| 1. |
- Akner, Gunnar, 1953-, et al.
(författare)
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Personalized Geriatric Medicine
- 2014
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649 .- 1878-7657. ; 5, s. 145-146
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Amrouch, Cheima, et al.
(författare)
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Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort
- 2024
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The STOPP/START criteria are frequently applied in observational studies to assess potentially inappropriate prescribing in older adults. This study aimed to assess the applicability of the three available STOPP/START versions in two distinct data sources.Methods To evaluate the applicability of the three versions of STOPP/START criteria, we used two observational data sources: (i) Integrated Swedish administrative health registries (ISHR) encompassing routinely collected health data and (ii) the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K), based on health professional-led clinical assessments. The Anatomical Therapeutic Classification code (ATC) was used to categorise medications. Diseases were categorised using the international classification of diseases version 10 (ICD10).Results The first STOPP/START version demonstrated an applicability rate of 80% in ISHR and 84% in SNAC-K. The second version demonstrated an applicability of 64% in ISHR and 74% in SNAC-K. The third version showed an applicability of 66% in ISHR and 77% in SNAC-K. Challenges in applicability included broad definitions, vague terminology, and the lack of information on disease severity, symptomatic traits, and stability of certain conditions.Conclusion The applicability of the STOPP/START criteria in observational studies seems to have decreased in more recent versions of the tool. Population-based studies with comprehensive clinical assessments may offer higher applicability compared to studies based on administrative data. Future versions of the STOPP/START criteria should prioritise clear and unambiguous definitions to improve their applicability in research and promote result generalisability and comparability.
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| 3. |
- Bahat, Gulistan, et al.
(författare)
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Paving the way for applying GLIM criteria in clinical practice and research : how to define mild to moderate and severe reduced muscle mass
- 2022
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Ingår i: European Geriatric Medicine. - : Springer Nature. - 1878-7649 .- 1878-7657. ; 13:3, s. 611-614
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Tidskriftsartikel (refereegranskat)abstract
- Key summary pointsAim To report grade 1 and grade 2 reduced muscle mass cut-offs for skeletal muscle mass (SMM) adjusted by body mass index (BMI) to increase the applicability of the GLIM criteria. Findings Grade 1 vs. grade 2 low muscle mass (LMM) thresholds were 1.189 and 0.954 kg/BMI vs. 1.049 and 0.823 kg/BMI in males and females, respectively. Message While validation studies are needed to evaluate their predictive ability, our approach presented here seems applicable and the cut-off values acceptable for use until population-specific values in different populations or global generic cut-offs are identified. Purpose Among approaches to adjust skeletal muscle mass (SMM) for body size, adjustment for body mass index (BMI) correlated better with functional measures. To enhance applicability of GLIM criteria, we report grade 1 and grade 2 reduced muscle mass cut-offs for SMM adjusted by BMI. Methods 301 young, healthy adults involving students, patient relatives and staff working in the university hospital were included. SMM was estimated by bio-impedance analysis (BIA). SMM index (BMI) [SMMI(BMI)] was calculated as SMM/BMI. Grade 1 low muscle mass (LMM) was defined as "mean young SMMI(BMI)-one standard deviation" and grade 2 LMM as "mean young SMMI(BMI)-two standard deviations". Results Mean age was 26.5 +/- 4.6 (62.1% male). Grade 1 vs grade 2 LMM thresholds were 1.189 and 0.954 kg/BMI vs 1.049 and 0.823 kg/BMI in males and females, respectively. Conclusion This is the first report identifying stage 1 and stage 2 LMM thresholds for SMMI adjusted by BMI. Studies are needed to evaluate their predictive validity.
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| 4. |
- Balducci, Marco, et al.
(författare)
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SARS-CoV-2 vaccination and risk of infectious diseases in hospitalized older patients
- 2024
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657. ; 15:2, s. 509-517
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Vaccinations, for example flu vaccine, may be a cause of cross-reactive immunostimulation that prevents a larger spectrum of infections. However, whether SARS-CoV-2 vaccinations may also determine this effect is unclear. This study aims, first, to assess the incidence of infections at hospital admission and during the hospitalization in older inpatients vaccinated and unvaccinated against SARS-CoV-2; second, to compare length of hospital stay and in-hospital mortality between vaccinated and unvaccinated individuals.Methods This retrospective study included 754 older inpatients admitted to the Geriatrics and Orthogeriatrics Units of the University Hospital of Ferrara (Italy) between March 2021 and November 2021. Sociodemographic and health-related data, and the diagnosis of infections at hospital admission and during hospitalization were collected from medical records.Results The sample’s mean age was 87.2 years, 59.2% were females, and 75.5% were vaccinated against SARS-CoV-2. Vaccinated individuals had 36% lower odds of intra-hospital infections (OR = 0.64, 95%CI 0.44–0.94) and 39% lower in-hospital death (HR = 0.61, 95%CI 0.39–0.95), also after adjusting for potential confounders, while no significant results emerged about infections at hospital admission. Considering the hospitalization’s endpoints, SARS-CoV-2 vaccination was associated with a lower probability of being transferred to long-term care or other hospital departments than returning home (OR = 0.63, 95%CI 0.40–0.99).Conclusions In older inpatients, SARS-CoV-2 vaccination seems to be associated with a lower likelihood of intra-hospital infectious diseases not caused by SARS-CoV-2 and all-cause in-hospital mortality. The vaccination coverage in the older population could limit not only the onset and severity of COVID-19 but also the occurrence of other infectious diseases.
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| 5. |
- Blain, H., et al.
(författare)
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A comprehensive fracture prevention strategy in older adults : the European union geriatric medicine society (EUGMS) statement
- 2016
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Ingår i: European Geriatric Medicine. - : Elsevier. - 1878-7649 .- 1878-7657. ; 7:6, s. 519-525
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Tidskriftsartikel (refereegranskat)abstract
- Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest group on falls and fracture prevention of the European union geriatric medicine society (EUGMS), in collaboration with the International association of gerontology and geriatrics for the European region (IAGG-ER), the European union of medical specialists (EUMS), the Fragility fracture network (FFN), the International osteoporosis foundation (IOF) - European society for clinical and economic aspects of osteoporosis and osteoarthritis (ECCEO), outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.
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| 6. |
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| 7. |
- Bruyere, O., et al.
