Hemostatic agents may be necessary to start rehabilitation earlier. Post-discharge outcomes may be related to ADL scores at discharge. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Functional Activity After Flatfoot Reconstruction With Lateral Column Lengthening.

The objective of this study was to evaluate return to activity following flatfoot reconstruction with lateral column lengthening (LCL) by assessing functional postoperative data and identifying patient characteristics associated with poor function following surgery. Consecutive patients that underwent operative flatfoot correction including LCL and other necessary procedures from 2014 to 2019 by 3 fellowship trained foot and ankle orthopedic surgeons were retrospectively administered Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and FAAM Sports questionnaires with no preoperative scoring available. Patient demographic factors, comorbidities, and radiographic features were evaluated as predictors of outcome scores to simulate return to activity. Statistical analysis, including student's t-tests and analysis of variance, was performed. A total of 54 patients were included. A body mass index (BMI) of 30 kg/m2 or greater was associated with a lower ADL score (P = .002) and Sports score (P = .002). Preoperative hindfoot valgus of 9° or higher was associated with higher ADL scores (P = .040). Neither age nor any flatfoot radiographic parameters yielded significant differences in functional scores. This study demonstrated relatively high average FAAM scores in both the ADL and the sports subscales, consistent with previous studies. This study also identified lower BMI and greater preoperative hindfoot valgus as potential predictors of improved functional outcome following reconstruction. Level III: Retrospective case control.

Activities and participation after primary total hip arthroplasty; posterolateral versus direct anterior approach in 860 patients.

Background and purposeIn the past decade, a shift occurred in surgical total hip arthroplasty (THA) approaches to the posterolateral (PLA) and direct anterior approach (DAA). Comparisons of postoperative activities and participation between surgical approaches for THA are sparse. We therefore investigated the association between PLA and DAA for THA regarding the construct “activity and participation” (ICF model) during the first postoperative year.Patients and methodsThis was an observational cohort study on osteoarthritis patients scheduled for primary THA in 2 hospitals. Questionnaires to assess the ICF domain “activity and participation” were completed preoperatively, and 3, 6, and 12 months postoperatively (HOOS Activities of daily living (ADL) and Sport and Recreation Function (SR), Hospital for Special Surgery Hip Replacement Expectations Survey, and questions regarding return to work). Each hospital exclusively performed one approach (PLA [Alloclassic-Zweymüller stem] or DAA [Taperloc Complete stem]) for uncemented THA. Hospital was included as instrumental variable, thereby addressing bias by (un)measured confounders. Adjusted mixed-effect models were used, stratified by employment.ResultsTotal population: 238 PLA (24% employed) and 622 DAA (26% employed) patients. At 12 months, the PLA group had a lower ADL score (–7, 95% CI –12 to –2 points). At 6 months, significantly fewer PLA patients had fulfillment of the expectation sports-performance (OR = 0.3, CI 0.2–0.7]. Other outcomes were comparable.Employed population: At 6 and 12 months, PLA patients scored clinically lower on ADL (respectively –10, CI –19 to 0 and –9, CI –19 to 0 points) and SR (respectively –13, CI –21 to –4 and –9, CI –18 to –1 points). At 6 months, fewer PLA patients fulfilled the expectation joining recreational activities (OR = 0.2, CI 0.1–0.7]. Fulfillment of other expectations was comparable between groups. PLA patients less often returned to work within 3 months (31% vs. 45%), but rates were comparable at 12 months (86% vs. 87%).InterpretationOverall, functional recovery regarding “activity and participation” was comparable for PLA and DAA. Among employed patients, DAA resulted in better functional recovery and more fulfillment of expectations compared with PLA patients. DAA might also facilitate faster return to work.

