scholarly journals LO034: Does head injury matter? Comparison of functional outcomes in elderly who have sustained a minor trauma with or without head injury: a prospective multicenter cohort study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S41-S41
Author(s):  
A. Brousseau ◽  
M. Emond ◽  
M. Sirois ◽  
R. Daoust ◽  
L.E. Griffith ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Head Injury ◽  
Adult Population ◽  
Functional Decline ◽  
Minor Trauma ◽  
Post Injury ◽  
Multicenter Cohort Study ◽  
A Minor ◽  
The Impact

Introduction: The older adult population is growing. The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a MT-HI on the functional and cognitive outcomes six months post injury of older adults who sustained a minor trauma. Methods: This multicenter prospective cohort study in eight sites included patients who were: aged 65 years or older, presenting to the emergency department (ED) within two weeks of injury with a chief complaint of a minor trauma, discharged within 48 hours, and independent for their basic activities of daily living prior to the ED visit. Participants underwent a baseline evaluation and a follow-up evaluation at six months post-injury. The main outcome was the functional decline measured with the Older Americans’ Resources and Services (OARS) scale six months after the trauma. Results: All 926 eligible patients were included in the analyses: 344 MT-HI patients and 582 without head injury. After six months, the functional decline was similar in both groups, 10.8% and 11.9% respectively (RR=0.79 [95% CI: 0.55-1.14]). The proportion of participants with mild cognitive disabilities was also similar, 21.7% and 22.8% respectively (RR=0.91 [95% CI: 0.71-1.18]). Furthermore, for the group of patients with a MT-HI, the functional outcome was not statistically different with or without the presence of a co-injury (RR= 1.35 [95% CI: 0.71-2.59]), or with or without the presence of a mTBI as defined by the WHO criteria (RR= 0.90 [95% CI: 0.59-1.13]). Conclusion: This study did not demonstrate that the occurrence of a MT-HI is associated with a worse functional or cognitive prognosis than other minor injuries without a head injury in an elderly population six months after injury.

scholarly journals Comparison of functional outcomes in elderly who have sustained a minor trauma with or without head injury: a prospective multicenter cohort study

CJEM ◽  
2016 ◽  
Vol 19 (5) ◽  
pp. 329-337 ◽  
Author(s):  
Audrey-Anne Brousseau ◽  
Marcel Émond ◽  
Marie-Josée Sirois ◽  
Raoul Daoust ◽  
Lauren E. Griffith ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Head Injury ◽  
Functional Outcomes ◽  
Functional Decline ◽  
Minor Trauma ◽  
Post Injury ◽  
Multicenter Cohort Study ◽  
A Minor ◽  
The Impact

AbstractObjectivesThe consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a head injury on the functional outcomes six months post-injury in older adults who sustained a minor trauma.MethodsThis multicenter prospective cohort study in eight sites included patients who were aged 65 years or older, previously independent, presenting to the emergency department (ED) for a minor trauma, and discharged within 48 hours. To assess the functional decline, we used a validated test: the Older Americans’ Resources and Services Scale. The cognitive function of study patients was also evaluated. Finally, we explored the influence of a concomitant injury on the functional decline in the MT-HI group.ResultsAll 926 eligible patients were included in the analyses: 344 MT-HI patients and 582 minor trauma without head injury. After six months, the functional decline was similar in both groups: 10.8% and 11.9%, respectively (RR=0.79 [95% CI: 0.55–1.14]). The proportion of patients with mild cognitive disabilities was also similar: 21.7% and 22.8%, respectively (RR=0.91 [95% CI: 0.71–1.18]). Furthermore, for the group of patients with a MT-HI, the functional outcome was not statistically different with or without the presence of a co-injury (RR=1.35 [95% CI: 0.71–2.59]).ConclusionThis study did not demonstrate that the occurrence of a MT-HI is associated with a worse functional or cognitive prognosis than other minor injuries without a head injury in an elderly population, six months after injury.