(författare)
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Assessment of muscle mass, muscle strength and physical performance in clinical practice : An international survey
- 2016
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649 .- 1878-7657. ; 7:3, s. 243-246
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Several tools are available for the assessment of muscle mass, muscle strength and physical performance in clinical research. However, few data are available on the usage of these tools in clinical practice.Methods: This study aimed to assess their usage by means of a large online international survey. Since sarcopenia is a specific condition where the assessment of muscle mass, muscle strength and physical performance is important, the survey also assessed the tools used for the diagnosis of this geriatric syndrome.Results: The survey was completed by 255 clinicians from 55 countries across 5 continents. Among these clinicians with geriatrics, rheumatology and endocrinology as major fields of interest, 53.3% assess muscle mass in daily practice, 54.5% muscle strength and 71.4% physical performance. However, the tools used are very different and no single tool is used by all clinicians. The tools and the cut-off values used by clinicians to diagnose sarcopenia are also heterogeneous.Conclusion: Because some tools used for the assessment of muscle mass, muscle strength or physical performance in daily practice are less validated than others, a greater awareness from the clinicians of the importance of using appropriate tools is needed.
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| 8. |
- Cabrera, Esther, et al.
(författare)
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Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes : A systematic review
- 2015
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Ingår i: European Geriatric Medicine. - Oxford : Elsevier BV. - 1878-7649 .- 1878-7657. ; 6:2, s. 134-150
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Tidskriftsartikel (refereegranskat)abstract
- Background: Two-thirds of nursing home residents suffer from dementia and there is a need for effective and efficient interventions with meaningful outcomes for these individuals. This study aims to identify current best practices in non-pharmacological interventions in nursing homes.Methods: A systematic literature review was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guideline. Studies and Randomized Controlled Trials (RCT) evaluating non-pharmacological interventions focused on improving the Quality of Care (QoC) and/or Quality of Life (QoL) of people with dementia (PwD) living in nursing homes were included. For individual study evaluation, the Cochrane Collaboration risk of bias assessment tool was used.Results: A total of 31 articles were included and five main categories emerged: psychosocial and educational, physical activity, sensorial therapies, staff-focused interventions and complex interventions. Psychosocial interventions were the most exhaustively studied and evaluated interventions. Few studies related to physical therapy were identified and they did not provide enough evidence of their effectiveness. Therapeutic touch was revealed to have positive effects on residents with dementia.Conclusion: Psychosocial interventions have been shown to have the potential to improve the QoL and QoC of people with dementia in nursing homes. Before implementation of the intervention, it is recommended that activities are adjusted according to residents' characteristics and external factors controlled to achieve effectiveness and to structure a well-designed intervention. However, there is not enough evidence to support the effectiveness of non-pharmacological interventions in general. Further well-designed research is needed on non-pharmacological interventions in nursing facilities. (C) 2014 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
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| 9. |
- Cawthon, Peggy M., et al.
(författare)
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Defining terms commonly used in sarcopenia research : a glossary proposed by the Global Leadership in Sarcopenia (GLIS) Steering Committee
- 2022
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Ingår i: European Geriatric Medicine. - : Springer. - 1878-7649 .- 1878-7657. ; 13:6, s. 1239-1244
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Tidskriftsartikel (refereegranskat)abstract
- MethodsThe aim of this paper is to define terms commonly related to sarcopenia to enable standardization of these terms in research and clinical settings. The Global Leadership Initiative in Sarcopenia (GLIS) aims to bring together leading investigators in sarcopenia research to develop a single definition that can be utilized worldwide; work on a global definition of sarcopenia is ongoing. The first step of GLIS is to develop the common terminology, or a glossary, that will facilitate agreement on a global definition of sarcopenia as well as interpretation of clinical and research findings.ResultsSeveral terms that are commonly used in sarcopenia research are defined, including self-reported measures of function and ability; objective physical performance tests; and measures related to muscle function and size.ConclusionAs new methods and technologies are developed, these definitions may be expanded or refined over time. Our goal is to promote this common language to describe sarcopenia and its components in clinical and research settings in order to increase clinical awareness and research interest in this important condition. We hope that the use of common terminology in sarcopenia research will increase understanding of the concept and improve communication around this important age-related condition.Key summary pointsAimThe aim of this paper is to define terms commonly related to sarcopenia to enable standardization of these terms in research and clinical settings.FindingsThis paper provides definitions for commonly used terminology in sarcopenia in both clinical and research settings. As new methods and technologies are developed, this terminology may be expanded or refined over time.MessageWe hope that the use of common terminology in sarcopenia research will increase understanding of the concept and improve communication around this important age-related condition.
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| 10. |
- Dahlqvist, Jenny, et al.
(författare)
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Does comprehensive geriatric assessment (CGA) in an outpatient care setting affect the causes of death and the quality of palliative care? A subanalysis of the age-FIT study
- 2019
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 10:3, s. 455-462
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purposes of this study were to retrospectively study whether comprehensive geriatric assessment (CGA) given to community-dwelling old patients with high health care usage has effects regarding: (1) the cause of death and (2) the quality of the provided palliative care when compared to patients without CGA-based care. Method: This study includes secondary data from a randomised controlled trial (RCT) with 382 participants that took place in the periods 2011–2013. The present study examines all electronical medical records (EMR) from the deceased patients in the original study regarding cause of death [intervention group (IG) N = 51/control group (CG) N = 66] and quality of palliative care (IG N = 33/CG N = 41). Descriptive and comparative statistics were produced and the significance level was set at p < 0.05. Results: The causes of death in both groups were dominated by cardiovascular and cerebrovascular diseases with no statistical difference between the groups. Patients in the intervention group had a higher degree of support from specialised palliative care teams than had the control group (p = 0.01). Conclusion: The present study in an outpatient context cannot prove any effects of CGA on causes of death. The study shows that CGA in outpatient care means a higher rate of specialised palliative care, but the study cannot show any effects on the palliative quality parameters measured. Further studies with statistical power are needed.
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| 11. |
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| 12. |
- Dong, Huan-Ji, et al.
