| 1. |
- Dahlin-Ivanoff, Synneve, 1950, et al.
(författare)
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Comprehensive geriatric assessment of frail older people: ideals and reality
- 2018
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Ingår i: Journal of Interprofessional Care. - : Informa UK Limited. - 1356-1820 .- 1469-9567. ; 32:6, s. 728-734
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Tidskriftsartikel (refereegranskat)abstract
- We explored different professionals’ views on and experiences of comprehensive geriatric assessment (CGA) of frail older people. Forty-six professionals working in hospitals, primary care, or municipal health and social care participated in 10 focus groups. Professional groups comprised of occupational therapists, physiotherapists, nurses, physicians, and social workers. Participants shared an ideal image of how the CGA of frail elderly people should be conducted. Experience-based competence was more often used as an assessment tool than standardized tests. The ideal image contrasted with reality, listening to the needs expressed, with the person’s problems, needs, and priorities in the foreground, as described by the categories: a need that can be met; different perspectives on needs; needs can be hidden; and needs assessment is affected by the collaboration around the person, by the context, and by the dialogue. The health and social care professionals’ first priority is to make a person-centred tailor-made comprehensive geriatric assessment and not be bound to instruments. Clear guidelines need to be developed, stating which profession assesses what, when and how in order to ensure that person-centred needs are assessed including structures and procedures for how communication and collaboration within the team as well as between the organizations are achieved in order to perform a good person-centred CGA.
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| 2. |
- Holmgren, Eva, 1972-
(författare)
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Getting up when falling down : reducing fall risk factors after stroke through an exercise program
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis was to identify fall risk individuals (+55) after stroke by validating a fall risk index and in post-stroke individuals with high risk of falls evaluate the impact of an intervention program on fall risk factors.A previously developed fall risk index was validated, modified and re-validated. The validation showed a sensitivity of 97% and a specificity of 26%. This result was not considered sufficiently accurate. Therefore a modified index was created in the Validation sample and re-validated back in the Model fit sample. The modified index was reduced to three items and included postural stability + visuospatial hemi-inattention + male sex.The randomized controlled trial contained an intervention program (IP) with High-Intensity Functional Exercises as well as implementation these exercises in to real life situations together with educational group discussions. The participants were enrolled and randomized three to six months after their stroke. The assessments were performed at the Clinical Research Center at Norrlands University Hospital. The Intervention Group (IG) received a program of 35 sessions (exercise and group discussions) and the Control Group (CG) received five group discussions.Performing daily activities at 6 months follow-up and falls-efficacy post-intervention and at the 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). The IP did not have a statistically significant impact on Balance or Lifestyle activities. When evaluating gait, step time variability for the paretic leg and the variability in Cycle Time for the paretic and non-paretic leg were improved for the IG. The time spent on the non –paretic leg in the gait cycles’ most stable phase, Double Support, was reduced by almost half (0.9 sec to 0.4 sec) since baseline for the IG after the intervention and remained reduced to the three month follow-up. Quality of Life showed an improvement in the CG compared with the IG for the mental scales, Mental Component Scale and Mental Health subscale at the 3 month follow-up (p=.02).In conclusion, this intervention program significantly improved performance of everyday life activities, falls-efficacy and the variability in gait. These are three major fall risk factors and might in the long run have an impact on decreasing falls in persons that had a stroke.
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| 3. |
- Holmgren, Eva, 1972-, et al.
