Deverá a idade ser um fator decisivo de seleção para internação num Centro de Reabilitação após um AVC?

Aims: Stroke represents one of the main causes of mobility and mortality, occurring in three-quarters of the elderly. Rehabilitation aims at improving deficits, function and social integration of patients with stroke sequelae. We characterized an elderly population admitted for post-stroke rehabilitation and evaluated the differences in the functional evolution between elderly and non-elderly patients.Methods: We analyzed retrospectively all the patients suffering a stroke admitted in a Centre of Rehabilitation Medicine between June 1, 2014, and May 31, 2016. Patients were divided into 2 groups: elderly (65 years) and non-elderly (<65 years). The following variables were analyzed: sex, age, days of admission, post-discharge destination and Functional Independence Measure (FIM) at admission and discharge.Results: We analyzed 134 patients with stroke. The majority were elderly with a mean age of 72.07±6.50. 51.3% were men and the number of days of admission was 107.4±59.5 (vs 109.50±55.7 days in the non-elderly group). 86.4% of these patients were discharged home. Comparing FIM mean values at admission and discharge, we found differences between these two groups, the elderly patients having lower FIM values at admission (75.75 vs 82.96 non-elderly; p=0.005) and at discharge (88.93 vs 99.12 non-elderly; p=0.005). There was also some difference in the FIM increase between admission and discharge in these groups. Despite not being statistically significant.Conclusions: Most patients hospitalized were over 65 years old. FIM values at admission of the elderly patients are lower than of the non-elderly, probably because the latter present specific characteristics associated with the ageing process. Although FIM increases were lower in the elderly patients’ group, this difference was not significant whereby they appeared to have functionally benefited as much as the non-elderly. Therefore, age on its own does not appear to be a decision criteria for admission.

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Sex Differences in Stroke Rehabilitation Care in Alberta

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.53 ◽

2020 ◽

Vol 47 (4) ◽

pp. 494-503

Author(s):

Eric Tanlaka ◽

Kathryn King-Shier ◽

Theresa Green ◽

Cydnee Seneviratne ◽

Sean Dukelow

Keyword(s):

Stroke Rehabilitation ◽

Living Arrangement ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Stroke Severity ◽

Discharge Destination ◽

Stroke Patients ◽

Rehabilitation Care ◽

The Impact

ABSTRACT:Background:Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation.Methods:Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination.Results:Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40–80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10−4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10−13). Further, male patients (p = 6.4 × 10−7) and those < 65 years (p = 1.4 × 10−23) were more likely to be discharged home without homecare.Conclusion:There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.

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How to Treat Hepatocellular Carcinoma in Elderly Patients

Pharmaceuticals ◽

10.3390/ph14030233 ◽

2021 ◽

Vol 14 (3) ◽

pp. 233

Author(s):

Piera Federico ◽

Emilio Francesco Giunta ◽

Annalisa Pappalardo ◽

Andrea Tufo ◽

Gianpaolo Marte ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Elderly Patients ◽

Elderly Population ◽

Primary Tumour ◽

The Elderly ◽

Chronic Liver Diseases ◽

Old Patients ◽

Choice Of Treatment ◽

Definition Of ◽

Optimal Treatment Strategy

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.

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744. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine and Influenza Vaccine Against Pneumococcal Pneumonia Among Elderly Patients Aged 65 Years and Older in the Republic of Korea: A Case–Control Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.751 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S267-S267

Author(s):

Jong Hun Kim ◽

Byung Chul Chun ◽

Joon Young Song ◽

Hyo Youl Kim ◽

In-Gyu Bae ◽

...

Keyword(s):