(författare)
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Effects of proactive healthcare on pain, physical and activities of daily living functioning in vulnerable older adults with chronic pain: a pragmatic clinical trial with one- and two-year follow-up
- 2024
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Ingår i: European Geriatric Medicine. - : SPRINGER. - 1878-7649 .- 1878-7657.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To investigate the changes in pain, physical and activities of daily living (ADL) functioning in vulnerable older adults with chronic pain after proactive primary care intervention. Methods This study was embedded in a prospective, pragmatic, matched-control multicenter trial at 19 primary care practices in Sweden, with proactive medical and social care (Intervention Group, IG, n = 134) in comparison with usual care (Control Group, CG, n = 121). Patients with chronic pain, defined as pain experienced longer than 3 months, were included in this subgroup analysis. Data on pain aspects, physical and ADL functioning were collected in the questionnaires at baseline, one- and two-year follow-up (FU-1 and FU-2). Data on prescribed pain medications was collected by local health authorities. Results Mean age was 83.0 +/- 4.7 years with almost equal representation of both genders. From baseline until FU-2, there were no significant within-group or between-group changes in pain intensity. Small adjustments of pain medication prescriptions were made in both groups. Compared to FU-1, the functional changes were more measurable at FU-2 as fewer participants had impaired physical functioning in IG (48.4%) in comparison to CG (62.6%, p = 0.027, Effect Size phi = 0.14). Higher scores of ADL-staircase (more dependent) were found in both groups (p < 0.01, Effect Size r = 0.24 in CG and r = 0.16 in IG). Conclusion Vulnerable older adults with chronic pain seemed to remain physical and ADL functioning after proactive primary care intervention, but they may need tailored strategies of pain management to improve therapeutic effects.
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| 13. |
- Ekdahl, Anne
(författare)
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The organisation of hospitals and the remuneration systems are not adapted to frail old patients giving them bad quality of care and the staff feelings of guilt and frustration
- 2014
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Ingår i: European Geriatric Medicine. - : Elsevier Masson. - 1878-7649 .- 1878-7657. ; 5:1, s. 35-38
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the coming half-century, the population of old people will increase, especially in the oldest age groups. Therefore, the prevalence of multiple chronic conditions, and consequently, the need of health care including care in hospital, is rising. Materials and methods: This article includes results from three mainly qualitative articles (interviews with frail old people, physicians, and an observational study in acute medical wards) and a cross-sectional survey of newly discharged elderly patients. Results: Health care does not take a holistic approach to patients with more complex diseases, such as frail old people. The remuneration system rewards high production of care in terms of numbers of investigations and operations, turnover of hospital beds, and easy accessibility to care. Frail old people do not feel welcome in hospital, with their complex diseases and a need of more time to recover. The staff providing care feels frustrated, and often guilty when taking care of old people. Discussion and conclusion: To improve quality of care of frail elderly, a model is suggested with the following main components: more hospital wards which can address the patients whole situation medically, functionally, and psychologically, i.e comprehensive geriatric assessment (CGA). Better identification of frail elderly people is necessary, together with a change in remuneration system, with a focus on the patients functional status and quality of life. More training in geriatrics is required for staff to feel confident when treating frail old people.
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| 14. |
- Ekdahl, A. W., et al.
(författare)
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Frailty and comprehensive geriatric assessment organized as CGA-ward or CGA-consult for older adult patients in the acute care setting : a systematic review and meta-analysis
- 2015
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Ingår i: European Geriatric Medicine. - : Elsevier. - 1878-7649 .- 1878-7657. ; 6:6, s. 523-540
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Forskningsöversikt (refereegranskat)abstract
- Background: With worldwide population aging, increasing numbers of people need hospital care. Evidence suggests comprehensive geriatric assessment (CGA) is superior to usual care.Objective: To summarize the evidence for the effects of CGA in frail and moderately frail patients compared with usual care in acute care settings.Data sources: CINAHL, PsycInfo, Cochrane Library, EMBASE, and PubMed were searched in October 2011, January 2013, and February 2015.Study eligibility: Randomized controlled trials.Participants: Older adults aged ≥ 65 years who were admitted to hospital with a complex condition, divided into frail and moderately frail groups.Intervention: CGA.Control: Usual care.Outcomes: Change in housing, personal activities of daily living (PADL), instrumental activities of daily living (IADL), readmission, cognitive function, depression, quality-of-life care-giver burden, and mortality.Study appraisal and synthesis: The grading of recommendations assessment development and evaluation (GRADE) system to assess the quality of evidence and PRISMA-guidelines for meta-analyses and reviews. Continuous data were presented as standardized mean differences and dichotomous data were presented as risk differences.Results: Twenty-nine articles based on 17 unique studies (6005 patients in total). CGA was categorized as CGA-ward or CGA-consult. In the frail group, CGA-ward was superior to usual care for change in housing, PADL, and depression. CGA-consult was superior to usual care for PADL and IADL in the moderately frail group.Conclusion: There was a stronger effect for frail older adults and CGA-ward compared with usual care. This highlights the importance of detecting frailty. However, the degree of evidence was limited.
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| 15. |
- Elyn, Antoine, et al.
(författare)
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End of life care practice and symptom management outcomes of nursing home residents with dementia : secondary analyses of IQUARE trial
- 2019
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 10:6, s. 947-955
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Tidskriftsartikel (refereegranskat)abstract
- Purpose End-of-life care is a central issue in nursing homes. Poor care outcomes have been reported, especially among residents with dementia. Our aim was two-fold: to assess whether the diagnosis of dementia was associated with specific patterns of care and symptom management for residents with dementia during the last 6 months of life, and to compare these patterns of care between residents with dementia who died within 6 months and those who survived longer. Methods Secondary prospective analyses of the IQUARE trial (trial registration number NCT01703689). 175 nursing homes in South West France. Residents with and without dementia at baseline (May-June 2011), stratified according to their vital status at 6-month follow-up. Results Of 6275 residents enrolled in IQUARE study (including 2688 with dementia), 494 (7.9%) died within 6 months. Compared to residents without dementia (n = 254), those with dementia (n = 240) were less likely to be self-sufficient (OR = 0.08, 95% CI 0.01-0.64). They were more likely to have physical restraints (OR = 1.65, 95% CI 1.08-2.51) and less likely to be prescribed benzodiazepines (OR = 0.58, 95% CI 0.38-0.88). Among residents with dementia, those who died during the first 6 months of follow-up were more likely to be identified with a formal end-of-life status (OR = 5.71, 95% CI 3.48-9.37) although such identification remains low with only 15% of them. They were more likely to experience pain (OR = 1.43, 95% CI 1.04-1.97) and to be physically restrained (OR = 1.46, 95% CI 1.08-1.98). However, pain relief and psychological distress management were not improved. Conclusions Poor quality indicators such as physical restraints are associated with end-of-life care for residents with dementia. Among symptom management outcomes, pain medication remains low even if pain complaint increased at life end.
