Outcomes In Older People Research Articles

Erratum: “Bias in Environmental Cohort Studies: The Example of Bone Lead and Mortality”

Unrecognized biases in prospective environmental cohort studies may result in under- or overestimating the health effects of the exposure under investigation. In this issue of EHP, researchers examine the problem of bias using data on lead exposure and mortality in men and directed acyclic graphs (DAGs) to illustrate causal relationships between variables that could bias results.1 The study data came from 835 white male participants, average age 67 years, who were part of the Normative Aging Study (NAS), which began in 1963. Between 1991 and 1999, the men had undergone measurement of lead in their patellas. For the current analysis, the researchers looked at associations between patella lead and mortality from all causes, from cardiovascular disease, and from ischemic heart disease. Bone lead, rather than blood lead, is a better biomarker for cumulative environmental exposure,2 and patella lead in particular has been associated in past studies with risk of ischemic heart disease death.3 Directed acyclic graphs helped researchers pinpoint areas where bias related to recruitment and participation may have affected the Normative Aging Study and similar studies. The authors used DAGs to visualize relationships among variables that applied to the NAS participants. DAGs link variables with directional arrows to identify those that may bias results. The present study focused on potential errors related to participant selection and participation issues that may affect other cohort studies used in environmental health research. By explicitly visualizing assumptions with DAGs, researchers can identify where bias creeps in and find ways to avoid it.4 “Researchers don’t always recognize the assumptions they make when analyzing data,” says study leader Marc Weisskopf, an epidemiologist at the Harvard T.H. Chan School of Public Health. As the team analyzed the DAGs, they realized that age at enrollment appeared to be influencing the risk associations. Overall, men with the highest patella lead levels were twice as likely as those with the lowest lead levels to die from ischemic heart disease. However, among the subset of 637 men who were 45 or younger when they entered the NAS cohort, those with the highest patella lead levels were estimated to be 4.6 times as likely to die from ischemic heart disease as those with the lowest levels. When the data were further adjusted to account for men who dropped out of the cohort, the estimated risk among younger men with the highest lead levels climbed to 5.2 times that of younger men with the lowest exposures.1 Men who were older when they enrolled in the NAS likely did not represent older men in general. That’s because many older men have cardiovascular conditions, which makes them less likely to participate in studies.5 Furthermore, the NAS specifically did not accept participants with pre-existing cardiovascular disease.1 In contrast, because younger people tend to be healthier, their health status is less likely to influence whether they enter a study. Ideally, long-term studies such as the NAS would follow younger participants for a longer time to avoid recruitment biases. However, the longer a cohort is followed, the more expensive the study becomes. “This is particularly problematic with environmental exposures that are related to health conditions that affect people’s likelihood of participating in studies,” Weisskopf says. “Younger people are healthier to start, and it’s less likely that a health condition drives who enters a study.” Socioeconomic status presents another source of potential bias. Less affluent people are both more likely to be exposed to environmental toxicants and less likely to participate in epidemiological studies, and those who do enroll are more likely to drop out.6 “It’s not random who drops out of a cohort,” notes Weisskopf. Aside from the bias-related findings, the results suggest that previous estimates of lead’s influence on mortality may have been overly conservative. “They hint that we may be underestimating the health effects of other environmental toxicant exposures as well, especially in the context of health outcomes in older people and/or exposures associated with selection and attrition,” says Jennifer Weuve, an associate professor of internal medicine at Chicago’s Rush Medical College, who was not involved in the analysis. She says the methods used by Weisskopf’s team could be applied to other environmental epidemiology cohorts to improve estimates of health risks.

A systematic review of instruments for measuring outcomes in economic evaluation within aged care.

BackgroundThis paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector.MethodsOnline databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000.ResultsThe most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care.ConclusionIn the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0372-8) contains supplementary material, which is available to authorized users.