Quality of life and activities of daily living of myasthenia gravis patients in Hospital Seberang Jaya, Malaysia using MGQOL-15 and MGADL scores: A cross sectional study

Background &amp; Objective: Myasthenia gravis (MG) is an immune mediated neuromuscular disease with a wide range of clinical symptoms causing fatigability, which can influence quality of life (QoL) and activity of daily living (ADL). Patient-derived quality of life, as assessed by questionnaires has proven to be an essential outcome measures when used in conjunction with clinical examination. The objective of this study is to explore factors associated with QoL and ADL of MG patients in Hospital Seberang Jaya, Malaysia. Methods: In this cross-sectional study 35 MG patients were recruited from the Neurology clinic of Hospital Seberang Jaya, Penang. An interview-administered questionnaire was utilized. The questionnaire consisted of 3 parts: Socio-demographics (age, gender, ethnicity), Clinical factors (MG type, MG crisis, Ach Antibody positivity, thymoma was recorded) and QoL assessment using validated MG-QoL-15 and MGADL questionnaires respectively. Descriptive and bivariate analysis was conducted using SPSS version 23. Results: Our sample were 57% males, and the mean age was 54.34 years, range 19 to 81 years. Higher score of MG-QoL-15 and MGADL indicates lower QoL of MG patients. In bivariate analysis, Non-Malays were 8 times more likely to have better QoL compared to Malays (OR=8, 95%CI =1.726-37.09, p = 0.005). Patients with poorer ADL score were 6.5 times more likely to have lower QOL compared to those with lower ADL score (OR = 6.5, 95% CI = 1.3-31.8, p = 0.016). Other clinical factors were not significantly associated with QoL. Conclusion: This study showed that the non-Malay MG patients and those with lower grades of the disease (grade I to II) had better QoL.

Delirium and geriatric syndromes in hospitalized older patients: Results from World Delirium Awareness Day

Objective: To determine the point prevalence of delirium and the associated risk factors in geriatric inpatients. Patients and Methods: Sixty-two hospitalized patients aged 60 years and over were recruited. The Mini Nutritional Assessment-Short Form (MNA-SF), the FRAIL scale, Katz Activities of Daily Living (ADL), and Lawton-Brody Instrumental ADL (IADL) questionnaires were administered. A delirium evaluation test (Confusion Assessment Method-CAM) was performed for diagnosing delirium. Mortality was evaluated one month after the index date. Results: The median age was 71.5 (range, 60-96) years. Delirium was detected in 29% of the patients. Frailty and dementia were associated with delirium (p<0.001 and p=0.001; respectively). Polypharmacy, indwelling urinary catheter, and low albumin were also related to delirium (p=0.025, p=0.007, and p=0.002; respectively). Age over 70 years, low Katz ADL and low MNA-SF scores were found to be independently associated with delirium in multivariate regression analysis models. The median hospitalization time was longer in the delirium group (p=0.029). Survival analysis at one month showed no significant difference between the delirium and non-delirium groups. Conclusion: Age over 70 years, impaired functionality in ADL and malnutrition were independently associated with delirium.

In-hospital pulmonary rehabilitation after completion of primary respiratory disease treatment improves physical activity and ADL performance: A prospective intervention study.