Elderly Patients ◽

Elderly Population ◽

Case Control Study ◽

The Elderly ◽

Case Control ◽

Polysaccharide Vaccine ◽

Vaccine Effectiveness ◽

Pneumococcal Polysaccharide Vaccine ◽

The Republic ◽

Control Study

Abstract Background The national immunization program (NIP) of annual influenza vaccination to the elderly population (≥65 years of age) in the Republic of Korea (ROK) has been implemented since 1987. Recently, the 23-valent pneumococcal polysaccharide vaccine (PPV23) through the NIP has been provided to the elderly population in the ROK since May 2013. The aim of this study was to assess PPV23 and influenza vaccine (IV) effectiveness in preventing pneumococcal pneumonia (PP) among elderly patients ≥65 years of age. Methods A case–control study using a hospital-based cohort was conducted. Cases of PP including bacteremic PP and nonbacteremic PP were collected from 14 hospitals in the pneumococcal diseases surveillance program from March 2013 to October 2015. Controls matched by age and sex in the same hospital were selected. Demographic, clinical information, and vaccination histories were collected. Previous immunization was categorized into “vaccinated” if a patient had received vaccines as follows: PPV23 (4 weeks to 5 years) and IV (2 weeks to 6 months) prior to the diagnosis of PP for case patients and prior to the hospital admission for control patients. Adjusted odds ratio (OR) was calculated, controlling for underlying medical conditions. Vaccine effectiveness was defined as (1 – OR) × 100. Results During the study period, a total of 661 cases (104 bacteremic PP cases and 557 nonbacteremic PP cases) and 661 controls were enrolled for analyses. For overall patients ≥65 years of age, there was no significant vaccine effectiveness against PP. For young elderly patients with 65–74 years, IV alone (1.2%, [95% confidence interval (CI) −95.3% to 50.0%]) and PPV23 alone (21.9%, [95% CI −39.0% to 56.1%]) were not effective. However, significant vaccine effectiveness of PPV23 plus IV against PP was noted (54.4%, [95% CI 6.9–77.7%], P = 0.031). For older elderly patients ≥75 years of age, no significant vaccine effectiveness was observed. Conclusion Our study indicates that PPV23 plus IV may be effective in preventing PP among young elderly patients with 65–74 years, suggesting additive benefits of influenza plus PPV23 vaccination. Further studies are required to confirm the persistent additive protective effectiveness. Disclosures All authors: No reported disclosures.

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Abstract TP137: Robotic Upper Limb Therapy by a Trained Volunteer on an Inpatient Stroke Rehabilitation Unit

Stroke ◽

10.1161/str.48.suppl_1.tp137 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lisa Spinelli ◽

Christine Trudell ◽

Lisa Edelstein ◽

Mike Reding

Keyword(s):

Upper Limb ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Functional Independence ◽

Rehabilitation Unit ◽

Software Applications ◽

Upper Limb Function ◽

Straight Line ◽

One Step ◽

Safety Considerations

Introduction: Having a therapist observe patients engaged in Robotic Upper Limb Therapy (RULT) is considered inefficient use of a therapist’s time and skill. We therefore assessed the feasibility of (RULT) administered by a trained volunteer. Methods: The Volunteer had two 30-minute training sessions by an Occupational Therapist (OT) rehearsing the MIT-Manus Planar Upper Limb Robotic software applications, proper positioning of the patient, and device shut-off and safety considerations. Initial patient sessions were supervised by the patient’s OT until the Volunteer demonstrated satisfactory performance. Inpatients on a Stroke Rehabilitation Unit were referred by their OT for RULT if they could initiate horizontal gravity-eliminated movement of the forearm and could follow one step commands. They were enrolled in 25 minute (RULT) sessions based upon the Volunteer’s availability from one to three half-days per week. Functional Independence Measures and Fugl-Meyer Scores were recorded at the time of Stroke Unit Admission by the OT unaware of (RULT) score results. Statistical analyses were performed using SPSS version 11.5 and significance was attributed if p<0.05 using 2-tailed analyses. Results: A total of 28 patients were enrolled in (RULT) but 2 were unable to participate due to pain in the affected upper limb. Participants had a mean of 3 ± 1.5 SD treatments each. Both the patients and volunteer considered their involvement in the program as worthwhile and meaningful. Admission MIT-Manus Adaptive-3 treatment software data showed that the Normalized Jerk+Line+Target (Norm JLT) Score [defined as (Jerk Score/237)+(Deviation from a Straight Line/13)+(Target Distance Error/14)] demonstrated a significant Spearman-rho Correlation with admission Functional Independence Measure (FIM) upper dressing r = -0.56 p=.003; and FIM grooming subscores r = -0.415, p=.035. The Norm JLT score also predicted change in Fugl-Meyer Upper Limb scores from admission to discharge r = - .788, p = 0.000. Conclusions: Robotic Upper Limb Therapy by a trained Volunteer on an inpatient Stroke Rehabilitation Unit is easily administered, is viewed by the patients and volunteer as rewarding, and provides objective measures useful for assessing upper limb function and outcome.