Person-centered and Integrated Care for Ageing Populations

Background: Disintegrated and uncoordinated services and those neglecting the concerns of users tend to be associated to negative health outcomes for older people. Objectives: This paper is aimed at exploring how the concept of person centred care can be relevant for ageing populations and its implications for health systems.Methods: These involved a critical review of the literature, both standard scientific data banks as well as internet-based sources. Results: It was found that the best way to reorient health systems towards the goal of healthy ageing is by placing older people at the centre of service delivery. While people-centered and integrated services are fundamental for all including ageing people, the strategy mix may be optimized by attending to the goals of healthy ageing and the older person’s values. Discussion and Conclusions: An older person-centred integrated health care delivery model that focuses on prevention and care coordination seems to be the best approach to reorienting health systems. Successful older-people-centred health services are organized around the needs of older people, acknowledging their intrinsic value and contribution to society, and enabling their functional abilities.

Chronic kidney disease in older people - diagnosis, aetiology and consequences.

The prevalence of chronic kidney disease (CKD) steeply rises with age but there is controversy regarding the diagnosis and clinical significance of CKD in older people. This article reviews recent advances in our understanding with respect to the diagnosis, aetiology and adverse outcomes associated with CKD in older people. Comparisons with measured glomerular filtration rate in a cohort of older people found that the Chronic Kidney Disease Epidemiology Collaboration equation using creatinine and cystatin C performs at least as well as other equations developed to estimate glomerular filtration rate in older populations. Several studies have identified modifiable risk factors in earlier life that are associated with increased risk of developing CKD in later life, including blood pressure, biomarkers of cardiovascular disease and lower serum bicarbonate. Numerous studies have confirmed that CKD in older people is associated with an increased risk of multiple adverse outcomes including death, end-stage kidney disease, cardiovascular events, acute kidney injury, severe infections and cognitive decline. CKD is associated with the same adverse outcomes in older people as younger people. Further studies are required to develop interventions to reduce the incidence of CKD in older people and improve the associated adverse outcomes.

Impact of health literacy on medication adherence in older people with chronic diseases

Medication adherence is a key factor of the therapy of chronic diseases in older people with chronic diseases. Inadequate health literacy results in poor health outcomes. Therefore, the aim of this study is to investigate the effect of health literacy on medication adherence to provide information for improving health outcomes in older people with chronic disease. This was a cross-sectional study of older people (people aged over 65 years) with chronic diseases in Korea taking one or more medications for 6 months and over from an academic referral medical center. Each patient completed a structured questionnaire by interview or self-report. Of the 291 older participants, 30.6% had high medication adherence. In hierarchical multiple regression analysis, health literacy was the strongest predictor of medication adherence (β = 0.190, P = 0.001). In addition, perceived health status, use of magnifying glass, and assistance with medication administration were also significant factors related to medication adherence. In conclusion, enhancing health literacy may improve medication adherence of older people with chronic disease. The development, implementation and evaluation of health literacy interventions for older people with chronic conditions are important to increase medication adherence and potentially improve patient outcomes. Such programs would also raise awareness of the impact of health literacy on patient outcomes. Furthermore, this could contribute to reducing health inequalities worldwide.

The Predictive Value of the EWGSOP Definition of Sarcopenia: Results From the InCHIANTI Study.