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| 16. |
- Freiberger, Ellen, et al.
(författare)
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Short physical performance battery is not associated with falls and injurious falls in older persons : longitudinal data of the SCOPE project
- 2024
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657.
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Falls and fall-related injuries in older persons are a major public health problem. Our objective was to study the predictive value of the Short Physical Performance Battery (SPPB) in the cohort of the SCOPE project on falls, injurious falls, and possible difference of prediction between indoors and outdoors falls.METHODS: For this sub-study of the SCOPE project participants reporting no falls at baseline, and survey data on falls at the 12-month and 24-month follow-up were included. Participant´s characteristics were assessed during the baseline interview and medical examinations. Falls as well as injurious falls and fall circumstances were obtained self-reported. SPPB and its association with fallers vs. no fallers at 12 and at 24 months were studied with logistic regression models.RESULTS: The 1198 participants had a median age of 79 years (77-82), and a median SPPB of 10 (8-11), with a 52.5% of female. A total of 227 and 277 falls (12- and 24- month visits, respectively) were reported. In the crude model, the SPPB sum scores (p < 0.001) as well as most single item scores were significant different between fallers and non-fallers over time. However, the association was attenuated in models adjusted for age, sex, marital status, number of medications, quality of life, handgrip strength, and muscle mass [e.g., 12 months; OR 0.94 (0.87-1.02)]. While SPPB fails to differentiate between injurious and non-injurious falls (p = 0.48), a lower SPPB score was associated with falls at home (p < 0.01) after 24 months.CONCLUSION: SBPP was not able to significantly predict the risk of falling as well as experiencing an injurious fall.TRIAL REGISTRATION: This study was registered prospectively on 25th February 2016 at clinicaltrials.gov (NCT02691546).
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| 17. |
- Gustafson, Yngve, et al.
(författare)
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Delirium. A Swedish perspective.
- 2010
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649 .- 1878-7657. ; 1:6, s. 374-376
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Tidskriftsartikel (refereegranskat)abstract
- The incidence and duration of delirium is probably the best measurement of the quality of acute hospital care of old people. A patient with delirium is always seen as a diagnostic challenge to the geriatric team since the only effective treatment is to prevent, detect and treat the underlying causes of delirium. Predisposing and precipitating factors has to be dealt with simultaneously and the best conditions for the recovery of the brain have to be created. New threats to the brain have to be prevented and harmful medication should be avoided. Long-term follow-up of the patient with delirium is necessary since delirium can be the first symptom of a preclinical dementia.
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| 18. |
- Gustafson, Yngve, et al.
(författare)
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Depression in old age in Austria, Ireland, Portugal and Sweden
- 2013
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649 .- 1878-7657. ; 4:3, s. 202-208
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Tidskriftsartikel (refereegranskat)abstract
- Depression is the third leading cause of disease burden worldwide and the most frequent psychiatric disorder in the older adult population. Depression in old age is disabling, both psychosocially and physically, decreases quality of life and increases mortality. This paper explores the epidemiology, screening, diagnosis and management of depression in old age in four European countries in an attempt to gain a better understanding of the issues contributing to the variability in clinical practice. The prevalence of depression in community dwelling older individuals is high, but studies in the oldest population and in specific settings (like nursing homes) are few. Depression may go undiagnosed, and wide screening programs for early identification of this disease are uncommon. Depression screening is consistently included in comprehensive geriatric assessment, and most geriatricians appear to be confident in its diagnosis and management. Old age psychiatry is still largely underdeveloped, except for Ireland. Primary care physicians start treatment of depression in most countries, referring only complex cases for specialised care. SSRIs seem to be the first line treatment, but choice of antidepressants is widely variable in different countries. Availability of non-pharmacological therapies is still low, and only highly skilled centres use a multifaceted approach to depression care. Attitudes towards depression and mental illness are still mostly negative, which may hinder identification and management of this highly prevalent geriatric problem.
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| 19. |
- Hallgren, Jenny, 1978-, et al.
(författare)
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Risk factors for hospital readmission among Swedish older adults
- 2018
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Ingår i: European Geriatric Medicine. - : Springer. - 1878-7649 .- 1878-7657. ; 9:5, s. 603-611
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge.MethodsA prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/ Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions.ResultsOf the 772 participants, [mean age 69.7 (±11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the frst week; mean days from hospital discharge to readmission was 7.9 (±6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p=0.039) and being a male (OR 1.84, p=0.006) increased the risk of readmission.ConclusionsMost older persons that are readmitted return to hospital within the frst week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.
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| 20. |
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| 21. |
- Lapi, Francesco, et al.
(författare)
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How to support general practitioners to better detect sarcopenia among older adults : a nested case-control analysis
- 2024
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study explores correlations of sarcopenia and its proxies, such as history of falls, asthenia, and ambulation issues, with frailty levels among older adults in primary care.Methods In a cohort of 546,590 patients aged 60 years or older, “definite” sarcopenia cases were operationally defined through the use of non-specific diagnostic codes coupled with inspection of free-texts. Proxies of sarcopenia, such as falls history, asthenia, and ambulation issues were considered as well. Frailty was calculated using an Index intended to primary care.Results Overall, 171 definite sarcopenia cases were found, rising to 51,520 cases when including proxies (9.4% prevalence). There was a significant association between severe frailty and increased odds of sarcopenia, consistently observed across different event definitions.Conclusions Sarcopenia was strongly associated with severe frailty in primary care. The history of falls, asthenia, and ambulation issues were reliable proxies to raise the suspect of sarcopenia. Improved strategies for sarcopenia detection, focusing on specific indicators within severely frail individuals, are warranted.
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| 22. |
- Mazya, A. L., et al.
(författare)
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The Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT) - A randomised controlled trial aimed to prevent hospital readmissions and functional deterioration in high risk older adults : A study protocol
- 2013
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Ingår i: European Geriatric Medicine. - : Elsevier. - 1878-7649 .- 1878-7657. ; 4:4, s. 242-247
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundCare of old people with multimorbidity living at home is often fragmented with lack of coordination and information exchange between health care professionals, the elderly and their relatives. This paper describes the protocol of a randomised, controlled study, which aims to compare the efficacy of caring for older people with multimorbidity and three or more hospital admissions in the previous year at a geriatric ambulatory department based on Comprehensive Geriatric Assessment (CGA) versus usual care.Participants and methodsA total of 400 community-dwelling old people with multimorbidity who are living in the city of Norrköping (Sweden) and one of their relatives are recruited for this trial and randomized to an intervention and a control group. Participants in the intervention group receive interdisciplinary care after a CGA at an Ambulatory Geriatric Unit with easy accessibility during working hours in addition to usual care. The control group receives usual care provided by the primary care or hospital.OutcomesThe primary outcome is number of hospitalisation, the secondary outcomes are health-related outcomes including measures of frailty, cognition, symptom burden, feeling of security, quality of life of participants and relatives and as well as costs for health and social care. Participants will be followed for 2 years.DiscussionThis study will contribute to evidence of the effect of two different care models. The study has the potential to change care for older people with multimorbidity.
