Individual Pharmacotherapy Management (IPM) - I: a group-matched retrospective controlled clinical study on prevention of complicating delirium in the elderly trauma patients and identification of associated factors

Abstract Background Delirium is one of the most frequent complications in hospitalized elderly patients with additional costs such as prolongation of hospital stays and institutionalization, with risk of reduced functional recovery, long-term cognitive impairment, and increased morbidity and mortality. We analyzed the effect of individual pharmacotherapy management (IPM) in the University Hospital Halle in geriatric trauma patients on complicating delirium and aimed to identify associated factors. Methods In a retrospective controlled clinical study of 404 hospitalized trauma patients ≥70 years we compared the IPM intervention group (IG) with a control group (CG) before IPM implementation. Delirium was recorded from the hospital discharge letter. The medication review and data records included baseline data, all medications, diagnoses, electrocardiogram (ECG), laboratory and vital parameters during hospitalization. The IPM internist and the senior trauma physician guaranteed personnel and structural continuity in the implementation of the interdisciplinary patient rounds. Results There was a highly matched congruence between CG and IG in terms of age, gender, residency, BMI, most diagnoses, and injury patterns to compare the two groups. The total number of medications per patient was 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG). Our targeted IPM focus on 6 frontline aspects with reduction of antipsychotics, anticholinergic burden, benzodiazepines, serotonergic opioids, elimination of pharmacokinetic and pharmacodynamic drug interactions and overdosage reduced complicating delirium from 5% to almost zero at 0.5%. The association of IPM with a significant 10-fold reduction, OR = 0.09 [95% CI 0.01–0.7], in univariable regression, maintained of clinical relevance in multivariable regression OR = 0.1 [95% CI 0.01–1.1]. Factors most strongly associated with complicating delirium in univariable regression were cognitive dysfunction, nursing home residency, muscle relaxants, antiparkinsonian agents, xanthines, transient disorientation documented in the fall risk scale, antibiotic-requiring infections, antifungals, antipsychotics, and intensive care stay, the two latter maintaining significance in multivariable regression. Conclusions IPM is associated with a highly effective prevention of complicating delirium in the elderly trauma patients. For patient safety it should be integrated as an essential preventative contribution. The associated factors help identify patients at risk.

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‘Vidangadi Lauha’ for Obese Type 2 Diabetes mellitus; Randomized controlled clinical study

10.21203/rs.3.rs-1086283/v1 ◽

2021 ◽

Author(s):

Punam Khobarkar ◽

Jayant Gulhane ◽

Amit Nakanekar

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Clinical Study ◽

Targeted Treatment ◽

High Density Lipoproteins ◽

Control Group ◽

Randomized Controlled ◽

Controlled Clinical Study

Abstract Type 2 Diabetes mellitus in obese persons is becoming threatening disease due to increasing prevalence of its microvascular and macro vascular complications. A multi targeted treatment can be considered better over single targeted treatment; in view of multiple pathways involved in pathogenesis of diabetes and its complications. This open labelled randomized controlled clinical Study was aimed to evaluate clinical efficacy of ‘Vidangadi Lauha’(An Ayurveda formulation) in comparison with metformin for obese type II diabetes mellitus. Participants were divided into two groups. Trial group received Vidangadi Lauha 5gm BID and control group received tablet metformin 500mg BID for duration of 3 months. Among 550 screened participants 120 participants were eligible, out of them 100 participants were enrolled and randomized by computer generated method, out of them 80 patients (40 in each group) completed the trial. Both the treatments were equally effective in reducing blood sugar fasting(F), post meal(PM) glycated Haemoglobin (HbA1C) and Body Mass Index (BMI). Vidangadi Lauha is more effective in reducing Ayurvedic Symptoms, waist hip ratio and cholesterol as compared to Metformin. High Density Lipoproteins (HDL) were improved by minor clinical difference in both the groups. Both the treatment does not have statistically significant effect in reducing Low Density Lipoproteins (LDL).

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A Geriatrics-Focused Hospitalist Trauma Comanagement Program Improves Survival and Quality Measures for Older Adults: A Propensity Score-Matched Analysis

10.21203/rs.3.rs-256284/v1 ◽

2021 ◽

Author(s):

Nasen J. Zhang ◽

Liron Sinvani ◽

Tung Ming Leung ◽

Michael Qiu ◽

Cristy L. Meyer ◽

...

