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Tests the effects associated with an integrated-intervention to advertise usage of sex along with reproductive : health care along with legal rights amid girls using afflictions within Ghana: a new quasi-experimental study protocol.
Diseases associated with mobility limitation and limb pain were more common in RC2 and FC2 than in the other clusters. Cardiovascular diseases and risk factors were more prevalent in RC3 and FC3. Among the frail a new cluster emerged, FC4, containing individuals with higher rates of cognitive and eye problems and a clearly poor health status. CONCLUSION This exploratory study may provide relevant information for the clinical management of older patients with multimorbidity, even though the chronic disease clusters identified were similar in robust and frail individuals.PURPOSE Since there is only limited evidence available for geriatric rehabilitation patients, this systematic review and meta-analysis aims to characterize the nutritional status in this population and its relationship with functionality. METHODS Eight databases were searched for full-text articles reporting baseline nutritional intake and status of adults ≥ 60 years in rehabilitation settings. Pooled estimates were calculated for prevalence of malnutrition and risk of malnutrition based on the Mini Nutritional Assessment (MNA) and for mean body mass index (BMI). Associations between nutritional status (MNA, MNA short form and BMI) and functional status (Barthel Index and Functional Independence Measure) and prevalence of sarcopenia were reviewed. RESULTS 62 out of 1717 references were eligible for inclusion. Pooled prevalence [95% confidence interval (CI)] of malnutrition and risk of malnutrition were 13 (5-20) % and 47 (40-54) %. Pooled estimate (95% CI) for BMI was 23.8 (23.2-24.5) kg/m2. Existing data suggest a risk for low protein and energy intake and vitamin D deficiency. Functional status differed widely. Seven out of ten studies reported significant associations between reduced nutritional status and reduced functionality, whilst two out of seven studies reported significant associations between higher BMI and functionality. Prevalence of sarcopenia was high with 40-76% in this population. CONCLUSIONS Although geriatric rehabilitation populations and settings were heterogeneous, a relevant percentage of geriatric rehabilitation patients were affected by a reduced nutritional status. Nutritional status was associated with decreased functionality. This emphasizes the need for screening for malnutrition and targeted nutritional intervention.PURPOSE Development and validation of a delirium risk assessment score. Predisposing risk factors for delirium were used, which are easily assessed at hospital admission without additional clinical or laboratory testing. METHODS A systematic literature search identified ten risk factors acute admission, alcohol use > 4 units/day, cognitive impairment, ADL impairment, age > 75 years, earlier delirium, hearing/vision problems, number of medication ≥ 5, number of morbidities > 2 and male. The DRAS was developed in a mixed patient population (N = 842) by the use of univariate and multivariate analyses and -2 log-likelihood calculation to weigh the risk factors. Based on the sensitivity and specificity, a cutoff score was calculated. The validation was performed in 3 cohorts (N = 408, N = 186, N = 365). In cohort 3, the DRAS was compared (AUC, sensitivity and specificity) to 3 instruments (Inouye, Kalisvaart, VMS rules). RESULTS The delirium incidence was 31.8%, 20.3%, 15.6% and 15.1%. All risk factors were independently predictive for delirium, except male. The multivariate analyses excluded morbidities. The final DRAS consists of 8 items; acute admission, cognitive impairment, alcohol use (3 points), ADLimpairment/mobilityproblems (2 points), higher age, earlier delirium, hearing/vision problems, and medication (1 point). The total score is 15 points and at a cut-of score of 5 or higher the patient is at risk of developing a delirium. The cutoff was at 5 or more points, AUC 0.76 (95% CI 0.72-0.79), sensitivity 0.77, specificity 0.60. Validation cohorts AUC was 0.75 (95% CI 0.96-0.81), 0.76 (95% CI 0.70-0.83) and 0.78 (95% CI 0.70-0.87), sensitivity 0.71, 0.67 and 0.89 and specificity 0.70, 0.72 and 0.60. The comparison revealed the highest AUC for the DRAS. CONCLUSION Based on an admission interview, the delirium risk can be easily evaluated using the DRAS shortlist score of predisposing risk factors for delirium in older inpatients.PURPOSE To assess the performance of peak expiratory flow (PEF) for sarcopenia screening in patients with chronic obstructive pulmonary disease (COPD), using the revised European Working Group on Sarcopenia in Older People (EWGSOP-2) criteria as the reference standard in pulmonary rehabilitation patients; and second, to study the factors associated with low PEF in this population. METHODS Diagnostic accuracy study conducted in consecutive community-dwelling COPD rehabilitation patients. Sensitivity, specificity, accuracy, likelihood ratios, predictive values, and area under the Receiver-Operating Characteristic curve were retrospectively calculated for PEF (index test) and compared with EWGSOP-2 criteria (reference standard). RESULTS Of 151 potentially eligible patients, 79 (67.5 ± 7.1 years; 78.8% men) fulfilled inclusion criteria and 10 (12.7%) had a diagnosis of sarcopenia. The PEF cut-off with highest accuracy (65.8%) was PEF ≤ 200 L/min (sensitivity 90%, specificity 62.3%, and positive and negative likelihood ratios 2.39 and 0.16, respectively). Airway obstruction and muscle mass were significantly associated with PEF ≤ 200 L/min. CONCLUSIONS Considering the EWGSOP-2 criteria as the reference standard, a cut-off of PEF ≤ 200 L/min showed only fair validity for detecting sarcopenia, so it cannot be recommended as a stand-alone