scholarly journals Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis

Geriatrics ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 86
Author(s):  
Filipa Pereira ◽  
Boris Wernli ◽  
Armin von Gunten ◽  
María del Rio Carral ◽  
Maria Manuela Martins ◽  
...  
Keyword(s):  
Functional Status ◽  
Hospital Discharge ◽  
Functional Decline ◽  
Population Based ◽  
Cross Sectional ◽  
Adverse Health Outcomes ◽  
Lengths Of Stay ◽  
General Mobility ◽  
Body Care ◽  
Geriatric Inpatients

This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients’ hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75–84 years old (n = 15,485). On average, the polymedicated patients’ hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263–1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.

Poor Functional Outcomes in Pediatric Intensive Care Survivors in Brazil: Prevalence and Associated Factors

2021 ◽  
Author(s):  
Vanessa C. Dannenberg ◽  
Gabrielle C. Borba ◽  
Paula M. E. Rovedder ◽  
Paulo R. A. Carvalho
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Functional Status ◽  
Invasive Mechanical Ventilation ◽  
Functional Decline ◽  
Pediatric Intensive Care ◽  
Young Age ◽  
Functional Impairments ◽  
Cross Sectional ◽  
Functional Changes

AbstractSurvivors of pediatric critical illnesses develop temporary or permanent functional impairments. We do not have enough data on Brazilian children, however, and the available evidence mainly shows results from high-income countries. Our objective was to assess changes in children and adolescents' functional status surviving critical illnesses in Brazil, and to identify which factors contribute to these functional changes at pediatric intensive care unit (PICU) discharge. To develop this cross-sectional study, two researchers blinded to previous patient information applied the Functional Status Scale (FSS) with patients and caregivers at two different times in a tertiary PICU. The FSS examines six function domains as follows: (1) mental status, (2) sensory functioning, (3) communication, (4) motor functioning, (5) feeding, and (6) respiratory status. The functional decline/poor outcome was defined as an increase in points sufficient to alter the FSS total scores at discharge when comparing to the total baseline score. A total of 303 patients completed the study. Of these, 199 (66%) were with previous chronic conditions. The prevalence of functional decrease was 68% at PICU discharge. Young age (<12 months) and mechanical ventilation time ≥11 days increased by 1.44 (95% confidence interval [CI]: 1.20–1.74, p < 0.001) and 1.74 (95% CI: 1.49–2.03, p < 0.001), respectively, the chances of poor functional results at PICU discharge. This study is the first in Brazil to show that during the episode of critical illness, young age (≤12 months) and duration of invasive mechanical ventilation independently increased the chances of functional impairment in children.

Abstract 2145: The Long-term Trajectory Of Functional Decline Before And After Stroke: The Northern Manhattan Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Mandip Dhamoon ◽  
Yeseon P Moon ◽  
Myunghee C Paik ◽  
Consuelo McLaughlin-Mora ◽  
Ralph L Sacco ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Status ◽  
Functional Decline ◽  
Population Based ◽  
Insurance Status ◽  
Population Based Study ◽  
Before And After ◽  
Over Time

Background: Previous research in our population showed a steeper long-term decline in functional status after first ischemic stroke among those with Medicaid or no insurance compared to those with Medicare or private insurance. With only post-stroke data, it was unknown whether these findings were caused by the stroke. We sought to compare the long-term trajectory of functional status before and after ischemic stroke. Methods: The Northern Manhattan Study contains a prospective, population-based study of stroke-free individuals >40 years of age, followed for a median of 10 years. The Barthel index (BI) was assessed annually. Generalized estimating equations were used to assess functional decline over time before and after stroke. The 6 months after stroke were ignored, since the course of recovery during this period is well documented, and our interest was the long-term course of functional status. Follow-up was censored at the time of recurrent stroke. Sociodemographic and medical risk factors were included and results were stratified by insurance status. Linearity of the curves was evaluated by plotting residuals against time and with a lowess curve. Results: Among 3298 participants, 261 had an ischemic stroke during follow-up, of which 51 died within 6 months of stroke. Among the remaining 210 participants, mean age at stroke (standard deviation) was 77+9 years, 38% were male, 52% were Hispanic, 37% had diabetes, and 31% had coronary artery disease. There was no difference in functional decline over time before and after stroke (p= 0.51), with a decline of 0.96 BI points per year before stroke (p<.0001) and 1.24 after stroke (p=0.001). However, when stratified by insurance status, among those with Medicaid or no insurance, in a fully adjusted model, there was a difference in slope before and after stroke (p=0.04), with a decline of 0.58 BI points per year before stroke (p=0.02) and 1.94 after stroke (p=0.001). Other predictors of worse functional status were increasing age, female sex, diabetes, and being married. Conclusion: In this large, prospective, population-based study with long-term follow-up, there was a significantly steeper decline in functional status after ischemic stroke compared to before stroke among those with Medicaid or no insurance, after adjusting for confounders. The cause of this differential decline is not known but may be related to poor control of risk factors, silent strokes, or an effect of socioeconomic status.

