scholarly journals The Prevalence of Metabolic Disease Multimorbidity and Its Associations With Spending and Health Outcomes in Middle-Aged and Elderly Chinese Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Yang Zhao ◽  
Puhong Zhang ◽  
John Tayu Lee ◽  
Brian Oldenburg ◽  
Alexander van Heusden ◽  
...  
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Outpatient Care ◽  
Daily Living ◽  
Service Use ◽  
Health Care Service ◽  
National Level ◽  
Chinese Adults ◽  
The Impact

Objective: Metabolic diseases have been a clinical challenge worldwide and a major public health issue. Very few studies from China investigated the impact of metabolic multimorbidity on healthcare and health outcomes at the national level. This study aims to examine the association of metabolic multimorbidity with health service utilization, spending, functional and mental health.Materials and Methods: This is a nationally representative cross-sectional study, utilizing the data from the China Health and Retirement Longitudinal Study in 2015, including 11,377 participants aged 45 years and older. Multivariable regression models were used to assess the association of metabolic multimorbidity with healthcare, out-of-pocket expenditure (OOPE), the activities of daily living (ADL) limitation, the instrumental activities of daily living (IADL) limitation, and depression.Results: Overall, 30.50% of total participants had metabolic multimorbidity in 2015 in China. Compared with single disease, metabolic multimorbidity were associated with the number of outpatient visits [incident rate ratio (IRR) = 1.30, 95% CI = 1.05, 1.62] and days of inpatient care (IRR = 1.52, 95% CI = 1.28, 1.81). Metabolic multimorbidity was positively associated with the OOPE on outpatient care (coefficient = 82.99, 95% CI = 17.70, 148.27) and physical functional difficulties, including ADL limitation (odds ratio = 1.36, 95% CI = 1.18, 1.57).Conclusions: Metabolic multimorbidity is associated with higher levels of health-care service use, greater expenditure for outpatient care, and more difficulties in ADL among Chinese adults. China's health-care systems need to shift from single-disease models to new financing and service delivery models to effectively manage metabolic multimorbidity.

The Impact of Intrinsic Capacity on Adverse Outcomes in Older Hospitalized Patients: A One-Year Follow-Up Study

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Xingkun Zeng ◽  
Shanshan Shen ◽  
Liyu Xu ◽  
Yanyan Wang ◽  
Yinghong Yang ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Composite Score ◽  
Adverse Health Outcomes ◽  
Intrinsic Capacity ◽  
The Impact

Background: Intrinsic capacity (IC) is a novel view focusing on healthy aging. The effect of IC on adverse outcomes in older hospitalized Chinese adults is rarely studied. Objectives: This study focused on investigating the impact of IC domains on the adverse health outcomes including new activities of daily living (ADL) dependency, new instrumental activities of daily living (IADL) dependency, and mortality over a 1-year follow-up. Methods: In a retrospective observational population-based study, a total of 329 older hospitalized patients from Zhejiang Hospital in China were enrolled and completed 1-year follow-up. The 5 domains of IC including cognition, locomotion, sensory, vitality, and psychological capacity were assessed at admission. The IC composite score was calculated based on these domains, and the higher IC composite score indicated the greater amount of functional capacities reserved. Multivariate logistic regression models were used to explore the association between IC at baseline and 1-year adverse outcomes. Results: During the 1-year follow-up, 69 patients (22.5%) experienced new ADL dependency, 103 patients (33.6%) suffered from new IADL dependency, and 22 patients (6.7%) died. After adjusting for age, sex, education level, comorbidities, and polypharmacy, low Mini-Mental State Examination (MMSE) scores at admission predicted 1-year new ADL dependency (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.12–4.78) and new IADL dependency (OR = 2.15, 95% CI: 1.14–4.04) among older hospitalized patients, but no significance was obtained between IC domains and mortality. Higher IC composite score at admission was associated with decreased risks of 1-year new ADL dependency (OR = 0.53, 95% CI: 0.40–0.70) and new IADL dependency (OR = 0.76, 95% CI: 0.61–0.95), and 1-year mortality (OR = 0.48, 95% CI: 0.31–0.74) after adjustment for the possible confounders. Conclusions: Loss of ICs at admission predicted adverse health outcomes including new ADL and IADL dependency and mortality 1 year after discharge among older hospitalized patients.

scholarly journals Home Health Care Nursing Visit Intensity and Heart Failure Patient Outcomes

2011 ◽  
Vol 23 (6) ◽  
pp. 412-420 ◽  
Author(s):  
Jennifer S. Riggs ◽  
Elizabeth A. Madigan ◽  
Richard H. Fortinsky
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Activities Of Daily Living ◽  
Home Health Care ◽  
Daily Living ◽  
Secondary Analysis ◽  
Patient Characteristics ◽  
Home Health ◽  
Nursing Visit ◽  
The Impact