Keyword(s):

High Risk ◽

Propensity Score ◽

Older Adult ◽

Quality Indicators ◽

Intervention Group ◽

Geriatric Trauma ◽

Categorical Variables ◽

Control Group ◽

Trauma Patients ◽

Medical Complexity

Abstract Background: Given the increasing age and medical complexity of trauma patients, medical comanagement has been adopted as a strategy for high-risk patients. This study aimed to determine whether a geriatrics-focused hospitalist trauma comanagement program improves outcomes.Methods: A pre- and post-implementation study compared older adult trauma patients who were comanaged by a hospitalist with those prior to comanagement at a Level 1 trauma center. Criteria for comanagement included: age 65+, multiple comorbidities, and use of high-risk medications. Comanagement focused on geriatric trauma management guidelines. One-to-one propensity score matching (PSM) was performed based on age, gender, Injury Severity Score, Charlson comorbidity index, and initial admission to the intensive care unit (ICU). Outcomes included hospital mortality, length of stay (LOS), and orders for geriatrics-focused quality indicators. Differences were compared with the Wilcoxon Rank Sum test for continuous variables and chi- square or Fisher’s exact test for categorical variables.Results: From 792 control and 365 intervention patients, PSM resulted in 290 matched pairs. Three intervention group patients died compared to 14 in the control group (p=0.0068). Hospital LOS, 30-day readmission, ICU LOS, and ICU upgrades were not significantly different between groups. There was an overall trend toward improved geriatrics-focused quality indicators in the intervention group. Intervention group was less likely to be restrained (p=0.04), received earlier physical therapy (p=0.01), more doses of acetaminophen compared to control patients (p<0.0001), and more subcutaneous enoxaparin rather than heparin (p=0.0027).Discussion: Our main findings highlight the higher medical complexity and increased risks in older adult trauma patients, as well as the mortality reduction and adherence increase to geriatrics-focused quality indicators. Limitations of our study included use of a single center, the possibility of selection bias in analyzing historical data, and a low sample size, all of which may limit generalizability. Conclusions: Our study demonstrates that a geriatrics-focused hospitalist trauma comanagement program improves survival and quality of care.

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Effect of a Sleep Hygiene Education Program Using Telephone Follow-up Method on the Sleep Quality of the Elderly

Salmand ◽

10.32598/sija.15.4.2895.1 ◽

2021 ◽

Vol 15 (4) ◽

pp. 484-495

Author(s):

Maryam Moradi ◽

◽

Hamideh Mohammadzadeh ◽

Reza Noori ◽

Kokab Basiri Moghadam ◽

...

Keyword(s):

Sleep Quality ◽

Education Program ◽

Intervention Group ◽

The Elderly ◽

Sleep Hygiene ◽

Control Group ◽

Hygiene Education ◽

And Control

Objectives: Low quality sleep is one of the most common problems in old age. The present study aims to determine the effect of a sleep hygiene education program using Telephone Follow-Up (TFU) method on the sleep quality of the elderly. Methods & Materials: This quasi-experimental study was conducted on 80 eligible elderly people aged 60-74 years who were selected using a systematic random sampling method and were randomly assigned into intervention and control groups. The intervention group received a one-hour face-to-face education session on sleep hygiene. The TFU were carried out two times per week in the first month and once a week in the second month after intervention. The control group received routine care. The data collection tools were a demographic form and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The PSQI was completed for both groups immediately after the second month. Results: There was no statistically significant difference in the mean PSQI score before intervention in the intervention (8.02) and control (7.47) groups (P=0.32), but after the intervention, the mean PSQI score in the intervention group (5.42) was significantly reduced compared to the control group (7.67) (P<0.001). Conclusion: Sleep hygiene education program based on TFU improves the sleep quality of the elderly. It is recommended that health care providers use this method to improve the sleep quality of the elderly.

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Effect of 12 weeks of recreational soccer on bone mineral density and sarcopenia in the elderly: a randomized clinical trial

Journal of Physical Education ◽

10.4025/jphyseduc.v32i1.3257 ◽

1989 ◽

Author(s):

Guilherme Henrique de Lima Matias ◽

◽

André dos Santos Costa ◽

Romulo Maia Carlos Fonseca

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Repeated Measures ◽

Intervention Group ◽

The Elderly ◽

Whole Body ◽

Control Group ◽

Mineral Density ◽

Before And After ◽

Post Hoc

Objective: To verify the effect of recreational soccer on bone mineral density and sarcopenia in the elderly. Methods: Fourteen elderly people aged 65.9 ± 3.4 years were selected. They were separated into two groups: the intervention group and the control group; the intervention group played recreational soccer for 12 weeks on two days of the week. Assessments were performed for bone mineral density and body muscle mass before and after the intervention. For statistical analysis, the repeated measures ANOVA with Bonferroni’s post hoc test was used. Results: After 12 weeks, there was a significant change in bone mineral density in the region of the total femur (p = 0.020). Analyzing the participants’ sarcopenia, no significant results were found after the intervention period. Conclusion: Playing recreational soccer causes a significant improvement in the total femur and maintains bone regions in the spine, whole body, and femoral neck. Also, it promotes a removal from the threshold for sarcopenia screening in the elderly.