Dance as Prevention of Late Life Functional Decline Among Nursing Home Residents

2015 ◽  
Vol 36 (12) ◽  
pp. 1453-1470 ◽  
Author(s):  
Katerina Machacova ◽  
Hana Vankova ◽  
Ladislav Volicer ◽  
Petr Veleta ◽  
Iva Holmerova
Keyword(s):  
Nursing Home ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Functional Decline ◽  
Nursing Home Residents ◽  
Late Life ◽  
Cost Of Care ◽  
Control Group ◽  
Adverse Health Outcomes

Late life deterioration of functional status is associated with adverse health outcomes and increased cost of care. This trial was conducted to determine whether dance-based intervention could reverse functional decline among nursing home (NH) residents. A total of 189 residents of seven NHs in the Czech Republic were randomly assigned to intervention and control groups. More detailed data were collected in a subsample of 52 participants. Intervention consisted of 3-month dance-based exercise. Functional status was assessed by the get-up-and-go test, basic activities of daily living (ADL), instrumental activities of daily living (IADL), and senior fitness tests (SFTs). Participants in the control group experienced a significant decline in get-up-and-go test, IADL, and in four of the six SFTs. The intervention proved to be effective in preventing this deterioration and improved chair stand test and chair sit-and-reach test. The findings indicate that a relatively simple dance-based exercise can slow down deterioration of functional status in NH residents.

scholarly journals Apathy and cognitive and functional decline in community-dwelling older adults: results from the Baltimore ECA longitudinal study

2010 ◽  
Vol 22 (5) ◽  
pp. 819-829 ◽  
Author(s):  
Diana E. Clarke ◽  
Jean Y. Ko ◽  
Constantine Lyketsos ◽  
George W. Rebok ◽  
William W. Eaton
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
General Health Questionnaire ◽  
Functional Decline ◽  
Population Based ◽  
Community Dwelling ◽  
Public Health Importance ◽  
Cross Sectional ◽  
Prevalence Estimates

ABSTRACTBackground: Apathy, a complex neuropsychiatric syndrome, commonly affects patients with Alzheimer's disease. Prevalence estimates for apathy range widely and are based on cross-sectional data and/or clinic samples. This study examines the relationships between apathy and cognitive and functional declines in non-depressed community-based older adults.Methods: Data on 1,136 community-dwelling adults aged 50 years and older from the Baltimore Epidemiologic Catchment Area (ECA) study, with 1 and 13 years of follow-up, were used. Apathy was assessed with a subscale of items from the General Health Questionnaire. Logistic regression, t-tests, χ2 and Generalized Estimating Equations were used to accomplish the study's objectives.Results: The prevalence of apathy at Wave 1 was 23.7%. Compared to those without, individuals with apathy were on average older, more likely to be female, and have lower Mini-mental State Examination (MMSE) scores and impairments in basic and instrumental functioning at baseline. Apathy was significantly associated with cognitive decline (OR = 1.65, 95% CI = 1.06, 2.60) and declines in instrumental (OR = 4.42; 95% CI = 2.65, 7.38) and basic (OR = 2.74; 95%CI = 1.35, 5.57) function at 1-year follow-up, even after adjustment for baseline age, level of education, race, and depression at follow-up. At 13 years of follow-up, apathetic individuals were not at greater risk for cognitive decline but were twice as likely to have functional decline. Incidence of apathy at 1-year follow up and 13-year follow-up was 22.6% and 29.4%, respectively.Conclusions: These results underline the public health importance of apathy and the need for further population-based studies in this area.

