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Koczy P.,Robert Bosch GmbH | Becker C.,Robert Bosch GmbH | Rapp K.,Robert Bosch GmbH | Rapp K.,University of Ulm | And 9 more authors.
Journal of the American Geriatrics Society

Objective: To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes. Design: Cluster-randomized controlled trial. Setting: Forty-five nursing homes in Germany. Participants: Three hundred thirty-three residents who were being restrained at the start of the intervention. Intervention: Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints. Measurements: The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms. Results: The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05-4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG. Conclusion: The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication. © 2011 The American Geriatrics Society. Source

Van Houwelingen A.H.,Leiden University | Cameron I.D.,University of Sydney | Gussekloo J.,Leiden University | Putter H.,Leiden University | And 6 more authors.

Transitions between disability states in older people occur frequently. This study investigated predictors of disability transitions in the oldest old and was performed in the Leiden 85-plus study, a population-based prospective cohort study among 597 participants aged 85 years. At baseline (age 85 years), data on sociodemographic characteristics and chronic diseases were obtained. Disabilities in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured annually for 5 years with the Groningen Activities Restriction Scale (GARS). Mortality data were obtained. A statistical multi-state model was used to assess the risks of transitions between no disabilities, IADL disability, BADL disability, and death. At baseline, 299 participants (50.0%) were disabled in IADL only, and 155 participants (26.0%) were disabled in both BADL and IADL. During 5-year follow-up, 374 participants (62.6%) made >1 transition between disability states, mostly deterioration in disability. Males had a lower risk of deterioration [hazard ratio (HR), 0.75 (95% CI, 0.58-0.96)] compared to females. No gender differences were observed for improvement [HR, 0.64 (95% CI, 0.37-1.11)]. Participants with depressive symptoms were less likely to improve [HR, 0.50 (95% CI, 0.28-0.87)]. Participants with depressive symptoms [HR, 1.46 (95% CI, 1.12-1.91)], >1 chronic disease [HR, 1.60 (95% CI, 1.27-2.01)], and with cognitive impairment [HR, 1.60 (95% CI, 1.20-2.13)] had the highest risk of deteriorating. Disability is a dynamic process in the oldest old. Deterioration is more common than improvement. Older men are less likely to deteriorate than women. The presence of depressive symptoms, chronic disease, and cognitive impairment predicts deterioration. © American Aging Association 2013. Source

Villani A.M.,Flinders University | Crotty M.,Flinders University | Cameron I.D.,University of Sydney | Kurrle S.E.,Hornsby Ku ring gai Health Service | And 4 more authors.
Age and Ageing

Background: accurate and practical assessment methods for assessing appendicular skeletal muscle (ASM) is of clinical importance for the diagnosis of geriatric syndromes associated with skeletal muscle wasting. Objectives: the purpose of this study was to develop and cross-validate novel anthropometric prediction equations for the estimate of ASM in older adults post-surgical fixation for hip fracture, using dual-energy X-ray absorptiometry (DEXA) as the criterion measure. Subjects: community-dwelling older adults (aged ≥65 years) recently hospitalised for hip fracture. Setting: participants were recruited from hospital in the acute phase of recovery. Design: validation measurement study. Measurements: a total of 79 hip fracture patients were involved in the development of the regression models (MD group). A further 64 hip fracture patients also recruited in the early phase of recovery were used in the cross-validation of the regression models (CV group). Multiple linear regression analyses were undertaken in the MD group to identify the best performing prediction models. The linear coefficient of determination (R2) in addition to the standard error of the estimate (SEE) were calculated to determine the best performing model. Agreement between estimated ASM and ASMDEXA in the CV group was assessed using paired t-tests with the 95% limits of agreement (LOA) assessed using Bland-Altman analyses. Results: the mean age of all the participants was 82.1 ± 7.3 years. The best two prediction models are presented as follows: ASMPRED-EQUATION_1: 22.28 - (0.069 * age) + (0.407 * weight) - (0.807 * BMI) - (0.222 *MAC) (adjusted R2: 0.76; SEE: 1.80kg); ASMPRED-EQUATION_2: 16.77 - (0.036 * age) + (0.385 * weight) - (0.873 * BMI) (adjusted R2: 0.73; SEE: 1.90kg). The mean bias from the CV group between ASMDEXA and the predictive equations is as follows: ASMDEXA - ASMPREDEQUATION_ 1: 0.29 ± 2.6kg (LOA: -4.80, 5.40kg); ASMDEXA - ASMPRED-EQUATION_2: 0.13 ± 2.5kg (LOA: -4.77, 5.0kg). No significant difference was observed between measured ASMDEXA and estimated ASM (ASMDEXA: 16.4 ± 3.9kg; ASMPRED-EQUATION_1: 16.7 ± 3.2kg (P = 0.379); ASMPRED-EQUATION_2: 16.6 ± 3.2kg (P = 0.670)). Conclusions: we have developed and cross-validated novel anthropometric prediction equations against DEXA for the estimate of ASM designed for application in older orthopaedic patients. Our equation may be of use as an alternative to DEXA in the diagnosis of skeletal muscle wasting syndromes. Further validation studies are required to determine the clinical utility of our equation across other settings, including hip fracture patients admitted from residential care, and also with a longer-term follow-up. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. Source