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| 23. |
- Mezera, Vojtech, et al.
(författare)
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The experiences of early career geriatricians throughout Europe during the COVID-19 pandemic
- 2022
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 13:3, s. 719-724
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Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 pandemic has severely affected older adults and brought about unprecedented challenges to geriatricians. We aimed to evaluate the experiences of early career geriatricians (residents or consultants with up to 10 years of experience) throughout Europe using an online survey. We obtained 721 responses. Most of the respondents were females (77.8%) and residents in geriatric medicine (54.6%). The majority (91.4%) were directly involved in the care of patients with COVID-19. The respondents reported moderate levels of anxiety and feelings of being overloaded with work. The anxiety levels were higher in women than in men. Most of the respondents experienced a feeling of a strong restriction on their private lives and a change in their work routine. The residents also reported a moderate disruption in their training and research activities. In conclusion, early career geriatricians experienced a major impact of COVID-19 on their professional and private lives.
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| 24. |
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| 25. |
- Nägga, Katarina, et al.
(författare)
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Evaluation of short cognitive screening tests in 85-year-old men and women
- 2015
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649 .- 1878-7657. ; 6:6, s. 545-550
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The study aimed to investigate different aspects of cognition using the Cognitive Assessment Battery (CAB) in community-dwelling older adults aged 85 years. We also investigated the eventual influence of sex on the results and aimed to identify predictors for further cognitive decline after 1 year. Methods: CAB consists of 10 subtests covering the cognitive domains of speed and attention, learning and episodic memory, visuospatial abilities, language, and executive functions. Cognitive tests were performed at baseline (n = 335) and follow-up after 1 year (n = 270). Results: Univariate statistics revealed that men performed better than women on episodic memory (P < 0.05) and on the naming test (P < 0.001). However, floor effects in the paragraph memory test were revealed. There was a high rate of abnormal results on Token Test (67%), PaSMO (50%), Clox (48%), and the cube copying (40%) tests in participants with normal cognition. Logistic regression showed that impaired results on the Stroop III test (odds ratio, 2.38; P < 0.05) was independently associated with an increased risk of cognitive decline. Conclusion: Men performed better than women on the memory and on the naming test. However, due to floor effects in the paragraph memory test in 85 year olds, these results can be disputed. The high rate of abnormal results on the Token Test, PaSMO, Clox, and the cube copying tests in cases with normal cognition indicate that these tests are less suitable for screening in the age group. Impaired result on the Stroop test increased the risk more than two-fold for cognitive decline after 1 year. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
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| 26. |
- Palmer, Katie, et al.
(författare)
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Association of polypharmacy and hyperpolypharmacy with frailty states : a systematic review and meta-analysis
- 2019
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 10:1, s. 9-36
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Forskningsöversikt (refereegranskat)abstract
- Purpose: To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa.Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I-2 statistic and publication bias with Egger's and Begg's tests.Results: Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR=1.52; 95% CI 1.32-1.79) and frail persons (pooled OR=2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR=1.95; 95% CI 1.41-2.70) and frail (OR=6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR=1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty.Conclusions: Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals.
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| 27. |
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| 28. |
- Probert, Noelle, 1994-, et al.
(författare)
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Surgical-site infection after hip fracture surgery : preoperative full-body disinfection compared to local disinfection of the surgical site-a population-based observational cohort study
- 2022
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Ingår i: European Geriatric Medicine. - : Springer. - 1878-7649 .- 1878-7657. ; 13:5, s. 1098-1097
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Swedish national guidelines recommend full-body disinfection (FBD) with 4% chlorhexidine before hip fracture surgery to prevent surgical-site infection (SSI) despite little evidence. Our objective was to compare preoperative FBD with local disinfection (LD) of the surgical site regarding SSI incidence.METHODS: All patients with hip fracture, operated at a hospital in Sweden, January 1, 2018 to December 31, 2019 were included. Patients in 2018 (n = 237) were prepared with FBD and patients in 2019 (n = 259) with LD. Primary outcome was SSI and secondary outcome was SSI and/or death. We adjusted for potential confounders with logistic regression. The adjusted analysis was performed in two models to enable assessment of variables that lacked either outcome; in the first model, these variables were not adjusted, and the second model was restricted to a sub-population not affected by respective variables.RESULTS: There were 16 (6.8%) cases of SSI in 2018 and 8 (3.1%) cases in 2019. FBD (2018) compared to LD (2019) presented an adjusted OR of 1.9 (95%CI 0.8-4.9, P = 0.16) respectively 2.0 (95%CI 0.8-5.1, P = 0.14) in the two models of the logistic regression. In addition, 40 (16.9%) patients in 2018 and 29 (11.2%) patients in 2019 had the combined outcome of SSI and/or death, adjusted OR 1.6 (95% CI 0.9-2.8, P = 0.08) respectively 1.7 (95% CI 0.9-2.9, P = 0.06).CONCLUSION: We found a non-significant increased risk of SSI 2018 compared to 2019 after adjustment. Randomized control trials are needed. Nonetheless, results suggest that LD is not inferior to FBD regarding SSI prevention, meaning patients could potentially be spared substantial pain.
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| 29. |
- Rennemark, Mikael, 1951-, et al.
(författare)
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Changes in mood, activity level and cognition at the age of 66 years, associated with leaving working life before the age of 60 : longitudinal results from the SNAC study
- 2013
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657. ; 4:Supplement 1, s. S208-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Age of retirement has economical implications as we tend to live longer with the result that an increasing number of older inhabitants have to share limited economical resources. This is however not only an economical issue. It is also of interest to investigate health- and quality of life-related factors associated with age of retirement. The aim of this study was to investigate changes in mood, activity level, and cognition at the age of 66 years associated with leaving working life before the age of 60 years.
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| 30. |
- Roller-Wirnsberger, R, et al.