Introduction:Pulmonary rehabilitation improves the physical condition of patients with chronic respiratory disease; however, there are patients who cannot leave the hospital because of their low activities of daily living (ADLs), despite the completion of primary respiratory disease treatment and rehabilitation during treatment. Therefore, this study demonstrated that those patients recovered their ADLs through in-hospital pulmonary rehabilitation after treatment completion.Methods:We prospectively studied 24 hospitalized patients who had some remaining symptoms and showed low ADL scores of 9 points or less on the short physical performance battery after undergoing treatment for respiratory disease in Fukujuji Hospital from October 2018 to October 2019, excluding 2 patients who had re-exacerbation and 1 patient who could not be examined using the incremental shuttle walk test (ISWT). After completion of the primary respiratory disease treatment, patients moved to the regional comprehensive care ward, and they received pulmonary rehabilitation for 2 weeks. In the ward, patients who could not yet leave the hospital could undergo pulmonary rehabilitation for up to 60 days. Data were evaluated three times: upon treatment completion (baseline), postrehabilitation, and 3 months after baseline. The main outcome was an improvement in the incremental shuttle walk test (ISWT) postrehabilitation.Results:The median age of the patients was 80 (interquartile range (IQR): 74.8–84.5), and 14 patients (58.3%) were male. The ISWT distance significantly increased postrehabilitation (median [IQR]: 60 m [18–133] vs 120 m [68–203], P < .001). The Barthel Index (BI) (P < .001), the modified Medical Research Council (P < .001), and other scale scores were also improved. Among patients with acute respiratory diseases such as pneumonia, chronic obstructive pulmonary disease, and interstitial pneumonia, ISWT and other data showed improvement at the postrehabilitation timepoint. Ten patients who could perform examinations at 3 months after baseline were evaluated 3 months after taking baseline data prior to starting rehabilitation. The ISWT showed significant improvement 3 months after baseline compared to baseline (P = .024), and the ISWT distance was maintained after rehabilitation.Discussion and conclusions:Physical activity, symptoms, mental health, and ADL status in patients who had not recovered after primary treatment completion for respiratory diseases could improve through in-hospital pulmonary rehabilitation.

Risk factors for in‐hospital mortality in patients with advanced lung cancer with interstitial pneumonia undergoing systemic chemotherapy: A retrospective and observational study using a nationwide administrative database in Japan

BackgroundThe safety profile of systemic chemotherapy for lung cancer patients with interstitial pneumonia (IP) in clinical practice remains unclear. Using Diagnostic Procedure Combination (DPC) data from the Japanese administrative database, we investigated the mortality of hospitalized lung cancer patients with IP as they underwent a course of systemic chemotherapy nationwide.MethodsThe DPC data of patients with stage IIIB or IV lung cancer as defined by the Union for International Cancer Control Tumor‐Nodes‐Metastases 6th and 7th editions from April 2014 to March 2016 were obtained. Among those patients, only patients with concomitant IP and receiving systemic chemotherapy without radiotherapy were included.ResultsAmong 1524 included patients, 70 (4.6%) died in the hospital. Multivariate analysis revealed that low activities of daily living (ADL) scores on admission (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.24–4.12, p = 0.008) and high‐dose corticosteroid therapy following chemotherapy (HR 2.62, 95% CI 1.44–4.77, p = 0.002) were strongly associated with in‐hospital mortality. It was determined that patients possibly received high‐dose corticosteroids for IP exacerbations; these patients had a higher in‐hospital mortality rate of 67.7% (21/31 patients) and a significantly shorter median survival time of 55 days (95% CI 31–69 days, p < 0.001) than those who did not receive high‐dose corticosteroids.ConclusionAcute exacerbation of IP treated with systemic high‐dose corticosteroids is significantly associated with in‐hospital mortality, and a low ADL score on admission is a risk factor for in‐hospital mortality in lung cancer patients with IP who undergo systemic chemotherapy.

Risk factors for poor outcome in older patients admitted in a surgical intensive care unit.

The benefit of a stay in an intensive care unit (ICU) is not certain for older patients, particularly in the surgical context. The objective of this study was to identify the factors associated with an unfavourable outcome in this population. Prospective, descriptive, monocentric study conducted in the surgical ICU of a French university hospital. Patients aged ≥75 years admitted in the surgical ICU for a predicted length of stay ≥48 hours were included. Patients received an initial and a 6-months nutritional and functional assessment performed by physicians and nurses. The outcome was considered as favourable if the Katz Activities of Daily Living (ADL) variation (ADL delta=6-months ADL - ICU admission ADL) was between 0 and -0.5 point 6 months after ICU discharge and unfavourable if the ADL delta decreased by more than 0.5 points or if the patient had died 6 months after ICU discharge. Fifty-six patients-32 (57%) male-aged 79 [77; 83]y were included. ICU mortality was 19%; 6-month mortality was 22%. Median ADL delta was -0.5 [-0.5-0] points. A low ADL score (P=.0438) and a low albumin level (P=.0213) at admission were the two independent factors associated with an unfavourable outcome. Mortality and loss of independence were high in this elderly population during and after their surgical ICU stay. The benefit of a systematic collaboration between intensive care specialists, ICU nurses, and geriatricians, to assess and manage nutritional and functional problems and to prevent a pejorative outcome in patients over 75 years old admitted in surgical ICU needs to be studied. There should be systematic screening for objective markers of undernutrition and frailty on ICU admission of older patients as they are associated with a poor prognosis.