Cameron I.D.,University of Sydney | Kurrle S.E.,Hornsby Ku ring gai Health Service | Uy C.,Hornsby Ku ring gai Health Service | Lockwood K.A.,Hornsby Ku ring gai Health Service | And 2 more authors.
BMC Geriatrics

Background: Malnutrition is a problem for many older people recovering from a hip and other major fractures. Oral supplementation with high calorie high protein nutrients is a simple intervention that may help older people with fractures to improve their recovery in terms of rehabilitation time, length of hospital stay and mortality. This paper reports a pilot study to test the feasibility of a trial initiated in a hospital setting with an oral supplement to older people with recent fractures. Method. A randomized controlled trial with 44 undernourished participants admitted to a hospital following a fracture. The intervention group (n = 23) received a high calorie high protein supplement for forty days in addition to their diet of choice. The control group (n = 21) received high protein milk during their hospital stay in addition to their diet of choice and their usual diet when discharged from hospital. Results: All participants were women and their mean age was 85.3 ( 6.1) years. Twenty nine (65%) participants had a hip fracture. At baseline no differences were measured between the two groups regarding their nutritional status, their cognitive ability or their abilities in activities of daily living. There were no significant differences between the intervention and control group with reference to nutritional or functional parameters at 40 day and 4 month follow-ups. Median length of stay in hospital was 18.0 days, with 12 participants being readmitted for a median of 7.0 days. Conclusion: It is feasible to perform a randomised trial in a hospital and community setting to test the effect of an oral high energy high protein supplement for older people. Due to the limited number of participants and incomplete adherence with use of the supplements no conclusion can be drawn about the efficacy or effectiveness of this intervention. © 2011 Cameron et al; licensee BioMed Central Ltd. Source

Gunewardene R.,Hornsby Ku ring gai Health Service | Lampe L.,Hornsby Ku ring gai Health Service | Lampe L.,University of Sydney | Ilchef R.,University of Sydney
Australasian Psychiatry

Objective: Psychiatric populations may be particularly at risk of hepatitis C (HCV), less likely to receive appropriate interventions and at greater risk of liver damage due to comorbid substance abuse. This study sought to determine the prevalence of HCV in two inpatient psychiatric populations of seriously mentally ill patients and the relationship to risk factor screening. Method: Two inpatient units were chosen in similar socio-economic areas. Persons admitted to these wards over the course of the study were invited to participate and provided with pre-test counselling. Where informed consent was obtained, individuals were included in the study. It was planned to screen all consenting patients. However, funding was reduced for one site meaning that only patients with identified risk factors could be screened there. Results: Around 18% of psychiatric inpatients admitted to risk factors for HCV. The prevalence of HCV with screening of all consenting patients in unit A was 3.2%. With selective screening in unit B, 41.7% of those with identified risk factors tested positive. These results compare to the Australian community rate of approximately 1.1%. Conclusion: Results are consistent with elevated rates of HCV in mentally ill populations elsewhere in the world, and provide support for selective screening. © 2010 The Royal Australian and New Zealand College of Psychiatrists. Source

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