Sarcopenia is associated with increased risk of adverse outcomes in older people. Aim of the study was to explore the predictive value of the European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic algorithm in terms of disability, hospitalization, and mortality and analyze the specific role of grip strength and walking speed as diagnostic criteria for sarcopenia. Longitudinal analysis of 538 participants enrolled in the InCHIANTI study. Sarcopenia was defined as having low muscle mass plus low grip strength or low gait speed (EWGSOP criteria). Muscle mass was assessed using bioimpedance analysis. Cox proportional and logistic regression models were used to assess risk of death, hospitalization, and disability for sarcopenic people and to investigate the individual contributions of grip strength and walking speed to the predictive value of the EWGSOP's algorithm. Prevalence of EWGSOP-defined sarcopenia at baseline was 10.2%. After adjusting for potential confounders, sarcopenia was associated with disability (odds ratio 3.15; 95% confidence interval [CI] 1.41-7.05), hospitalization (hazard ratio [HR] 1.57; 95% CI 1.03-2.41), and mortality (HR 1.88; 95% CI 0.91-3.91). The association between an alternative sarcopenic phenotype, defined only by the presence of low muscle mass and low grip strength, and both disability and mortality were similar to the association with the phenotypes defined by low muscle mass and low walking speed or by the EWGSOP algorithm. The EWGSOP's phenotype is a good predictor of incident disability, hospitalization and death. Assessment of only muscle weakness, in addition to low muscle mass, provided similar predictive value as compared to the original algorithm.

Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study.

Excessive daytime sleepiness (EDS) imposes a wide range of adverse health-related outcomes in older people, such as disability, which impair everyday activities and may increase the risk of fall. Few studies have explored EDS in Brazilian older people living in the community who are typically cared in primary health services. This study aims to investigate the prevalence of EDS and its sociodemographic, physical and mental health correlates among community-dwelling older adults. This is an exploratory, population-based study derived from Frailty in Brazilian Older Adults (FIBRA) study including adults aged 65 years and older. Participants with a score ≥ 11 points on the Epworth Sleepiness Scale were considered as having excessive daytime sleepiness. A structured, multidimensional questionnaire was used to investigate sociodemographic, physical and mental health, and self-rated health variables. The sample was composed of 776 older adults, of whom 21% (n = 162) presented excessive daytime sleepiness. Multivariate regression analysis revealed that EDS is associated with obesity (OR = 1.50; 95%CI 1.02 - 2.20), urinary incontinence (OR = 1.53; 95%CI 1.01 - 2.31), poor self-rated health (OR = 1.54; 95%CI 1.06 - 2.24), and depression symptoms (OR = 1.49; 95%CI 1.00 - 2.20). Our results suggest that healthcare professionals should identify older adults with EDS and implement intervention strategies to minimize the negative impact of the co-occurrence of this condition with obesity, depression and urinary incontinence over health and quality of life.

Serum uric acid and incident osteoporotic fractures in old people: The PRO.V.A study

PurposeAlthough high serum uric acid (SUA) levels are associated with negative outcomes in older people, recent studies reported that hyperuricemia could help protect against the onset of bone fractures. We consequently examined whether baseline SUA levels were associated with risk of incident osteoporotic fractures in a representative group of elderly people with no fractures or other bone-modifying conditions or drugs at the baseline. MethodsAmong 3099 people aged ≥65years initially involved in the PRO.V.A. study, 1586 participants with no prior diagnosis of osteoporotic fractures, and no conditions or medication affecting bone metabolism at the baseline were followed up for 4.4±1.2years. Baseline SUA levels were classified in gender-specific quintiles. Incident osteoporotic fractures were considered as any new fractures occurring at the usual sites of osteoporotic fractures. ResultsAt the baseline, participants with higher SUA levels had significantly less osteoporosis and lower serum beta cross-laps levels, but higher serum parathormone concentrations irrespective of gender. Over a 4.4-year follow-up, 185 subjects were diagnosed with a new osteoporotic fracture, giving rise to an incidence of 25 events per 1000person-years. Cox's regression analysis, adjusted for potential baseline and follow-up confounders, revealed no relationship between high SUA levels and incident fractures during the follow-up in the sample as a whole (p for trend=0.46) or by gender (p for trend=0.14 in males and 0.64 in females). ConclusionsBaseline SUA concentrations were not associated with the onset of new osteoporotic fractures over a 4.4-year follow-up in our sample of community-dwelling older men and women.

Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study.

