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Sharifi F.,Tehran University of Medical Sciences | Najafi B.,Tehran University of Medical Sciences | Fakhrzadeh H.,Tehran University of Medical Sciences | Noroozian M.,Tehran University of Medical Sciences | And 11 more authors.
Archives of Iranian Medicine | Year: 2014

Background: Dementia is a disabling syndrome, which generally affects aged population more than any other age group. This syndrome has a growing prevalence and incidence worldwide. The prevalence and burden of this group of diseases in Iran have not been estimated in a community-based study yet. This paper aims to explain the systematic approach, data sources, research methodology, and statistical analysis that will be used to quantify the prevalence and burden of dementia at national and sub-national levels.Methods: This is the protocol of a secondary data study that explains the design and method of conducting the study. We will use several sources of data that will include a systematic review of articles and gray literature which have reported the prevalence or incidence of dementia and its uncertainty at national and sub-national levels in Iran, in addition to data about dementia-specific drug sales per each year at provincial levels, as well as data extracted from 23 million health insurance prescriptions over 8 years and some data from medical documents of Iranian Alzheimer’s Association members. The technical groups of National and Sub-national Burden of Disease will collect some covariate data, such as age and sex structure of population, urbanization status, mean years of schooling, plasma cholesterol, fasting plasma glucose, and systolic and diastolic blood pressure at provincial levels which will be used in our models. Two statistical models, namely spatio-temporal and hierarchical autoregressive models, will be used for interpolation and extrapolation of missing data.Conclusion: It seems that the study of national and sub-national burden of dementia could provide more accurate estimation of prevalence and burden of dementia in Iran with an acceptable level of uncertainty than the previous studies. © 2014, Academy of Medical Sciences of I.R. Iran. All rights reserved.

Sharifi F.,Tehran University of Medical Sciences | Fakhrzadeh H.,Tehran University of Medical Sciences | Memari A.,Kahrizak Charity Foundation | Najafi B.,Tehran University of Medical Sciences | And 10 more authors.
Archives of Gerontology and Geriatrics | Year: 2015

Background: Fall is one of the most important outcomes of geriatric medicine. The European Assessment System (EASY) Care Standard provides a tool for assessing the risk of the falls. We aimed to evaluate the validity of the Easy-Care risk of the falls (ECRF) sub-score among the residents of a large nursing home. Method: A longitudinal study was conducted within a maximum of 34 months following up for falling in Kahrizak Charity Foundation. At the baseline the demographic, mental status and the depression data of 194 subjects aged ≥60 was collected. The Easy-Care standard tools and Performance-Oriented Mobility Assessment (POMA) were also used for data collecting. The time, location, and cause of the falls were recorded immediately after each fall incident. The Correlation between POMA and ECRF scores and the factor analysis of ECRF were considered as the concurrent and construct validity respectively. The Factor affecting the fall occurrence was assessed using the Cox-regression model. Result: The mean age of the participants was 76.02 (SD 8.82). Fifty two individuals (27.3%) fell at least once during the mean 756 (SD 187)-day follow up. The Spearman correlation coefficient between ECRF and POMA scores was -0.458 (P< 0.01). Three components were detected in the factor analysis of the ECRF. In the univariate Cox-regression model, the hazard ratio was 1.04 (CI: 1.00-1.07) for each score increase of the ECRF. For the six-month follow-up, at the ECRF cut-off point two of eight, the sensitivity and specificity were calculated as 85.7% and 64.5% respectively. Conclusion: It seems that the ECRF is a valid tool for predicting the next 6 months' fall incidents in older adults. © 2015 Elsevier Ireland Ltd.

Lin S.-H.,Community Health Center | Philp I.,Hull and East Yorkshire NHS Hospitals Trust
Journal of Clinical Nursing | Year: 2015

Aims and objectives: To explore the health needs of older Aboriginal people, using a multidimensional instrument. The gender differences related to their health needs were also addressed. Background: Health status and life expectancy between Aborigines and non-Aborigines have been shown to differ. The investigation of the health needs of Aboriginal people is however scarce, particularly among the older adult population. There is a need to address unmet health needs and improve information on the health needs assessment of the older Aboriginal population. Design: A cross-sectional design was used. Methods: Aboriginal people aged 65 and over were randomly sampled to take part in the present study. A multidimensional instrument consisting of eight domains and three cross-domain categories was used to assess their health needs. Results: A group of older Aboriginal people was recruited (n = 90, mean age = 73·5). The top three identified needs were 'mental health and well-being', 'staying healthy' and 'social participation'. The female participants had statistically significant higher scores for the 'mental health and well-being', 'getting around' domains and in the 'risk of falls' than the male ones. A regression model demonstrated that the health need of 'looking after oneself' was associated with all cross-domain categories of health need, which are 'independence', 'risk of breakdown in care' and 'risk of falls'. Conclusions: The present study has revealed major health needs among older Aboriginal people and found that older female Aborigines have more health needs than older male Aborigines. Further study to identify effective approaches to address these needs among this group is warranted. Relevance to clinical practice: The findings can be used to identify effective approaches to addressing health needs among older Aboriginal people with a consideration of gender. Only then can resources be allocated and prioritised in a culturally sensitive and gender-specific manner nationally and globally. © 2015 John Wiley & Sons Ltd.

Philp I.,Hull and East Yorkshire NHS Hospitals Trust | Mills K.A.,1 Apley Park Mews | Thanvi B.,Integrated and Community Care | Ghosh K.,South Warwickshire NHS Foundation Trust | Long J.F.,Hull and East Yorkshire NHS Hospitals Trust
International Journal of Integrated Care | Year: 2013

Introduction: Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay amongst frail older people. In this study, we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions. Methods: We systematically searched the following databases: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified. Results: A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge. Conclusions: Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people.

Bwalya G.M.,Hull and East Yorkshire NHS Hospitals Trust | Srinivasan V.,Hull and East Yorkshire NHS Hospitals Trust | Wang M.,University of Leicester
Journal of ECT | Year: 2011

Objective: To review anesthesia practice patterns associated with electroconvulsive therapy (ECT) in the UK. Methods: A 12-item questionnaire survey on the practice of ECT anesthesia was sent to all units in the UK identified as providing ECT services. Results: One hundred thirty active ECT units were identified. Sixty-six (51%) responded. Forty-five percent of respondents worked in units located within acute hospital boundaries and 53% outside acute hospital boundaries. Forty-seven percent of respondents were associated with units providing consultant anesthetic cover for 75-100% of ECT sessions. Twenty-seven percent of the units did not use capnography, 17% did not use continuous electrocardiography, and 16% did not use noninvasive blood pressure monitoring. Limitations: Results were entirely from respondents. No practices were directly observed. Conclusions: Although there is apparent widespread recognition of ECT Accreditation Service guidelines, compliance with recommended standards is variable. Given the typically high comorbidity of ECT patients, and indications of elevated anesthetic risk from non-UK studies, this has important implications for the safety of ECT anesthesia in the UK. Copyright © 2011 by Lippincott Williams & Wilkins.

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