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Reduction of stress and blood pressure with meditation therapy in elderly groups in balai pelayanan sosial tresna werdha (BPSTW) in Yogyakarta

International Journal of Health Science and Technology ◽

10.31101/ijhst.v1i1.941 ◽

2019 ◽

Vol 1 (1) ◽

pp. 31-38

Author(s):

Fajarina Lathu A

Keyword(s):

Blood Pressure ◽

Physical Health ◽

Stress Measurement ◽

Intervention Group ◽

The Elderly ◽

Nursing Intervention ◽

Health Problems ◽

Control Group ◽

Depression Anxiety Stress Scale ◽

Physical Health Problems

Stress in elderly institution residents is an interesting phenomenon to study. Sustained stress in the elderly can be harmful and cause mental and physical health problems. Hypertension is one of the physical health problems that can result from stress. Nursing Intervention Classification 2013 recommends the use of Meditation Therapy to address the problem. Meditation is a self-directed exercise to relax and calm the mind, besides that meditation is an easy and inexpensive activity. This certainly provides benefits for the institution in caring for the elderly. Less information on meditation therapy, challenging nurses to perform scientific verification.Scientific proof of reduced stress and blood pressure in elderly groups at the Balap Pelayanan Tresna Werdha (BPSTW) in Yogyakarta This research is a quasy experiment with pretest and posttest with control group. The treatment group was given meditation therapy for 7 times a week, while the control group was not given treatment. Respondents were selected using simple random sampling. Stress measurement using the DASS (Depression Anxiety Stress Scale) and blood pressure were measured using a digital sphygmomanometer. The stress in intervention group of elderly after being treated results decreased by 1.8, whereas in the control group it increased by 0.029. The systole blood pressure in the intervention group of elderly decreased 6.257 mmHg and 0.457 mmHg in the control group. When the elderly diastole blood pressure in the intervention group experienced an average decrease of 3.4 mmHg, while in the control group it increased by 1.057 mmHg. Conclusion: Meditation therapy is significant for reducing stress and blood pressure in the elderly at the Balai Pelayanan Tresna Werdha (BPSTW) in Yogyakarta

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Knowledge, Attitude, and Skill of Family to Treat Elderly with Diabetes Mellitus at Home through the Empowerment of Elderly Cadre in Lampung

10.20944/preprints202104.0551.v1 ◽

2021 ◽

Author(s):

Komang Achjar ◽

Dwi Agustanti ◽

Sri Parasitha ◽

Moses Glorino Rumambo Pandin

Keyword(s):

Diabetes Mellitus ◽

Intervention Group ◽

Sampling Technique ◽

The Elderly ◽

T Test ◽

Control Group ◽

Attitude Score ◽

Control Group Design ◽

Significant Difference ◽

At Home

Diabetes is a chronic disease that often causes progressive complications in the elderly. Along with the decline in cognitive function in the elderly, it causes dependence on disciplined management of diabetes mellitus. This dependence causes a very important mentoring role to be given. The purpose of this study is to provide knowledge, attitudes, and family skills to care for the elderly with diabetes mellitus at home through the empowerment of elderly cadres in Lampung. This research method is a quasi-experimental research with a control group design with a total of 64 elderly respondents and 64 families selected by simple random sampling technique. The assessment used an instrument for assessing family abilities that the researcher developed included aspects of knowledge, attitudes, and skills. The results of the dependent t-test analysis showed a significant increase in the knowledge and skills variable in the intervention group (0.000) but decreased in the attitude variable with p 0.198. Meanwhile, the increase in value also occurred in the attitude and skill variables in the control group. So that the results of the independent t-test only showed a significant difference in the attitude score (0.000) with the highest score in the control group. So that there is no significant increase in the ability of the family after the implementation of elderly cadres empowerment.

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Increasing Medical Adherence in Elderly With Type 2 Diabetes Mellitus: A Systematic Review

International Quarterly of Community Health Education ◽

10.1177/0272684x18819969 ◽

2018 ◽

Vol 39 (2) ◽

pp. 109-117

Author(s):