(författare)
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Massive open online courses (MOOCs) for long-distance education in geriatric medicine across Europe : A pilot project launched by the consortium of the project "Screening for Chronic Kidney Disease among Older People": SCOPE project
- 2019
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Ingår i: European geriatric medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 10:6, s. 989-994
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo cover the increasing need for professional knowledge, skills and competences in the care of older people, new learning techniques have been developed. Using the Internet to provide educational material has come into focus of many academic institutions as the learning content can easily be transferred to a larger audience. Since the first launch of a “massive open online course” (MOOC) in 2008, this educational format has raised increasing interest among education experts. The current publication provides insight into the new format of MOOCs in general and specifically describes a MOOC developed by a Pan-European Consortium “Screening for Chronic Kidney Disease (CKD) among Older People across Europe” (SCOPE), a project funded by the European Commission under the umbrella of the Horizon 2020 program.MethodsTechnical background, learning theories and content of the MOOC of the SCOPE project are presented in this overview.ResultsThe MOOC of the SCOPE project is provided on the MOOC ICT platform iMoox. The courses are built up of video clips, textual descriptions, graphics, animations and audio designed with a clear structure and learning goals. The concise video clips with a maximum length of 15–20 min are equipped with additional learning material such as documents, links and asynchronous communication opportunities.ConclusionMOOCs are recognized as a contemporary approach to transfer required knowledge and skills not only in general but also in geriatric medicine, as the health and social care environment is ever-changing and becoming more complex.
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| 31. |
- Roux, Barbara, et al.
(författare)
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Prescription and deprescription of medications for older adults receiving palliative care during the last 3months of life : a single-center retrospective cohort study
- 2019
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 10:3, s. 463-471
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Tidskriftsartikel (refereegranskat)abstract
- PurposeNear the end of life, drugs to ensure comfort and improve quality of life should be prioritized, and unnecessary drugs should be avoided. The aim was to assess the evolution and quality of drug therapy throughout the last 3 months of life of older adults in need of palliative care.MethodsA single-center retrospective cohort study included older adults (65years) who died in a teaching hospital between 1 January 2014 and 30 June 2014 and had been identified as patients in need of palliative care in their last 3 months of life. Drugs were collected from electronic medical records and defined as unnecessary' or essential' based on a review of the literature.ResultsA total of 149 patients were included [age: 82.1 (SD 8.6)years, women: 46.3%]. The mean number of medications varied from 6.7 (SD 3.3) drugs 90 days before death, to 7.5 (SD 4.1) 7 days before death, to 5.6 (SD 3.6) on the day of death. During the final week of life, one additional prescription of essential drugs was observed for 75.2% of patients and 79.3% of patients had at least one unnecessary drug deprescribed. The most prescribed and deprescribed drug classes were, respectively, analgesics (56.4%) and antithrombotic agents (38.2%) during the last week of life.ConclusionsNear the end of life, medication therapy is adapted to the goals of palliative care. However, this only occurs during the last week of life. Earlier transition to palliative care is necessary to avoid exposure to unnecessary drugs.
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| 32. |
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| 33. |
- Sandlund, Christina, et al.
(författare)
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Exploring home rehabilitation therapists’ experiences of supporting older persons to physical exercise after acute hospitalization : a qualitative interview study
- 2024
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Ingår i: European Geriatric Medicine. - 1878-7649 .- 1878-7657.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose After hospitalization, older persons may face a decline in physical function and daily independence. In-hospital exercise interventions can mitigate this decline, and continued support from primary healthcare post-discharge may enhance sustainability. This study aimed to explore home rehabilitation therapists’ experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay.Methods This qualitative study was conducted alongside a randomized-controlled trial to investigate prerequisites for a transitional care intervention. Twelve interviews were conducted with physiotherapists, occupational therapists, and managers across seven rehabilitation therapy services in Stockholm, Sweden. Data were analyzed using reflexive thematic analysis.Results The analysis generated the theme Striving for individualized support for physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. It was based on four subthemes: The starting point is always the patient's current needs, goals, and prerequisites, Continuing the exercise initiated during hospitalization by adapting it to the patient’s situation at home, Work premises not tailored to patients with complex care needs, and A home care organization that lacks coordination and unified purpose.Conclusions Interventions supporting older persons to physical exercise after acute hospitalization need to be tailored to the individual, support motivation, and be adapted to the patient’s home situation. Challenges may arise when care recourses lack alignment with the patients’ needs, and when the collaboration among care providers is limited. The findings contribute valuable insights for future studies incorporating transitional care interventions in similar context.
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| 34. |
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| 35. |
- Soulis, George, et al.
(författare)
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Geriatric care in European countries where geriatric medicine is still emerging
- 2020
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Practicing geriatric medicine is a challenging task since it involves working together with other medical doctors while coordinating a multidisciplinary team. Global Europe Initiative (GEI) group within the European Geriatric Medicine Society gathers geriatricians from different regions where geriatrics is underrepresented or still developing to promote initiatives for the advancement of geriatric medicine within these countries. Methods: Here we present a first effort to describe several aspects that affect practicing geriatric medicine in five different countries: Greece, Portugal, Russia, Turkey, and Tunisia. Results: We can notice discrepancies between countries concerning all dimensions of geriatrics (recognition, training, educational and professional standards, academic representation, working context). Conclusions: These differences correspond to the specificities of each country and set the frame where geriatric medicine is going to be developed across Europe. EuGMS with GEI group can provide useful support.
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| 36. |
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| 37. |
- van De Glind, Esther, et al.
(författare)
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Evidence-based medicine in geriatrics
- 2012
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Ingår i: European Geriatric Medicine. - Oxford, United Kingdom : Elsevier. - 1878-7649 .- 1878-7657. ; 3:Suppl. 1, s. S14-S15
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Tidskriftsartikel (refereegranskat)abstract
- Session Description/Moderator Details.– Evidence-based medicine in geriatrics Geriatric patients often have multiple chronic conditions, use many medications and may suffer from cognitive and functional impairments. A study about prevalence of morbidities in the elderly showed, that 82% of patients aged 65 and over had at least one chronic condition; 24% had even four or more conditions [1]. Due to deteriorating organ functions they are prone to medication-related side effects [2]. Considering these complex problems, arriving at the best treatment for individual older people is complicated.
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| 38. |
- Vandewoude, M., et al.