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Prevalência, desempenho cognitivo e funcionalidade de idosos com Doença de Alzheimer em instituições de longa permanência de Bento Gonçalves

PAJAR - Pan-American Journal of Aging Research ◽

10.15448/2357-9641.2017.1.26051 ◽

2017 ◽

Vol 5 (1) ◽

pp. 23 ◽

Cited By ~ 2

Author(s):

Daniela Fernandes Tonholi ◽

Gisele Oltramari

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Performance ◽

Junior High School ◽

Functional Independence Measure ◽

The Elderly ◽

Functional Independence ◽

Cross Sectional Study ◽

Functional Evaluation ◽

Cross Sectional

Aims: To determine the prevalence, cognitive performance and functionality of elderly people with Alzheimer's disease in long-stay institutions for the elderlyin the city of Bento Gonçalves. Methods: Cross-sectional study including 24 elderly residents in long-stay institutions for the elderly, sociodemographic datawere obtained, and the elderly were subjected to functional evaluation by the Functional Independence Measure and evaluation of cognitive performancethrough the mental state the Mini (MMSE). Results: Most of the residents were female (83%), as 54.2% schooling had completed junior high school, mostof the elderly (70.8%) was admitted by the will of the family, 100% of the elderly showed cognitive performance bad, and the smaller the more dependentcognitive performance was the individual. Conclusion: institutionalized elderly with Alzheimer's disease had negative results on cognitive performance,as well as deficits in their ability to perform activities of daily living, thus altering their functionality.Keywords: aging; functionality; cognition; Alzheimer Disease; long-stay institutions.

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Evaluation of Functional Recovery by Motor Functional Independence Measure Test of Elderly After Hip Fracture in Serbia

Acta Médica Portuguesa ◽

10.20344/amp.4267 ◽

2014 ◽

Vol 27 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Natasa Radosavljevic ◽

Dejan Nikolic ◽

Milica Lazovic ◽

Zoran Radosavljevic ◽

Aleksandar Jeremic

Keyword(s):

Hip Fracture ◽

Functional Recovery ◽

Age Groups ◽

Functional Independence Measure ◽

Severity Index ◽

Functional Independence ◽

Post Discharge ◽

Third Age ◽

Period 2 ◽

Group 2

Introduction: The aim of the study was to evaluate motor functional status measured by motor Functional Independence Measure (mFIM) test in population above 65 years of age after the hip fracture. Material and Methods: We evaluated 203 patients after hip fracture by mFIM test on 3 occasions: at admission (Period-1), at discharge (Period-2) and 3 months after discharge (Period-3); 3 age groups: Group65-74, Group75-84 and Group85-up and 2 groups concerning Severity Index (SI): group 0-1.99 (SI1) and group ≥ 2 (SI2). Results: In same SI group there is significant increase in mFIM values for Period-2 and Period-3 for both genders and in first two age groups, while for those above 85 years of age with higher SI we found non-significant change in mFIM values between discharge and 3 months post discharge period. Discussion: The most significant improvement is obtained for women in first and third age groups and with higher SI. Conclusion: Gender is not significant predictor for motor functional recovery measured by mFIM test in patients with hip fracture, although the admittance mFIM is a good indicator for mFIM capacity recovery in women of certain age groups (first and third age groups).

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A Study to Examine the Relationship of the Assessment of Motor and Process Skills (AMPS) to other Tests of Cognition and Function

British Journal of Occupational Therapy ◽

10.1177/030802269605900603 ◽

1996 ◽

Vol 59 (6) ◽

pp. 260-263 ◽

Cited By ~ 30

Author(s):

Susanna E Robinson ◽

Anne G Fisher

Keyword(s):

Functional Independence Measure ◽

The Elderly ◽

Functional Independence ◽

Process Skills ◽

Observational Assessment ◽

Cognitive Component ◽

Significant Relationships ◽

Physical Scale ◽

And Function ◽

Relationship Of

In this study, the Assessment of Motor and Process Skills (AMPS), an observational assessment of functional ability, was compared with other tests of function and cognition, namely the Functional Independence Measure (RM), the CAMCOG (the cognitive component of the CAMDEX [Cambridge Examination for Mental Status in the Elderly]) and the Mini-Mental State Examination (MMSE). The subjects were people with diagnosed dementia or mild memory impairment. The results were as expected, revealing significant relationships between AMPS process ability and the CAMCOG, the MMSE and the FIM social/cognition scale, and between AMPS motor ability and the RM physical scale. This supported the validity of the AMPS as an evaluation of the interaction between cognitive impairments and disability in complex activities of daily living.