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

scholarly journals The Impact of Function Focused Care From Acute Care to Home Care and Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 629-629
Author(s):  
Silke Metzelthin ◽  
Sandra Zwakhalen ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
The Netherlands ◽  
Home Care ◽  
Acute Care ◽  
Long Term Care ◽  
Functional Decline ◽  
Term Care ◽  
The Us ◽  
The Impact

Abstract Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

scholarly journals A TRIAL TO IMPROVE MEDICATION SAFETY IN OLDER ADULTS: RECRUITMENT CHALLENGES HAVE GENERALIZABILITY IMPLICATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S711-S711
Author(s):  
Kathryn Anzuoni ◽  
Terry Field ◽  
Kathleen Mazor ◽  
Yanhua Zhou ◽  
Timothy Konola ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Odds Ratio ◽  
Adverse Drug Events ◽  
Functional Decline ◽  
Post Discharge ◽  
Recruitment Challenges ◽  
Hospital To Home ◽  
The Impact ◽  
Visiting Nurse

Abstract For older adults, the transition from hospital to home is a high-risk period for adverse drug events, functional decline, and hospital readmission. Randomized trials of interventions to improve this transition must recruit potential subjects immediately after hospital discharge, when people are recovering and tired. Within a randomized trial assessing the impact of a pharmacist home visit to provide medication assistance immediately post-discharge, we determined whether individuals who enrolled were comparable to those who were invited but did not enroll, and described reasons for not enrolling. Individuals ≥50 years of age discharged from the hospital and prescribed a high-risk medication were eligible. We attempted to recruit individuals by phone within 3 days of discharge, and recorded reasons for not enrolling. Of 3,606 eligible individuals reached, 3,147 (87%) declined, 361 (10%) were enrolled, and 98 (3%) were initially recruited but did not complete a consent form. Individuals ≥80 years of age (odds ratio 0.45, CI 0.25, 0.78) and those with an assigned visiting nurse (odds ratio 0.64, CI 0.48, 0.85) were least likely to enroll. Among those who provided a reason for declining (2,473) the most common reason given was the belief they did not need medication assistance (22%). An additional 332 (13%) declined because they were receiving visiting nurse services. Recruiting older adults recently discharged from the hospital is difficult and may under-enroll the oldest individuals, limiting the ability to generalize findings across older patient populations. Researchers planning RCTs among newly discharged older adults may need creative approaches to overcome resistance.

Functional trajectories before and after a new cancer diagnosis among community-living older adults.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21547-e21547
Author(s):  
Carolyn Jean Presley ◽  
Arti Hurria ◽  
Ling Han ◽  
Linda S Leo-Summers ◽  
Cary Philip Gross ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Depressive Symptoms ◽  
Cancer Diagnosis ◽  
Functional Decline ◽  
Severe Disability ◽  
Factors Associated ◽  
Disability Scale ◽  
Incident Cancer ◽  
Before And After

e21547 Background: We characterized distinct functional trajectories among older adults in the year before and after a new cancer diagnosis and identified factors associated with functional decline. Methods: Among a cohort study of persons 70+ y, we identified 170 participants (lung (15.7%), breast (12.4%), prostate (7.8%); 31.8% incurable at diagnosis)) with an incident cancer diagnosis from 1998-2014. We followed their functional course using 13 basic, instrumental, and mobility activities measured during monthly interviews. To identify functional trajectories, we fit a group-based trajectory model of the 13-item disability scale 12-months before and 12-months after the cancer diagnosis. Regression modeling determined predictors of functional decline, defined as a higher count on the 13-item disability scale. Results: Three pre-cancer functional trajectories were identified (mean age at diagnosis: 83 y (73-105 y); similarly, 3 post-cancer functional trajectories were identified among the 158 non-decedents. Participants with severe disability pre-diagnosis remained severely disabled post-diagnosis. Approximately 40% of participants with mild or moderate disability pre-diagnosis transitioned to a worse functional trajectory post-diagnosis (see Table). Moderate and severe disability pre-diagnosis were significantly associated with functional decline post-diagnosis (moderate vs. mild aRR: 3.10; 95% CI: 2.24-4.30; severe vs. mild aRR: 5.71; 95% CI: 3.60-9.07). Depressive symptoms (RR, 1.40; 95% CI: 1.02-1.91), and incurable stage (RR, 2.16; 95% CI: 1.54-3.03) were also associated with functional decline. Conclusions: Approximately 40% of older adults experienced functional decline after a new cancer diagnosis. Pre-cancer diagnosis functional trajectory, depressive symptoms, and incurable stage were significant predictors of post-diagnosis functional decline. [Table: see text]