scholarly journals Fear of Falling in Older Adults: A Scoping Review of Recent Literature

2021 ◽  
Vol 24 (4) ◽  
pp. 379-394
Author(s):  
Scott MacKay ◽  
Patricia Ebert ◽  
Cathy Harbidge ◽  
David B. Hogan
Keyword(s):  
Older Adults ◽  
Scoping Review ◽  
Fear Of Falling ◽  
Data Extraction ◽  
Functional Decline ◽  
Continuous Measure ◽  
Cross Sectional ◽  
Adverse Health Outcomes ◽  
Full Text Review ◽  
Short Term Mortality

Background  Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature.  Methods  A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis.  Results  The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline.  Conclusions  Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors. 

scholarly journals Absolute values of lung function explain the sex difference in breathlessness in the general population

2017 ◽  
Vol 49 (5) ◽  
pp. 1602047 ◽  
Author(s):  
Magnus Ekström ◽  
Linus Schiöler ◽  
Rune Grønseth ◽  
Ane Johannessen ◽  
Cecilie Svanes ◽  
...  
Keyword(s):  
General Population ◽  
Sex Difference ◽  
Respiratory Health ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Cross Sectional ◽  
Adverse Health Outcomes ◽  
Ordered Logistic Regression ◽  
Never Smokers ◽  
Sectional Analysis

Activity-related breathlessness is twice as common among females as males in the general population and is associated with adverse health outcomes. We tested whether this sex difference is explained by the lower absolute forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC) in females.This was a cross-sectional analysis of 3250 subjects (51% female) aged 38−67 years across 13 countries in the population-based third European Community Respiratory Health Survey. Activity-related breathlessness was measured using the modified Medical Research Council (mMRC) scale. Associations with mMRC were analysed using ordered logistic regression clustering on centre, adjusting for post-bronchodilator spirometry, body mass index, pack-years smoking, cardiopulmonary diseases, depression and level of exercise.Activity-related breathlessness (mMRC ≥1) was twice as common in females (27%) as in males (14%) (odds ratio (OR) 2.21, 95% CI 1.79−2.72). The sex difference was not reduced when controlling for FEV1 % predicted (OR 2.33), but disappeared when controlling for absolute FEV1 (OR 0.89, 95% CI 0.69−1.14). Absolute FEV1 explained 98−100% of the sex difference adjusting for confounders. The effect was similar within males and females, when using FVC instead of FEV1 and in healthy never-smokers.The markedly more severe activity-related breathlessness among females in the general population is explained by their smaller spirometric lung volumes.

scholarly journals A Research on Functional Status, Environmental Conditions, and Risk of Falls in Dementia

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Sima Ataollahi Eshkoor ◽  
Tengku Aizan Hamid ◽  
Siti Sa’adiah Hassan Nudin ◽  
Chan Yoke Mun
Keyword(s):  
Physical Activity ◽  
Functional Status ◽  
Environmental Quality ◽  
Environmental Conditions ◽  
Functional Decline ◽  
The Elderly ◽  
Sociodemographic Factors ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Risk Of Falls

This study aimed to determine the effects of disability, physical activity, and functional status as well as environmental conditions on the risk of falls among the elderly with dementia after adjusting for sociodemographic factors. Data were derived from a group including 1210 Malaysian elderly who were demented and noninstitutionalized. The study was a national cross-sectional survey that was entitled “Determinants of Health Status among Older Malaysians.” Approximately 17% of subjects experienced falls. The results showed that ethnic non-Malay(OR=1.73)and functional decline(OR=1.67)significantly increased the risk of falls in samples (P<0.05). The findings indicated that increased environmental quality(OR=0.64)significantly decreased the risk of falls (P<0.05). Disability, age, marital status, educational level, sex differences, and physical activity were found irrelevant to the likelihood of falls in subjects (P>0.05). It was concluded that functional decline and ethnic non-Malay increased the risk of falls but the increased environmental quality reduced falls.