Risk Factors for Mortality After Uncemented Bipolar Hemiarthroplasty for Geriatric Displaced Femoral Neck Fracture.

Uncemented bipolar hemiarthroplasty (UBHA) has been widely used to treat geriatric displaced femoral neck fracture (GDFNF), which results in a high 30-day mortality rate among the elderly. To date, few studies have focused on the risk factors for mortality after UBHA for GDFNF. In this retrospective study, elderly patients (age ≥70 years) who underwent UBHA for GDFNF were studied in order to provide helpful insight into the risk factors for mortality postoperatively. This retrospective study enrolled 835 elderly patients who underwent UBHA for GDFNF from January 2010 to December 2017. The Kaplan-Meier method and Cox regression analysis were used to identify significant risk factors predicting mortality after UBHA for GDFNF. Univariate analysis showed that underweight (body mass index <18.5 kg/m2), smoking, alcohol use, hypertension, chronic kidney disease, hypoproteinemia, low activities of daily living (ADL) score (0 to 2), and postoperative delirium were identified as the potential risk factors responsible for mortality after UBHA for GDFNF. Multivariate analysis suggested that underweight, hypoproteinemia, low ADL score, and postoperative delirium were significant risk factors predicting mortality after UBHA for GDFNF. Postoperative delirium was the most robust risk factor for mortality after UBHA for GDFNF. Underweight, hypoproteinemia, and low ADL score were also closely associated with mortality after UBHA for GDFNF. [Orthopedics. 2021;44(4):e570-e576.].

Improvement in Activities of Daily Living after Cataract Surgery in the Very Old.

The benefits of cataract surgery for patients aged ≥90 years in terms of improvements in activities of daily living (ADL) have been poorly evaluated using only limited data. Using a large nationwide administrative database of hospitalized patients, we investigated the improvement of ADL after cataract surgery in the very old (age of ≥90 years). We identified 84,747 patients with cataracts aged 80 to 89 years and 7,253 patients with cataracts aged ≥90 years who underwent cataract surgery in both eyes during hospitalization from April 2014 to March 2015. A retrospective matched-pair cohort study was performed to compare the proportion of patients with improved ADL after cataract surgery. We also compared the length of hospital stay between the two groups. Patients aged ≥90 years were more likely to be female and have a lower ADL score at admission. In the 1:4 matched-pair analysis with 7,253 versus 29,012 pairs, a lower proportion of patients aged ≥90 years had an improved ADL score (odds ratio, 0.33; 95% confidence interval, 0.29-0.36; P < 0.001) even after adjusting for other variables. Patients aged ≥90 years had a slightly shorter length of hospital stay than those aged 80 to 89 years (7.5 vs. 8.2 days, respectively; P < 0.001). In this large nationwide cohort of patients with cataracts, those aged ≥90 years showed significantly poorer improvement of ADL than did patients aged 80 to 89 years. Cataract surgery before the age of 90 years may be recommended for patients with cataracts.