scholarly journals Body mass index trajectories and functional decline in older adults: Three-City Dijon cohort study

2015 ◽  
Vol 31 (1) ◽  
pp. 73-83 ◽  
Author(s):  
Fanny Artaud ◽  
Archana Singh-Manoux ◽  
Aline Dugravot ◽  
Béatrice Tavernier ◽  
Christophe Tzourio ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Cohort Study ◽  
Body Mass ◽  
Functional Decline ◽  
Body Mass Index Trajectories

scholarly journals The Impact of Body Mass Index on Fluoroscopy Time During Lumbar Epidural Steroid Injection; A Multicenter Cohort Study

Pain Medicine ◽  
2016 ◽  
Vol 18 (1) ◽  
pp. 25-35 ◽  
Author(s):  
Zachary L. McCormick ◽  
Sarah C. Choxi ◽  
David T. Lee ◽  
Austin Marcolina ◽  
Joel Press ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Body Mass ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Fluoroscopy Time ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Epidural Steroid ◽  
The Impact

scholarly journals COMBINATION OF TOCILIZUMAB AND STEROIDS TO IMPROVE MORTALITY IN PATIENTS WITH SEVERE COVID-19 INFECTION: A SPANISH, MULTICENTER, COHORT STUDY

2020 ◽  
Author(s):  
Belen Ruiz-Antoran ◽  
Aranzazu Sancho-Lopez ◽  
Ferran Torres ◽  
Victor Moreno-Torres ◽  
Itziar de Pablo Lopez de Abechuco ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Oxygen Therapy ◽  
Inclusion Criteria ◽  
Multicenter Cohort Study ◽  
Inverse Probability ◽  
Multicenter Cohort ◽  
Tertiary Hospitals ◽  
Randomised Controlled ◽  
The Impact

Background: We aimed to determine the impact of tocilizumab use in severe COVID-19 pneumonia mortality. Methods: We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain, from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by Inverse Probability of the Treatment Weights (IPTW). Tocilizumab effect in patients receiving steroids during the 48h following inclusion was analyzed. Results: During the study period, 506 patients with severe COVID-19 fulfilled inclusion criteria. Among them, 268 were treated with tocilizumab and 238 patients were not. Median time to tocilizumab treatment from onset of symptoms was 11 days (IQR 8-14). Global mortality was 23.7%. Mortality was lower in patients treated with tocilizumab than in controls (16.8% versus 31.5%, HR 0.514 [95CI 0.355-0.744], p<0.001; weighted HR 0.741 [95CI 0.619-0.887], p=0.001). Tocilizumab treatment reduced mortality by 14.7% relative to no tocilizumab treatment (RRR 46.7%). We calculated a number necessary to treat of 7. Among patients treated with steroids, mortality was lower in patients treated with tocilizumab than in those treated with steroids alone (10.9% versus 40.2%, HR 0.511 [95CI 0.352-0.741], p=0.036; weighted HR 0.6 [95CI 0.449-0.804], p<0.001) (Interaction p=0.094). Conclusions: These results show that survival of patients with severe COVID-19 is higher in patients treated with tocilizumab than in those not treated, and that tocilizumab effect adds to that of steroids administered to non-intubated cases with COVID-19 during the first 48 hours of presenting with respiratory failure despite of oxygen therapy. Randomised controlled studies are needed to confirm these results.

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