Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · May 2015
Orthostatic hypotension, orthostatic intolerance and frailty: The Irish Longitudinal Study on Aging-TILDA.
Because frailty may represent impaired response to physiological stress we explored the associations between frailty and orthostatic hypotension (OH), and orthostatic intolerance (OI). This study was based on a cross-sectional analysis of 5692 community dwelling adults aged 50 years and older included in wave 1 of the Irish Longitudinal Study on Aging. Frailty was assessed using both the phenotypic (FP) and frailty index (FI) models. ⋯ In fully adjusted models OI remained related to slowness and low muscle strength and to higher FI scores. These data suggest OI symptoms in older adults may reflect various important underlying health deficits, indicative of increasing levels of frailty. Further assessment of frailty in patients experiencing OI is a potential opportunity for early intervention to delay functional decline.
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Arch Gerontol Geriatr · Jan 2015
Randomized Controlled TrialEffects on healthcare utilization of case management for frail older people: a randomized controlled trial (RCT).
Various healthcare interventions have been launched targeting the growing population of older people. The objective of this study was to investigate the of a case management intervention for frail old people (aged 65+ years) effects on healthcare utilization. ⋯ The effect on ED visits not leading to hospitalization meant that those in the control group were more likely to visit the ED for reasons that did not require hospitalization, suggesting that they may have been less monitored than the intervention group. The intervention has the potential to reduce the burden on outpatient care and ED.
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Arch Gerontol Geriatr · Jan 2015
Comparative StudyComparison of five indices for prediction of adverse outcomes in hospitalised Mexican older adults: a cohort study.
The aim of this prospective study was to investigate the ability of five indices of risk stratification to predict functional decline and prolonged length of stay (LOS) in older Mexicans hospitalized in the acute care setting. A total of 254 patients aged ≥60 years were followed up. Risk indices were constructed from baseline data collected during the first 48h of ward admission, and included: Frailty Index (FI), Hospital Admission Risk Profile (HARP), Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie (SHERPA), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Charlson's Co-morbidity Index (CCI). ⋯ Indices generally showed high specificity values (most were >80%), although all indices lacked adequate sensitivity values for outcome prediction (<80%). Geriatricians could use information from FI, SHERPA, APACHE II, HARP to guide patient management decisions. However, given that all indices lacked accuracy of prediction, results should be interpreted with caution.
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Arch Gerontol Geriatr · Jan 2015
Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning.
Depressive symptoms and antidepressant use are associated with greater fall risk in older people. This prospective study investigated interactions between depressive symptoms, antidepressant use and physical and cognitive function measures in relation to injurious or multiple falls in a large sample of community-living older people. Four-hundred and eighty-eight community-dwelling older people aged 70 years and over, underwent a comprehensive psychological, cognitive and physiological assessment and were prospectively monitored for falls over a 12-month follow up period. ⋯ Fall risk increased with the number of risk factors present: i.e. by 55% in participants with any two risk factors (RR=1.55; 95% CI=1.17-2.04) and by 144% in participants with three or four risk factors (RR=2.44; 95% CI=1.75-3.43). The study findings indicate that higher depressive symptoms and antidepressant use predict falls over 12-months, independent of reduced executive and physical functioning. Treatment of depressive symptoms using non-pharmacological approaches should be considered as part of fall prevention programs, especially in populations at high risk of falls.