Abstract 235: Predictors of functional decline over time in an urban population: The Northern Manhattan Study

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Mandip Dhamoon ◽  
Yeseon P Moon ◽  
Myunghee C Paik ◽  
Palma Gervasi-Franklin ◽  
Ralph L Sacco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Functional Status ◽  
Functional Decline ◽  
Population Based ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vascular Events ◽  
Over Time

Background: There is limited data on predictors of long-term functional status in population samples, and even less about the effect of vascular risk factors on function. We hypothesized that functional status would decline over time, and that vascular risk factors would affect function and mediate functional decline. Methods: The Northern Manhattan Study contains a prospective, population-based study of 3298 stroke-free individuals > 40 years of age, followed for a median of 11 years for vascular events. The Barthel index (BI) was assessed annually and analyzed as a continuous variable on a 100-point scale. Generalized estimating equations models were adjusted for demographic, medical, and social risk factors assessed at baseline. Models were censored and uncensored for stroke and myocardial infarction (MI) occurring during follow-up. Secondarily, motor and non-motor domains of the BI were analyzed separately, and models were stratified by age. Results: Mean age (standard deviation) was 69.2 (10) years, 37% were male, 52% Hispanic, 22% had diabetes, and 74% hypertension. Among 3298 participants, there were 33556 BI assessments. There was an annual decline of 1.02 BI points (p<0.0001). Predictors of change in BI over time included: age (−0.08 BI points per year; p<0.0001), Hispanic ethnicity (−0.22 per year, compared to white; p=0.016), female sex (−0.30 per year, compared to male; p<0.0001), diabetes (−0.38 per year, compared to non-diabetics; p=0.0002), and depression (−0.26 per year, compared to no depression; p=0.046). Results did not change when stroke and MI were censored. Magnitude and significance of predictors of BI were similar for motor and non-motor domains. The following had a different effect on change in BI in those above the median age (68 years), compared to those less than or equal to the median: age (−0.15 per year vs. −0.03; p for difference <0.0001), female compared to male sex (−0.43 per year vs. −0.15; p=0.049), and depression compared to no depression (−0.64 per year vs. −0.008, p=0.023). Conclusion: In this large, population-based, multi-ethnic study with long-term follow-up, we found a 1% mean decline in function per year that did not change when the effect of vascular events was excluded by censoring. Vascular risk factors predicted functional decline even in the absence of clinical events. The impact of gender sex and depression was stronger amongst the elderly.

scholarly journals Burden of Traumatic Brain Injuries in Children and Adolescents in Europe: Hospital Discharges, Deaths and Years of Life Lost

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 105
Author(s):  
Marek Majdan ◽  
Juliana Melichova ◽  
Dominika Plancikova ◽  
Patrik Sivco ◽  
Andrew I. R. Maas ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Hospital Discharge ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Population Based ◽  
Years Of Life Lost ◽  
Hospital Discharges ◽  
Cross Sectional ◽  
Aid Decision ◽  
Age Range

Children and adolescents are at high risk of traumatic brain injuries (TBI). To identify those most at risk across Europe, a comprehensive epidemiological study on the burden of TBI is needed. Our aim was to estimate the burden of TBI in the pediatric and adolescent population of Europe by calculating rates of hospital-based incidence, death and years of life lost (YLL) due to TBI in 33 countries of Europe in 2014 (most recent available data). We conducted a cross-sectional observational, population-based study. All cases with TBI in the age range 0 to 19, registered in the causes of death databases or hospital discharge databases of 33 European countries were included. Crude and age-standardized rates of hospital discharges, deaths and YLLs due to TBI; and pooled estimates for all countries combined were calculated. TBI caused 2303 deaths (71% in boys), 154,282 YLLs (68% in boys) and 441,368 hospital discharges (61% in boys) in the population of 0–19 year-olds. We estimated pooled age-standardized rates of death (2.8, 95% CI: 2.4–3.3), YLLs (184.4, 95% CI: 151.6–217.2) and hospital discharges (344.6, 95% CI: 250.3–438.9) for the analyzed countries in 2014. The population of 15–19 year-olds had the highest rates of deaths and YLLs, and the population of 0–4 year-olds had the highest rate of hospital discharges. Detailed estimates of hospital discharge, death and YLL rates based on high-quality, standardized data may be used to develop health policies, aid decision-making and plan prevention.

Sign in / Sign up

Export Citation Format

Share Document