(författare)
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The impact of an high intensive exercise program on gait after stroke : a randomized controlled trial
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Stroke often results in asymmetric gait with disturbed balance, which may increase the risk of accidental falls. The purpose of this study was to evaluate the impact of a high intensive exercise program after stroke on gait. 34 post-stroke individuals with risk of falls were included in the five week randomized controlled trial. The participants were assessed, included and randomized to the intervention group (IG) or control group (CG) at 3 to 6 months after stroke onset. The IG received a high intensive strength and balance exercise program along with a weekly educational group discussion on fall risk and security aspects, whereas the CG received weekly group discussions on hidden dysfunctions after stroke. Assessments were made before, post-intervention and at 3-months follow-up. Statistically significant (p<0.05) improvements were seen in the IG vs. the CG at post intervention compared with baseline in double support time for the non-paretic leg (DSTnp), variability (measured as coefficient of variation, CV) in Step Time for the paretic leg (STCVp) and the non-paretic leg (STCVnp), and in variability in Cycle Time for the paretic (CTCVp) and non-paretic leg (CTCVnp); at 3-months follow-up compared with baseline in DSTnp, STCVp, CTCVp and CTCVnp, and DSTCVp. At 3-months follow-up, the decrease in the STCVnp and the variability in Step Length of the non-paretic leg (SLCVnp) were more pronounced in the CG than in the IG. The findings suggest that high intensive exercise programs have a positive effect on gait, and can be useful in diminishing gait asymmetry as a fall-risk factor in people after stroke.
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| 4. |
- Holmgren, Eva, 1972-, et al.
(författare)
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What is the benefit of a high intensive exercise program on health-related quality of life and depression after stroke? : A randomized controlled trial
- 2010
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 12:3, s. 125-133
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to evaluate the impact of a high-intensive exercise program containing high-intensive functional exercises implemented to real-life situations together with group discussions on falls and security aspects in stroke subjects with risk of falls. This was a pre-specified secondary outcome for this study. For evaluation, Short Form-36 (SF-36) health-related quality of life (HRQoL) and the Geriatric Depression Scale-15 (GDS-15) were used. This was a single-center, single-blinded, randomized, controlled trial. Consecutive ≥55 years old stroke patients with risk of falls at 3–6 months after first or recurrent stroke were randomized to the intervention group (IG, n=15) or to the control group (CG, n=19) who received group discussion with focus on hidden dysfunctions but no physical fitness training. The 5-week high-intensive exercise program was related to an improvement in the CG in the SF-36 Mental Component Scale and the Mental Health subscale at 3 months follow-up compared with baseline values while no improvement was seen in the IG at this time. For the SF-36 Physical Component Scale, there was an improvement in the whole study group at 3 and 6 months follow-up compared with baseline values without any significant changes between the IG and CG. The GDS-15 was unchanged throughout the follow-up period for both groups. Based on these data, it is concluded that high-intensive functional exercises implemented in real-life situations should also include education on hidden dysfunctions after stroke instead of solely focus on falls and safety aspects to have a favorable impact on HRQoL.
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| 5. |
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| 6. |
- Westgård, Theresa, et al.
(författare)
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Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital : a feasibility study
- 2018
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Ingår i: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.Methods: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.Result: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].Conclusion: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.Trial registration: Clinical Trials ID: NCT02773914. Registered 16 May 2016.
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| 7. |
- Wilhelmson, Katarina, 1958, et al.
(författare)
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Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings (CGA-Swed) : A Randomised Controlled Study
- 2020
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Ingår i: Geriatrics (Basel, Switzerland). - : MDPI AG. - 2308-3417 .- 0016-867X. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study is to evaluate the effects of the Comprehensive Geriatric Assessment (CGA) for frail older people in Swedish acute hospital settings - the CGA-Swed study. In this study protocol, we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants. The study is a randomised controlled trial with an intervention group receiving the CGA and a control group receiving medical assessment without the CGA. Follow-ups were conducted after 1, 6 and 12 months, with dependence in activities of daily living (ADL) as the primary outcome measure. The study group consisted of frail older people (75 years and older) in need of acute medical hospital care. The study design, randomisation and process evaluation carried out were intended to ensure the quality of the study. Baseline data show that the randomisation was successful and that the sample included frail older people with high dependence in ADL and with a high comorbidity. The CGA contributed to early recognition of frail older people's needs and ensured a care plan and follow-up. This study is expected to show positive effects on frail older people's dependence in ADL, life satisfaction and satisfaction with health and social care.
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