BackgroundIn countries with high incomes, frailty indicators predict adverse outcomes in older people, despite a lack of consensus on definition or measurement. We tested the predictive validity of physical and multidimensional frailty phenotypes in settings in Latin America, India, and China.MethodsPopulation-based cohort studies were conducted in catchment area sites in Cuba, Dominican Republic, Venezuela, Mexico, Peru, India, and China. Seven frailty indicators, namely gait speed, self-reported exhaustion, weight loss, low energy expenditure, undernutrition, cognitive, and sensory impairment were assessed to estimate frailty phenotypes. Mortality and onset of dependence were ascertained after a median of 3.9 years.ResultsOverall, 13,924 older people were assessed at baseline, with 47,438 person-years follow-up for mortality and 30,689 for dependence. Both frailty phenotypes predicted the onset of dependence and mortality, even adjusting for chronic diseases and disability, with little heterogeneity of effect among sites. However, population attributable fractions (PAF) summarising etiologic force were highest for the aggregate effect of the individual indicators, as opposed to either the number of indicators or the dichotomised frailty phenotypes. The aggregate of all seven indicators provided the best overall prediction (weighted mean PAF 41.8 % for dependence and 38.3 % for mortality). While weight loss, underactivity, slow walking speed, and cognitive impairment predicted both outcomes, whereas undernutrition predicted only mortality and sensory impairment only dependence. Exhaustion predicted neither outcome.ConclusionsSimply assessed frailty indicators identify older people at risk of dependence and mortality, beyond information provided by chronic disease diagnoses and disability. Frailty is likely to be multidimensional. A better understanding of the construct and pathways to adverse outcomes could inform multidimensional assessment and intervention to prevent or manage dependence in frail older people, with potential to add life to years, and years to life.

Prevention and optimal management of sarcopenia: a review of combined exercise and nutrition interventions to improve muscle outcomes in older people

The growing recognition of sarcopenia, the age-related loss of skeletal muscle mass and function, has highlighted the need to understand more about its etiology. Declines in muscle mass and strength are expected aspects of aging, but there is significant variability between individuals in rates of loss. Although some of these differences can be explained by fixed factors, such as sex, much of the remaining variation is unexplained. This has led to increasing interest in the influence of adult lifestyle, particularly in the effects of modifiable factors such as physical activity and diet, and in identifying intervention opportunities both to prevent and manage sarcopenia. A number of trials have examined the separate effects of increased exercise or dietary supplementation on muscle mass and physical performance of older adults, but less is known about the extent to which benefits of exercise training could be enhanced when these interventions are combined. In a comprehensive review of the literature, we consider 17 studies of older adults (≥65 years) in which combined nutrition and exercise interventions were used to increase muscle strength and/or mass, and achieve improvements in physical performance. The studies were diverse in terms of the participants included (nutritional status, degree of physical frailty), supplementation strategies (differences in nutrients, doses), exercise training (type, frequency), as well as design (duration, setting). The main message is that enhanced benefits of exercise training, when combined with dietary supplementation, have been shown in some trials – indicating potential for future interventions, but that existing evidence is inconsistent. Further studies are needed, particularly of exercise training combined with dietary strategies that increase intakes of a range of nutrients, as well as bioactive non-nutrients, to provide the evidence on which public health and clinical recommendations can be based.

Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review.