Nursing home residents’ ADL status, institution-dwelling and association with outdoor activity: a cross-sectional study

IntroductionThe Norwegian regulations for nursing homes consider access to meaningful activities to be an indicator for the quality of nursing homes. Activities of daily living (ADL) provide important basic self-care skills for nursing home residents. Due to the physical changes caused by ageing and comorbidities, nursing home residents may experience functional decline over time, which may affect their ability to perform meaningful ADL, such as outdoor activity, which is considered a valuable and meaningful activity in Norwegian culture. This study aimed to investigate the association between ADL status, institution-dwelling and outdoor activity among nursing home residents.MethodsThis cross-sectional study included 784 residents aged >67 years living in 21 nursing homes in 15 Norwegian municipalities between November 2016 and May 2018. The Barthel Index was used to assess the nursing home residents’ ADL status. Other variables collected were age, gender, body weight and height, visits per month, institution, ward, and participation in weekly outdoor activities. Descriptive statistics were used to provide an overview of the residents’ characteristics. A Poisson regression model was used to test the association between the outdoor activity level as the dependent variable and ADL score, institution, and other control variables as independent variables.ResultsMore than half (57%) of the nursing home residents in this sample did not go outdoors. More than 50% of the residents had an ADL score <10, which indicates low performance status. Further, we found that residents’ ADL status, institution, ward, and number of visits had an impact on how often the residents went outdoors.DiscussionThe nursing home residents in this study rarely went outdoors, which is interesting because Norwegians appreciate this activity. Differences in the number of visits might explain why some residents went outdoors more often than other residents did. Our findings also highlight that the institutions impact the outdoor activity. How the institutions are organized and how important this activity is considered to be in the institutions determine how often the activity is performed.ConclusionThe low frequency of the outdoor activities might be explained by a low ADL score. More than 50% of the residents had an ADL score <10, which indicates low performance status. Despite regulations for nursing home quality in Norway, this result suggests that organizational differences matter, which is an important implication for further research, health policy and practice.

Risk factors for mortality and survival rates in elderly patients undergoing hemiarthroplasty for hip fracture.

The aim of this study was to analyze the relationship between mortality and possible risk factors in elderly patients surgically treated with hemiarthroplasty for hip fracture and to determine mortality rates and yearly survival outcome in a selected cohort. A total of 92 patients (51 men (55.4%) and 41 women (44.6%); mean age: 76.47 years) who underwent hemiarthroplasty for hip fracture were included into the study. The following data associated with risk factors were recorded for 92 patients: age, gender, pre-fracture activities of daily living (ADL), type of fracture, American Society of Anesthesiologists (ASA) score, therapeutic procedure, type of anesthesia, length of time after fracture until operation, postoperative mobility, and duration of hospitalization. A multivariate logistic regression test was used to evaluate the correlation between the risk factors and first- and second-year mortality rates. Third-year mortality rate after surgery was analyzed and compared with the general mortality rate in a similar population of the same age group living in the same city. The mortality rate was 18.5% (17 patients) after the first-year follow-up and 25% (23 patients) after the second year. The mortality risk after hip fracture was found to be 11.7 times greater than the similar age group population in the third year. In addition, there was a significant relationship between a low (dependent) preoperative ADL score, advanced age (>80 years), male gender, high ASA score and poor ability to walk (unable to walk), and first- and second-year mortalities (p<0.05). However, no significant relationship was found between fracture type, fracture side, anesthesia type, time from fracture to surgery, or duration of hospitalization and mortality (p>0.05). Advanced age, male gender, a high ASA score, a dependent preoperative ADL score, and a postoperative inability to walk were determined to be the most important risk factors affecting mortality in elderly patients with hip fracture. The mortality risk was 11.7 times greater than that of a population with similar characteristics. Level IV, Therapeutic study.

Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study.

To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults. Prospectively longitudinal cohort study. The study recruited 354 men aged 65 years and older in the veteran's retirement community. Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality. According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006). Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.

A Simple Target Interception Task as Test for Activities of Daily Life Performance in Older Adults.