This study is a secondary analysis of data for 107 home health care heart failure patients. The authors investigate the impact of patient characteristics and nursing visit intensity on change in activities of daily living (ADL) status and instrumental activities of daily living (IADL) status and improvement/stabilization of dyspnea. Prior hospital stay (ß = .38, p = .001) and nursing visit intensity (ß = –.39, p = .001) predict improvement in ADL status. The model for change in IADL status is not significant. Patients with more than two comorbidities (OR = 6.5, p = .04) and patients who received higher nursing visit intensity (OR = 7.0, p = .04) are more likely to have improved/stabilized dyspnea at home care discharge.

scholarly journals Smart Care Using a DNN-Based Approach for Activities of Daily Living (ADL) Recognition

2020 ◽  
Vol 11 (1) ◽  
pp. 10
Author(s):  
Muchun Su ◽  
Diana Wahyu Hayati ◽  
Shaowu Tseng ◽  
Jiehhaur Chen ◽  
Hsihsien Wei
Keyword(s):  
Neural Network ◽  
Health Care ◽  
Activities Of Daily Living ◽  
Video Processing ◽  
Daily Living ◽  
Deep Neural Network ◽  
Recognition System ◽  
Automatic Recognition ◽  
Data Filtering ◽  
Accuracy Rate

Health care for independently living elders is more important than ever. Automatic recognition of their Activities of Daily Living (ADL) is the first step to solving the health care issues faced by seniors in an efficient way. The paper describes a Deep Neural Network (DNN)-based recognition system aimed at facilitating smart care, which combines ADL recognition, image/video processing, movement calculation, and DNN. An algorithm is developed for processing skeletal data, filtering noise, and pattern recognition for identification of the 10 most common ADL including standing, bending, squatting, sitting, eating, hand holding, hand raising, sitting plus drinking, standing plus drinking, and falling. The evaluation results show that this DNN-based system is suitable method for dealing with ADL recognition with an accuracy rate of over 95%. The findings support the feasibility of this system that is efficient enough for both practical and academic applications.

scholarly journals Impairment in activities of daily living and readmission in older patients with heart failure: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044416
Author(s):  
Tan Van Nguyen ◽  
Huyen Thanh Dang ◽  
Mason Jenner Burns ◽  
Hiep HH Dao ◽  
Tu Ngoc Nguyen
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Older Patients ◽  
Tertiary Hospital ◽  
Logistic Regression Models ◽  
Hospitalised Patients ◽  
Patients With Heart Failure ◽  
The Impact

ObjectivesThis study aims to investigate the prevalence of impairment of activities of daily living (ADLs) in older patients with heart failure (HF), and to examine the impact of ADL impairment on readmission after discharge.Design and settingsA prospective cohort study was conducted in patients aged ≥65 years with HF admitted to a tertiary hospital in Vietnam from August 2016 to June 2017. Difficulties with six ADLs were assessed by a questionnaire. Participants were classified into two categories (with and without ADL impairment). The associations of ADL impairment with 3-month readmission were examined using logistic regression models.ResultsThere were 180 participants (mean age 80.6±8.2, 50% female) and 26.1% were classified as having ADL impairment. The most common impaired activity was bathing (21.1%), followed by transferring (20.0%), toileting (12.2%), dressing (8.9%), eating (3.3%), and continence (2.8%). During 3-month follow-up, 32.8% of the participants were readmitted to hospitals (55.3% in participants with ADL impairment, 24.8% in those without ADL impairment, p<0.001). ADL impairment significantly increased the risk of 3-month readmission (adjusted OR 2.75, 95% CI 1.25 to 6.05, p=0.01).ConclusionsIn summary, ADL impairment was common in older hospitalised patients with HF and was associated with increased readmission. These findings suggest further studies on ADL assessment and intervention during transition care for older patients with HF after discharge to prevent readmission.

Impact of community participation in primary health care: what is the evidence?

2015 ◽  
Vol 21 (1) ◽  
pp. 2 ◽  
Author(s):  
Jessamy Bath ◽  
John Wakerman
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Outcomes ◽  
Community Participation ◽  
Service Providers ◽  
Developmental Process ◽  
Service Access ◽  
Primary Health ◽  
Intermediate Outcomes ◽  
The Impact

Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.

scholarly journals The Impact of the COVID-19 Pandemic on Antibiotic Prescribing Trends in Outpatient Care: A Nationwide, Quasi-Experimental Approach

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1040
Author(s):  
Tânia Magalhães Silva ◽  
Marta Estrela ◽  
Eva Rebelo Gomes ◽  
Maria Piñeiro-Lamas ◽  
Adolfo Figueiras ◽  
...  
Keyword(s):  
Public Health ◽  
Outpatient Care ◽  
Experimental Approach ◽  
National Level ◽  
Series Data ◽  
Antibiotic Prescribing ◽  
Prescribing Trends ◽  
Quasi Experimental ◽  
The Impact

Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency.

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