BackgroundThe cumulative effect of taking multiple medicines with anticholinergic properties termed as anticholinergic burden can adversely impact cognition, physical function and increase the risk of mortality. Expert opinion derived risk scales are routinely used in research and clinical practice to quantify anticholinergic burden. These scales rank the anticholinergic activity of medicines into four categories, ranging from no anticholinergic activity (= 0) to definite/high anticholinergic activity (= 3). The aim of this systematic review was to compare anticholinergic burden quantified by the anticholinergic risk scales and evaluate associations with adverse outcomes in older people.MethodsWe conducted a literature search in Ovid MEDLINE, EMBASE and PsycINFO from 1984-2014 to identify expert opinion derived anticholinergic risk scales. In addition to this, a citation analysis was performed in Web of Science and Google Scholar to track prospective citing of references of selected articles for assessment of individual scales for adverse anticholinergic outcomes. The primary outcomes of interest were functional and cognitive outcomes associated with anticholinergic burden in older people. The critical appraisals of the included studies were performed by two independent reviewers and the data were extracted onto standardised forms.ResultsThe primary electronic literature search identified a total of 1250 records in the 3 different databases. On the basis of full-text analysis, we identified 7 expert-based anticholinergic rating scales that met the inclusion criteria. The rating of anticholinergic activity for medicines among these rating scales was inconsistent. For example, quetiapine was rated as having high anticholinergic activity in one scale (n = 1), moderate in another scale (n = 1) and low in two other scales (n = 2). Citation analysis of the individual scales showed that the Anticholinergic Cognitive Burden (ACB) scale was the most frequently validated expert based anticholinergic scale for adverse outcomes (N = 13).ConclusionsIn conclusion, there is not one standardised tool for measuring anticholinergic burden. Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects, poorer cognitive and functional outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0029-9) contains supplementary material, which is available to authorized users.

Housing: the unacknowledged key to our ageing challenge?

Purpose – The purpose of this paper is to highlight the strategic role of housing for older people and how it can address some of the key challenges facing politicians. The paper aims to encourage decision-makers and service providers to collaborate in new ways locally. Design/methodology/approach – The paper seeks to highlight the strategic role of housing for older people and how it can address some of the key challenges facing politicians. It aims to encourage decision makers and service providers to collaborate in new ways locally. Findings – The paper argues that: Housing for older people is rising up the political agenda, but as a niche issue rather than one of strategic and economic importance. A multi-agency and outcomes-based approach to the wellbeing of older people, based on place-shaping principles, needs to be mainstreamed locally. Older people have not escaped the impact of austerity measures and this has heightened the need for a range of high quality housing options, in supportive communities, in later life. Good housing options for older people could address the key issues vexing politicians, but there are obstacles to older people accessing such options. Originality/value – The paper suggests a radical, systemic approach is required to ensure better outcomes for older people and, in turn, to generate savings for the public purse.

IMPACT OF CLINICAL FRAILTY ON VASCULAR FLOW RESERVE AFTER INFRAPOPLITEAL INTERVENTION IN PATIENTS WITH CRITICAL LIMB ISCHEMIA

Frailty increases the risk of adverse outcomes in older people. Patients with critical limb ischemia (CLI) also had several clinical frailties. The aim of this study is to investigate between the physiological parameter in patients with CLI undergoing endovascular treatment (EVT) for isolated

The use of a frailty index to predict adverse health outcomes (falls, fractures, hospitalization, medication use, comorbid conditions) in people with intellectual disabilities.

Frailty in older people can be seen as the increased likelihood of future negative health outcomes. Lifelong disabilities in people with intellectual disabilities (ID) may not only influence their frailty status but also the consequences. Here, we report the relation between frailty and adverse health outcomes in older people with ID (50 years and over). In a prospective population based study, frailty was measured at baseline with a frailty index in 982 older adults with ID (≥50 yr). Information on negative health outcomes (falls, fractures, hospitalization, increased medication use, and comorbid conditions) was collected at baseline and after a three-year follow-up period. Odds ratios or regression coefficients for negative health outcomes were estimated with the frailty index, adjusted for gender, age, level of ID, Down syndrome and baseline adverse health condition. The frailty index was related to an increased risk of higher medication use and several comorbid conditions, but not to falls, fractures and hospitalization. Frailty at baseline was related to negative health outcomes three years later in older people with ID, but to a lesser extent than found in the general population.