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Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

Clinical Nursing Research ◽

10.1177/c10n1r5 ◽

2001 ◽

Vol 10 (1) ◽

pp. 40-51 ◽

Cited By ~ 3

Author(s):

Jan Coleman Gross ◽

Stacey W. Goodrich ◽

Mary E. Kain ◽

Elizabeth A. Faulkner

Keyword(s):

Nursing Care ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Program ◽

Two Factors ◽

Staffing Needs ◽

Care Index ◽

Strong Inverse Relationship

The purpose of this study was to evaluate the feasibility of using the Functional Independence Measure (FIM) to predict staffing needs of stroke patients in an acute inpatient rehabilitation program. The Patient Care Index (PCI) was concurrently administered with the FIM on all stroke admissions to a stroke rehabilitation unit over a 3-month period. One hundred fourteen patients 18 years of age or older admitted to the unit with a medical diagnosis of stroke were included in the sample. Total FIM score had a strong inverse relationship to the level of care indicated by the PCI at Days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = —.76 to —.87). Total FIM score and the need for staff supervision for safety were the two factors predictive of the level of nursing care. The FIM has potential to guide nurse-staffing decisions.

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Displaced olecranon fractures in the elderly: outcomes after non-operative treatment – a narrative review

EFORT Open Reviews ◽

10.1302/2058-5241.5.190041 ◽

2020 ◽

Vol 5 (7) ◽

pp. 391-397

Author(s):

Olga D. Savvidou ◽

Panagiotis Koutsouradis ◽

Angelos Kaspiris ◽

Leon Naar ◽

George D. Chloros ◽

...

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Operative Treatment ◽

Treatment Option ◽

Gold Standard ◽

Elderly Population ◽

Standard Of Care ◽

The Elderly ◽

Small Series ◽

Olecranon Fractures

Operative treatment with tension band wiring or plate is the gold standard of care for displaced olecranon fractures. In elderly patients, multiple comorbidities combine with increased intraoperative risks, and postoperative complications may yield poor results. There are small series in the literature that show promising results with non-operative treatment. Non-operative treatment may provide reasonable function and satisfaction in the elderly population and could be considered as a treatment option in this group, especially for those with comorbidities, to avoid postoperative complications and the need for re-operation. Cite this article: EFORT Open Rev 2020;5:391-397. DOI: 10.1302/2058-5241.5.190041

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Evaluating anticoagulation sensitivity among elderly patients managed with an institution’s heparin protocol using initial anti-factor Xa levels

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz304 ◽

2020 ◽

Vol 77 (Supplement_1) ◽

pp. S13-S18

Author(s):

Adley Lemke ◽

Jean Kohs ◽

Lynn Weber

Keyword(s):

Elderly Patients ◽

Retrospective Cohort ◽

Elderly Population ◽

Factor Xa ◽

The Elderly ◽

Target Level ◽

P Values ◽

Vein Thrombosis ◽

Coronary Syndrome ◽

Deep Vein

Abstract Purpose The purpose of this study was to assess an institution’s heparin protocols in elderly and nonelderly adult populations to see if a response difference was observed. Methods This was a retrospective cohort study of hospitalized adults who were prescribed unfractionated heparin due to surgery, acute coronary syndrome (ACS), or deep vein thrombosis/pulmonary embolism (DVT/PE) from February 11, 2016, through August 1, 2017. Patients were divided into nonelderly adults 18 to 69 years of age and elderly patients 70 years of age or older. The anti-factor Xa (anti-Xa) level after protocol initiation was compared to the institution’s goal range of 0.3 to 0.7 IU/mL. Outcomes of each protocol in the elderly population were compared to outcomes in their nonelderly counterparts to determine if there was a difference in heparin response. Results A total of 325 patients were included in the analysis, comprising 150 elderly and 175 nonelderly adults. Elderly patients had a higher initial anti-Xa levels than did their nonelderly adult counterparts in the ACS, DVT/PE, and surgery protocols, with P values of 0.02, <0.001, and 0.01, respectively. Only the ACS protocol demonstrated increased frequency of above-target-level anti-Xa levels in the elderly (P = 0.03). Conclusion Elderly patients had significantly higher initial anti-Xa levels than did nonelderly adult patients across all protocols. This study identifies the need to further study elderly patients’ increased heparin sensitivity to determine if a separate dosing protocol is needed.

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