(författare)
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Healthy brain ageing and cognition : Nutritional factors
- 2016
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649 .- 1878-7657. ; 7:1, s. 77-85
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Forskningsöversikt (refereegranskat)abstract
- Nutritional factors can influence the risk of Alzheimer's disease and its rate of clinical progression, suggesting that the association between diet, nutrient status and cognitive function deserves more attention. The European Union Geriatric Medicine Society (EUGMS) working group "Healthy Brain Ageing and Cognition" supports the development of practical recommendations for nutritional strategy, focused predominantly on the preventive aspects of diet and nutrition on cognitive decline. Adopting a healthy lifestyle and avoiding nutritional deficiencies in young or midlife adults is essential and there is compelling evidence to justify recommending a Mediterranean diet as a way of achieving these goals. There is currently insufficient evidence to endorse the use of specific nutrients to promote healthy brain ageing. In addition, currently there is no generally applicable evidence to recommend the use of single-agent micronutrient supplementation at any stage of dementia or for prevention. Omega-3 fatty acids or specific medical foods may be considered for selected patients with early dementia. When signs of malnutrition are detected, correction of specific deficiencies is necessary to improve nutritional status. Individuals at risk of malnutrition should be advised to improve nutritional intake from dietary food sources and should avoid taking high doses of specific nutrients as supplements. Nutritional awareness, advice and intervention are important in the general management and follow-up of people with cognitive problems.
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| 39. |
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| 40. |
- Visser, M., et al.
(författare)
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Towards developing a Core Outcome Set for malnutrition intervention studies in older adults : a scoping review to identify frequently used research outcomes
- 2022
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Ingår i: European Geriatric Medicine. - : Springer Nature. - 1878-7649 .- 1878-7657. ; 13:4, s. 867-879
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Forskningsöversikt (refereegranskat)abstract
- PurposeTo conduct a scoping review to provide a systematic overview of outcomes used in nutritional intervention studies focused on the treatment of protein-energy malnutrition in older adults.MethodsA systematic search of four electronic databases (Medline, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) was performed to retrieve randomized controlled trials (RCTs), published until March 9, 2020, that evaluated the effect of nutritional interventions to treat protein-energy malnutrition in older adults and those at risk for malnutrition. Two authors screened titles, abstracts and full texts independently. One author extracted data that were cross-checked by another author.ResultsSixty-three articles reporting 60 RCTs were identified. Most frequently used outcomes included body weight/body mass index (75.0% of RCTs), dietary intake (61.7%), functional limitations (48.3%), handgrip strength (46.7%), and body circumference (40.0%). The frequencies differed by setting (community, hospital and long-term care). For some outcomes there was a preferred assessment method (e.g., Barthel index for functional limitations), while for other outcomes (e.g., functional performance) a much greater variation was observed.ConclusionA large variation in outcomes, not only across but also within settings, was identified in nutritional intervention studies in malnourished older adults and those at risk. Furthermore, for many outcomes there was a large variation in the used assessment method. These results highlight the need for developing a Core Outcome Set for malnutrition intervention studies in older adults to facilitate future meta-analyses that may enhance our understanding on the effectiveness of treatment.
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| 41. |
- Yoshimatsu, Yuli, et al.
(författare)
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The diagnosis of aspiration pneumonia in older persons : a systematic review
- 2022
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Ingår i: European Geriatric Medicine. - : Elsevier Masson. - 1878-7649 .- 1878-7657. ; 13:5, s. 1071-1080
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Forskningsöversikt (refereegranskat)abstract
- Purpose Community-acquired pneumonia (CAP) is highly common across the world. It is reported that over 90% of CAP in older adults may be due to aspiration. However, the diagnostic criteria for aspiration pneumonia (AP) have not been widely agreed. Is there a consensus on how to diagnose AP? What are the clinical features of patients being diagnosed with AP? We conducted a systematic review to answer these questions. Methods We performed a literature search in MEDLINE®, EMBASE, CINHAL, and Cochrane to review the steps taken toward diagnosing AP. Search terms for “aspiration pneumonia” and “aged” were used. Inclusion criteria were: original research, community-acquired AP, age ≥ 75 years old, acute hospital admission. Results A total of 10,716 reports were found. Following the removal of duplicates, 7601 were screened, 95 underwent full-text review, and 9 reports were included in the final analysis. Pneumonia was diagnosed using a combination of symptoms, inflammatory markers, and chest imaging findings in most studies. AP was defined as pneumonia with some relation to aspiration or dysphagia. Aspiration was inferred if there was witnessed or prior presumed aspiration, episodes of coughing on food or liquids, relevant underlying conditions, abnormalities on videofluoroscopy or water swallow test, and gravity-dependent distribution of shadows on chest imaging. Patients with AP were older, more frailer, and had more comorbidities than in non-AP. Conclusion There is a broad consensus on the clinical criteria to diagnose AP. It is a presumptive diagnosis with regards to patients’ general frailty rather than in relation to swallowing function itself.
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| 42. |
- Zazzara, Maria Beatrice, et al.
(författare)
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Adverse drug reactions in older adults : a narrative review of the literature
- 2021
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 12, s. 463-473
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Forskningsöversikt (refereegranskat)abstract
- Purpose Adverse drug reactions (ADRs) represent a common and potentially preventable cause of unplanned hospitalization, increasing morbidity, mortality, and healthcare costs. We aimed to review the classification and occurrence of ADRs in the older population, discuss the role of age as a risk factor, and identify interventions to prevent ADRs.Methods We performed a narrative scoping review of the literature to assess classification, occurrence, factors affecting ADRs, and possible strategies to identify and prevent ADRs.Results Adverse drug reactions (ADRs) are often classified as Type A and Type B reactions, based on dose and effect of the drugs and fatality of the reaction. More recently, other approaches have been proposed (i.e. Dose, Time and Susceptibility (DoTS) and EIDOS classifications). The frequency of ADRs varies depending on definitions, characteristics of the studied population, and settings. Their occurrence is often ascribed to commonly used drugs, including anticoagulants, antiplatelet agents, digoxin, insulin, and non-steroidal anti-inflammatory drugs. Age-related factors-changes in pharmacokinetics, multimorbidity, polypharmacy, and frailty-have been related to ADRs. Different approaches (i.e. medication review, software identifying potentially inappropriate prescription and drug interactions) have been suggested to prevent ADRs and proven to improve the quality of prescribing. However, consistent evidence on their effectiveness is still lacking. Few studies suggest that a comprehensive geriatric assessment, aimed at identifying individual risk factors, patients' needs, treatment priorities, and strategies for therapy optimization, is key for reducing ADRs.Conclusions Adverse drug reactions (ADRs) are a relevant health burden. The medical complexity that characterizes older patients requires a holistic approach to reduce the burden of ADRs in this population.