MOBILITY AND FUNCTIONAL OUTCOMES FOR SARCOPENIA TRIALS

Major mobility disability (MMD) (1, 2), defined as inability to walk ¼ mile or 400 m, is a relevant definite outcome in clinical trials. MMD is of major public health significance. Ability to walk ¼ mile is measured in the US census (3) and in most epidemiologic surveys (4). The MMD outcome based on the 400 m walk test is a feasible, objective, reliable (5), well-validated and important clinical and public health outcome in older people (1, 2, 6), which has been successfully implemented in the LIFE-Pilot and LIFE (7, 8). We have shown it to be a more efficient outcome for clinical trials than self-reported disability or the Short Physical Performance Battery (SPPB) (9). Public health agencies use ability to walk ¼ mile or 400 m to define need and policy impact of interventions (4). Finally, people reporting the inability to walk 400 m incur higher health care costs of $4,000 per person per year, compared with those not reporting inability to walk 400 m (4, 6, 10-12) MMD is operationalized as the inability to complete a 400 m walk test within 15 min without sitting or help of another person or walker (2). Completing the walk in >15 min would be in an extremely slow pace (<0.45 m/sec), which is of little utility in daily life (13). A higher cut point (30 or 60 min), makes the assessment impractical and does not add to the clinical significance of the outcome. The time to walk 400 meters and the ability to complete the test will provide data to test effects of the interventions resulting from both attenuation of decline and increase in walking speed.

From Hospital to Home: Limited Nutritional and Functional Recovery for Older Adults.

The post-hospital period may be a vulnerable time for elders recovering from acute illness. Few studies have examined nutrition outcomes of older people at nutrition risk after acute hospitalisation. This study aims to describe a) standard nutrition care received by recently discharged older medical patients, b) change in nutritional and functional status at six weeks post-discharge and c) clinical outcomes at twelve weeks post discharge. Prospective cohort study. Two metropolitan teaching hospitals in Brisbane, Australia. Medical patients aged ≥65 years at risk of malnutrition (Malnutrition Screening Score ≥2) and discharged to independent living in the community. Nutritional status (Mini Nutritional Assessment (MNA), weight, lean body mass), functional status (grip strength, walk speed, activities of daily living) and health-related quality of life assessed on discharge and six weeks post-discharge. Inpatient and post-discharge nutrition intervention was recorded. Death and unplanned admissions were measured at 12 weeks. Of the 42 consented participants, only 14% (n=6) received post-discharge dietitian review and 19% (n=8) received practical nutrition supports at home (meal delivery, shopping assistance) as part of standard care. While there was a small improvement in MNA (18.4±4.0 to 20.1±4.2, p=0.004) and walk speed (0.7±0.3 m/s to 0.9±0.3, p=0.004) at six weeks, there was no difference in mean weight, lean body mass, grip strength or activities of daily living. Five (15%) participants lost ≥5% body weight. By twelve weeks, 17 participants (46%) had at least one unplanned hospital admission and four (10%) had died. Few patients at nutrition risk received nutrition-focussed care in the post-hospital period, and most did not improve nutritional or functional status at 6 weeks.

The contribution of comprehensive geriatric assessment to primary care physicians.

BackgroundTo provide quality care to the growing number of older patients, primary care physicians (PCPs) will require support from geriatric specialists. Multidisciplinary comprehensive geriatric assessment (CGA) has been found to improve outcomes in older people. This study explored the contribution of CGA to the management of older patients by their PCPs; PCP attitudes to CGA; and PCP satisfaction with CGA.MethodsTwo hundred PCPs in an Israeli Preferred Provider Organization were interviewed as part of an evaluative study of the contribution of a national outpatient CGA program to older patients, their families and physicians.ResultsThe main reasons for referral to CGA were cognitive impairment and rapid functional decline. Three domains described the contribution of CGA to PCPs: medical treatment, support in counseling patients, and treatment of cognitive impairment. About 69% of PCPs definitely agreed that CGA more fully addressed the physical, mental and social needs of patients than other consultative clinics. About half were very satisfied with the CGA staff’s attitudes to patients, their families and to the PCP.ConclusionsCGA contributed significantly to the care provided to older patients by PCPs. The expansion of CGA services deserves consideration.