Previous research showed that a simple target interception task reveals differences between younger adults (YA) and older adults (OA) on a large screen under laboratory conditions. Participants intercept downward moving objects while a horizontally moving background creates an illusion of the object moving in the opposite direction of the background. OA are more influenced by this illusory motion than YA. OA seem to be less able to ignore irrelevant sensory information than YA. Since sensory integration relates to the ability to perform Activities of Daily Living (ADL), this interception task can potentially signal ADL issues. Here we investigated whether the results of the target interception task could be replicated using a more portable setup, i.e., a tablet instead of a large touch screen. For YA from the same, homogeneous population, the main effects were replicated although the task was more difficult in the tablet set-up. After establishing the tablet’s validity, we analyzed the response patterns of OA that were less fit than the OA in previous research. We identified three different illusion patterns: a (large) illusion effect (indicating over integration), a reverse illusion effect, and no illusion effect. These different patterns are much more nuanced than previously reported for fit OA who only show over integration. We propose that the patterns are caused by differences in the samples of OA (OA in the current sample were older and had lower ADL scores), possibly modulated by increased task difficulty in the tablet setup. We discuss the effects of illusory background motion as a function of ADL scores using a transitional model. The first pattern commences when sensory integration capability starts to decrease, leading to a pattern of over-integration (illusion effect). The second pattern commences when compensatory mechanisms are not sufficient to counteract the effect of the background motion, leading to direction errors in the same direction as the background motion (reverse illusion). The third pattern commences when the task requirements are too high, leading OA to implement a probabilistic strategy by tapping toward the center of the screen.

Interleukin-6 and C-reactive protein, successful aging, and mortality: the PolSenior study

BackgroundIn the elderly, chronic low-grade inflammation (inflammaging) is a risk factor for the development of aging-related diseases and frailty. Using data from several thousand Eastern Europeans aged 65 years and older, we investigated whether the serum levels of two proinflammatory factors, interleukin-6 (IL-6) and C-reactive protein (CRP), were associated with physical and cognitive performance, and could predict mortality in successfully aging elderly.ResultsIL-6 and CRP levels systematically increased in an age-dependent manner in the entire study group (IL-6: n = 3496 individuals, p < 0.001 and CRP: n = 3632, p = 0.003), and in the subgroup of successfully aging individuals who had never been diagnosed with cardiovascular disease, myocardial infarction, stroke, type 2 diabetes, or cancer, and had a Mini Mental State Examination (MMSE) score ≥24 and a Katz Activities of Daily Living (ADL) score ≥5 (IL-6: n = 1258, p < 0.001 and CRP: n = 1312, p < 0.001). In the subgroup of individuals suffering from aging-related diseases/disability, only IL-6 increased with age (IL-6: n = 2238, p < 0.001 and CRP: n = 2320, p = 0.249). IL-6 and CRP levels were lower in successfully aging individuals than in the remaining study participants (both p < 0.001). Higher IL-6 and CRP levels were associated with poorer physical performance (lower ADL score) and poorer cognitive performance (lower MMSE score) (both p < 0.001). This association remained significant after adjusting for age, gender, BMI, lipids, estimated glomerular filtration rate, and smoking status. Longer survival was associated with lower concentrations of IL-6 and CRP not only in individuals with aging-related diseases/disability (HR = 1.063 per each pg/mL, 95 % CI: 1.052-1.074, p < 0.001 and HR = 1.020 per each mg/L, 95 % CI: 1.015-1.025, p < 0.001, respectively) but also in the successfully aging subgroup (HR = 1.163 per each pg/mL, 95 % CI: 1.128-1.199, p < 0.001 and HR = 1.074 per each mg/L, 95 % CI: 1.047-1.100, p < 0.001, respectively). These associations remained significant after adjusting for age, gender, BMI, lipids and smoking status. The Kaplan-Meier survival curves showed similar results (all p < 0.001).ConclusionsBoth IL-6 and CRP levels were good predictors of physical and cognitive performance and the risk of mortality in both the entire elderly population and in successfully aging individuals.