screening tool in older rehabilitation patients with COPD.PURPOSE Fall-related injuries are a significant cause of morbidity, mortality and functional decline among older people. The aim of this study is to analyze the incidence of fall-related emergency department (ED) visits and compare the characteristics of single and recurrent fallers in a population-based sample. METHODS Consecutive patients aged ≥ 80 years and living in the Tampere city region who visited collaborative emergency department within a two-year study period (1 January 2015 to 31 December 2016) due to fall-related injury were included. The incidence of fall-related injuries and recurrent falls was calculated using population statistics. RESULTS A total of 6915 ≥ 80-year-old patients visited our ED 17,769 times during the study period. Thirteen percent of these visits (n = 2347, median 87 years, 80-103 years; 74% female) were fall-related. The incidence of fall-related ED visits increased from 94/1000 person-years to 171/1000 among those aged 80-89 years and ≥ 90 years, respectively. Twenty-four percent of patients had recurrent falls (range 2-5) during the observational period. Twenty-five percent of those discharged home had a subsequent fall-related injury within one month after the index visit. The distribution of diagnoses was similar among those with single and recurrent falls. CONCLUSION Fall-related injuries are a significant health issue. Almost one in eight of all ED visits were fall-related, and 24% of patients had recurrent fall-related injuries. The risk of subsequent injury was high during the first month after the first injury, emphasizing the need to intervene with the fall risk promptly.PURPOSE Personality disorder (PD) assessment in older adults is challenging. In geriatric medicine, older adults with multi-morbidity are treated for their somatic, psychogeriatric, functional and social complaints and the presence of a PD can be a complicating factor in this treatment. Therefore, this study evaluates the diagnostic accuracy of a PD screening instrument, the Gerontological Personality disorder Scale (GPS) in a Dutch geriatric medicine population. METHODS Using an informant-based personality questionnaire (HAP) as a reference criterion, the psychometric properties of the GPS-informant version were assessed in a sample of N = 160 (62 male) outpatients (mean age = 81.7). RESULTS The internal consistency of the GPS (total score), Cronbach's alpha, was α = 0.69. And the average inter-item correlation (total score) was 0.14. The test-retest reliability was rs = 0.68. The sensitivity and specificity for the GPS were 0.91 and 0.67, respectively. The GPS items showed predictive validity for PD status with 87.4% of predictions being accurate based on a logistic regression analysis. CONCLUSIONS This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs in Dutch geriatric medicine outpatients. Infigratinib supplier The GPS is an adequate screening tool for PDs in geriatric medicine, given the high sensitivity. The diagnostic accuracy of the GPS-informant version is fair to excellent.PURPOSE To find if there are differences in health, functional, nutritional and psychological status among residents with cognitive impairment (CI) depending on where they stay, in nursing homes (NH) or residential homes (RH), and depending on the level of CI. To find factors increasing the probability that the resident with CI stays in the NH compared to RH. DESIGN A cross-sectional survey of a country-representative sample of 23 LTCIs randomly selected from all six regions in Poland was conducted in 2015-2016. We included 455 residents with CI 214 recruited from 11 NHs and 241 from 12 RHs. Data were collected using the InterRAI-LTCF tool. The descriptive analysis and logistic regression models were used. RESULTS The NH residents more frequently had worse functional and nutritional status, and psychotic symptoms than RH ones, while they did not differ significantly in health status, frequency of behavioral problems and aggression. More advanced CI was associated with higher presence of functional disability (ADL, bowel and bladder incontinence), nutritional decline (BMI, swallowing problems, aspiration, pressure ulcers) and psychological problems (aggression, resistance to care, agitation, hallucinations and delusions). Nevertheless, the level of CI severity did not increase the chance to stay in NH compared to RH, but ADL dependency did (OR 1.52, 95% CI 1.31-1.76). CONCLUSION The level of CI is significantly associated with physical, psychological and nutritional functioning of residents and thus may have an impact on care needs. Therefore, it is very important to use CI assessments while referring to NH or RH, to ensure that patients with CI are placed in an appropriate facility, where they may receive optimal care.PURPOSE In response to the growing recognition of geriatric rehabilitation and to support healthcare providers which need strategies to support older people with frailty who have experienced functional decline, we developed a consensus statement about core principles and future priorities for geriatric rehabilitation. METHODS We used a three-stage approach to establish consensus-preparation, consensus and review. RESULTS The consensus statement is grouped under 11 headings from (1) "Definition of GR" to (11) "Effective strategies to develop GR in Europe", which define geriatric rehabilitation in a way that is compatible with existing service models across Europe. Additionally future goals around research and education are highlighted. CONCLUSION The definitions of the consensus statement can provide a starting point for those wishing to further develop geriatric rehabilitation in their jurisdiction and help to develop strategic alliances with other specialties, serving as a basis for a pan-European approach to geriatric rehabilitation.
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