Abstract 296: Views on Cardiopulmonary Resuscitation Among Older Australians in Care

Background: Our objective was to measure the views of older Australians on Cardiopulmonary Resuscitation (CPR). Methods and Results: A brief explanation of CPR and a three question survey were sent to 187 Australian residential care facilities and 34 home care providers in April 2014. A total of 2213 respondents completed the survey, including 1943 residents from 163 residential care facilities, and 275 receiving care in the home from 24 providers (71% and 49% response rate, respectively). Respondents were mostly female (67.4%), and those in residential care were more likely to be aged over 75 years than those receiving care in the home (82.6% versus 70.4%). The majority of respondents indicated they understood what CPR is and what it means for them (Table). Over half indicated they would want CPR if required (55.1% for residents and 65.3% for those receiving home care), this was higher among younger residents (64.2% in ≤ 75 years and 53.2% in>75 years) but similar by sex. A large proportion believed they would fully recover after receiving CPR (44.1% of residential care and 58.1% of home care residents). Of those who agreed there was a good chance they would fully recover, almost all stated they would like to receive CPR if they had an arrest (94.8% of residential care and 91.4% of home care residents). Conversely, of those that disagreed, 98.6% of residential and 96.2% of home care respondents were unsure about or disagreed to receiving CPR. Conclusions: The desire for CPR in this population appears to be related to their perception as to whether or not they will fully recover. Outcomes for older people who have an arrest are typically poor. Despite this, a large proportion of respondents believed they would recover to their previous health state if they were to receive CPR. These findings highlight the need for more accurate information to inform discussions about end-of-life decisions.

Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes.

To evaluate the impact of frailty, measured using the Canadian Study of Health and Aging Clinical Frailty Scale, on outcomes of older people hospitalized with acute illness. Consecutive patients were randomly allocated to a model development sample or a model validation sample. Multivariate analyses were used to model in-hospital mortality, new nursing home placement, and length of stay. Variables selected in the development samples were tested in the validation samples. The mean age of all 2,125 patients was 82.9 years. Most (93.6%) were admitted through the emergency department. Frailty predicted in-hospital mortality (odds ratio [OR] = 2.97 [2.11, 4.17]), new nursing home placement (OR = 1.60 [1.14, 2.24]), and length of hospital stay (hazard ratio = 0.87 [0.81, 0.93]). Frailty is a strong predictor of adverse outcomes in older people hospitalized with acute illness. An increased awareness of its impact may alert clinicians to screen for frailty.

Validity and reliability of the Katz-15 scale to measure unfavorable health outcomes in community-dwelling older people.

To predict the risk of future unfavourable health outcomes in older people it is common to assess the level of both basic and instrumental activities of daily living. To accomplish this, the commonly used Katz-6 and the Lawton IADL questionnaires can be combined to form the 'Modified Katz ADL' scale, also known as the Katz-15 scale. So far, the validity and reliability of the Katz-15 scale is unknown. The objective of the current study is to investigate how well the Katz-15 is able to predict future unfavorable health outcomes and how this is related to the existing Katz-6 scale. We performed a follow-up study using data from a group of 60 year and older participants from a large Dutch clinical trial. We included 2321 participants in the analysis. The average age of the study population was 74 years and 44% was male. We studied the relation between the Katz-15 scale and a number of unfavourable health outcomes, such as hospitalization, admission to a nursing home, admission to a home for the aged and death within one year of follow-up. We found the Katz-15 to be both internally consistent and strongly associated with quality of life measures. We observed moderate to strong associations between the Katz-15 and the unfavourable health outcomes All associations studied were stronger for the Katz-15 scale as compared to the Katz-6 scale. The results of our study indicate that the Katz-15 scale is able to reliably and validly predict future unfavorable health outcomes. This makes the scale a valuable measure in determining both basic and instrumental activities of daily living.