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| 43. |
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| 44. |
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| 45. |
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| 46. |
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| 47. |
- Ekdahl, Anne
(författare)
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How to promote better care of elderly patients with multi-morbidity in Europe: A Swedish example
- 2012
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Ingår i: EUROPEAN GERIATRIC MEDICINE. - : Elsevier Masson. - 1878-7649. ; 3:2, s. 103-106
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Tidskriftsartikel (refereegranskat)abstract
- How to improve the care of elderly patients with multi-morbidity, regardless of borders between medical specialities and professions, starting from the patients point of view and ending with a powerful policy document with impact on the political system. A document written by the Swedish Association of Geriatric Medicine, the Swedish Association of General Practice and the Swedish Association of Internal Medicine.
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| 48. |
- Gustafsson, Markus, et al.
(författare)
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Case managers’ experiences of their everyday practice
- 2013
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Ingår i: European Geriatric Medicine. - Venice : Elsevier Masson SAS. - 1878-7649.
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Konferensbidrag (refereegranskat)abstract
- Introduction.– Today, there is an interest in how Case Management (CM) should be designed to best suit the complex needs of the older people with multi-morbidity. Current research on CM has mainly focused on health care costs and consumption, but the results have been inconsistent and ranging from positive outcomes to no effect. To improve CM, there is need to investigate what mechanisms are important for a successful intervention. To advance this knowledge, there is a necessity for studies investigating the experiences of those practicing CM i.e. Case Managers. There might be unknown factors or interpersonal factors that can contribute to a CM intervention's success or failure. Therefore, the aim of this study was to explore the Case Managers’ experiences of their everyday practice. Methods.– The study design was qualitative and descriptive utilizing an ethnographic approach, consisting of participant observations, a focus group interview and individual interviews with nine Case Managers conducted during 2012/2013. The interviews were recorded and transcribed verbatim and then subjected to content analysis. Results.– Three main themes described Case Managers’ experience of their everyday practice: navigating the older person, working to improve the health care system and being the older persons advocate. Conclusions.– Findings from this study sheds light on the complexity of CM for older people with multi-morbidity, from the experiences of Case Managers. These findings could help in the development of CM models designed for older people with complex health needs.
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| 49. |
- Holmström, Alexandra, et al.
(författare)
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An integrated multiple marker modality is superior to NT-proBNP alone in prognostic prediction in all-cause mortality in a prospective cohort of elderly heart failure patients
- 2013
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:6, s. 365-371
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Tidskriftsartikel (refereegranskat)abstract
- Background: Identifying the individual mortality risk for elderly heart failure (HF) patients is challenging because of heterogeneity, comorbidity and higher age. To overcome this, an integrated multiple marker modality has been proposed for better prognostic prediction than a single variable, this has not been evaluated. Aim: The aim of this study is to identify whether a multiple marker modality is better than N-terminal pro-B-type natriuretic peptide (NT-proBNP) alone for all-cause mortality in elderly HF patients. Methods: A prospective cohort of 361 patients (65 +/- 15 years) referred for echocardiography because of suspected HF was studied, among them, 179 had HF (71 +/- 13). In this cohort blood sampling, electrocardiogram and clinical examinations were performed within approximately 24 hours after the echocardiography. To assess prognostic value of multiple marker modality for all-cause mortality, patients were followed up for 24 +/- 7 months. Results: In the three multivariate analyses, NT-proBNP, cystatin C, red blood cell distribution width (RDW), midregional pro-atrial natriuretic peptide (MR-proANP), pulmonary artery pressure, estimated glomerular filtration rate (eGFR) less than 60 mL/min, anemia, diuretics and sinus rhythm are prognostic predictors of all-cause mortality in elderly HF patients. When analyzing all these variables in one multivariate analysis, only NT-proBNP, eGFR less than 60 mL/min, anemia and diuretics are prognostic predictors of all-cause mortality in elderly HF patients. Two different multiple marker models incorporating NT-proBNP, clinical and laboratory variables were created. The sensitivity and specificity of the two different multiple marker modalities are higher than for NT-proBNP alone. The risk score based on multivariate analysis Wald X-2 values is preferred considering its simplicity and feasibility in daily clinical practice. Conclusion: A multiple marker modality was proven to improve prognostic prediction in elderly HF patients compared to NT-proBNP alone. (C) 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
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| 50. |
- Holmström, Alexandra, et al.
(författare)
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Levels of copeptin among elderly patients in relation to systolic heart failure and heart failure with normal ejection fraction
- 2013
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:3, s. 139-144
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Tidskriftsartikel (refereegranskat)abstract
- Background: High copeptin levels are linked to a poor prognosis in heart failure (HF). Studies of copeptin levels in elderly HF patients with normal left ventricular ejection fraction (HFNEF) have reported conflicting results. Aim: The aim is to study the relationship between copeptin levels and HF in the elderly. Methods: In a prospective cohort of 261 patients with a mean age of 70 +/- 11 years, referred for echocardiography due to suspected HF. Electrocardiography, blood sampling and clinical examination were performed within approximately 24 hours after echocardiography. The study group was categorised according to the following definitions: systolic HF (SHF) (39%), HFNEF (previously called diastolic HF) (19%), uncertain HFNEF (19%), where only symptoms and partial echocardiography signs supported the diagnosis and a group in which HF was excluded (Non-HF) (23%). Results: Copeptin levels were higher in patients with SHF and HFNEF compared with non-HF patients. Patients with uncertain HFNEF had similar copeptin levels as the non-HF group. Copeptin across quartiles was related to an increased proportion of SHF, low ejection fraction (LVEF), high pulmonary artery pressure (PA) (all P < 0.01), signs of increased preload (LVDD) (P < 0.05), and higher levels of a panel of biomarkers (P < 0.01), but not to the incidence of HFNEF. In a stepwise multiple linear regression analysis there was a positive relationship between copeptin and cystatin C, high-sensitivity troponin T (both P < 0.001) and male gender (P < 0.05). Conclusion: Copeptin levels are elevated in both SHF and HFNEF in the elderly but not in patients in whom the HFNEF diagnosis is based only on symptoms and partial echocardiography findings.
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