Seyed Mohammad Mehdi Hazavehei ◽

Sahar Khoshravesh ◽

Zahra Taheri-Kharameh

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Educational Intervention ◽

Controlled Trial ◽

Intervention Group ◽

The Elderly ◽

Risk Of Bias ◽

Control Group ◽

Medical Adherence

Background One of the most common problems that the elderly with chronic diseases, especially diabetes, faces is lack or poor medical adherence. The aim of this study was to determine the effect of interventions in increasing medical adherence in the elderly with type 2 diabetes. Methods The databases of Cochrane, Embase, PubMed, Scopus, Science Direct, and web of science were searched until April 2017 free from time and language limitation. In review, only randomized controlled trial (RCT) design studies were investigated. The studies of interest were evaluated from three perspectives: educational intervention with or without theories/models of health education and promotion, educational intervention (individual or group education), and noneducational intervention to increase medical adherence. The qualification of RCTs was evaluated through Cochrane Collaboration Risk of Bias Tool. Results Finally, five studies were considered in this systematic review. Educational interventions were used in all of the studies, and in three of these studies, noneducational interventions such as support group, psychiatric consultation, and phone consultation were implemented along with educational intervention. In all studies, medical adherence in the intervention group increased when compared with the control group or basic conditions ( p < .05). All RCTs had high risk of bias. Conclusion This review provides evidence which must be considered in the elderly with diabetes a combination of the educational and noneducational methods to increase medical adherence. It is necessary to conduct studies with higher quality to assess the efficacy of interventions.

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Instrumental Balinese Flute Music Therapy Improves Cognitive Function and Serum Dopamine Level in the Elderly Population of West Denpasar Primary Health Care Center

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.116 ◽

2019 ◽

Vol 7 (4) ◽

pp. 553-558

Author(s):

Anak Agung Ayu Putri Laksmidewi ◽

Ni Putu Ayu Putri Mahadewi ◽

I Made Oka Adnyana ◽

I Putu Eka Widyadharma

Keyword(s):

Cognitive Function ◽

Classical Music ◽

Intervention Group ◽

The Elderly ◽

Flute Music ◽

Control Group ◽

Dopamine Level ◽

The Mean ◽

Main Instrument ◽

Western Classical Music

BACKGROUND: Musical artwork using Balinese flutes made from bamboo (timing buluh) by Agus Teja Sentosa, S.Sn is a combination of music played with flute as the main instrument which contains certain components resembling music therapy such as in western classical music by Antonio Lucio Vivaldi. AIM: This study aims to determine the improvement of cognitive function and increase in serum dopamine in the elderly after listening to music with Balinese flute as the main instrument. METHOD: The current study allocated 18 subjects in the control group listened to western classical music by Antonio Lucio Vivaldi, while 18 subjects in the intervention group listened to western classical music and music from Balinese flute as the main instrument by Agus Teja Sentosa, S.Sn. MoCA-Ina assessment and examination of serum dopamine levels were carried out initially and 21 days after listening to music intervention. RESULTS: The mean increase in cognitive function score was higher in the intervention group (5.22; p < 0.001) than in the control group (4.67; p < 0.001), this increase was not statistically significant with a value of p = 0.562 (p > 0.005). The mean increase in dopamine levels in the control group (3.60) was greater than in the treatment group (3.56), but the mean increase was not statistically significant (p = 0.085). CONCLUSION: There was a significant relationship between listening to the main instrumental Balinese flute music and the improvement of cognitive function, especially in the memory domain in all study subjects, but the mean increase in cognitive function and serum dopamine level did not reach statistical significance.

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Telephone follow-up of the elderly after cataract surgery

British Journal of Visual Impairment ◽

10.1177/0264619619874825 ◽

2019 ◽

Vol 38 (2) ◽

pp. 184-195

Author(s):

Tallita Mello Delphino Machado ◽

Rosimere Ferreira Santana ◽

Raquel Dantas Vaqueiro ◽

Carla Targino Bruno dos Santos ◽

Priscilla Alfradique de Souza

Keyword(s):

Cataract Surgery ◽

Older Persons ◽

Controlled Trial ◽

Intervention Group ◽

The Elderly ◽

Control Group ◽

Telephone Intervention ◽

Nursing Diagnosis ◽

Surgical Recovery

Study’s purpose: To analyze the effectiveness of telephone intervention for the nursing diagnosis of delayed surgical recovery in older persons who have undergone cataract surgery. Design: Blinded, randomized, and controlled trial. A total of 95 patients of both sexes who were over 60 years old and had undergone cataract surgery were divided into an intervention group (48 patients) and a control group (47 patients), allocated using BioEstat 5.3 Software. Results: The intervention included postoperative follow-up recovery of cataracts and prevention of complications performed on the 1st, 4th, 10th, and 20th postoperative days. After the intervention, the intervention group had a decrease in the length of surgical recovery ( p = .000). The occurrence in the intervention group was 6.3%, while in the control group, it was 36.2% (odds ratio (OR) = 0.118; confidence interval (CI) = 1.02, 10.23). The number of nursing interventions nevertheless decreased during the telephone follow-up. Conclusion: For older persons, the telephone guidelines increase adherence to treatment, promote clinical improvement, promote surgical recovery over time, and improve independence and autonomy.

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