The impact of functional limitations on disability and the moderating effects of psychological attributes in community-dwelling older persons

1998 ◽  
Author(s):  
G. I. J. M. Kempen ◽  
M. J. G. van Heuvelen ◽  
E. van Sonderen ◽  
R. H. S. van den Brink ◽  
A. C. Kooijman ◽  
...  
Keyword(s):  
Older Persons ◽  
Functional Limitations ◽  
Community Dwelling ◽  
Moderating Effects ◽  
Psychological Attributes ◽  
The Impact

The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons

1999 ◽  
Vol 48 (9) ◽  
pp. 1161-1172 ◽  
Author(s):  
Gertrudis I.J.M Kempen ◽  
Marieke J.G van Heuvelen ◽  
Eric van Sonderen ◽  
Rob H.S van den Brink ◽  
Aart C Kooijman ◽  
...  
Keyword(s):  
Older Persons ◽  
Functional Limitations ◽  
Community Dwelling ◽  
Moderating Effects ◽  
Psychological Attributes ◽  
Relationship Of ◽  
The Relationship

scholarly journals Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
A. Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Older Persons ◽  
Hospital Admissions ◽  
Community Dwelling ◽  
Trial Registration ◽  
Significant Finding ◽  
Complex Needs ◽  
Primary Practice ◽  
The Impact ◽  
Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

scholarly journals The Impact of a Submaximal Level of Exercise on Balance Performance in Older Persons

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Hani Asilah Alias ◽  
Maria Justine
Keyword(s):  
Sensory Integration ◽  
Older Persons ◽  
Community Dwelling ◽  
Rank Test ◽  
Clinical Test ◽  
Older Individuals ◽  
Balance Performance ◽  
Eyes Closed ◽  
Soft Surface ◽  
The Impact

Objective. The purpose of this study was to determine the impact of a submaximal level of exercise on balance performance under a variety of conditions.Material and Method. Thirteen community-dwelling older persons with intact foot sensation (age = 66.69 ± 8.17 years, BMI = 24.65 ± 4.08 kg/m2, female,n=6) volunteered to participate. Subjects’ balance performances were measured using the Modified Clinical Test of Sensory Integration of Balance (mCTSIB) at baseline and after test, under four conditions of stance: (1) eyes-opened firm-surface (EOF), (2) eyes-closed firm-surface (ECF), (3) eyes-opened soft-surface (EOS), and (4) eyes-closed soft-surface (ECS). The 6-minute walk test (6MWT) protocol was used to induce the submaximal level of exercise. Data was analyzed using the Wilcoxon Signed-Rank Test.Results. Balance changes during EOF (z=0.00,P=1.00) and ECF (z=-1.342,P=0.180) were not significant. However, balance changes during EOS (z=-2.314,P=0.021) and ECS (z=-3.089,P=0.02) were significantly dropped after the 6MWT.Conclusion. A submaximal level of exercise may influence sensory integration that in turn affects balance performance, particularly on an unstable surface. Rehabilitation should focus on designing intervention that may improve sensory integration among older individuals with balance deterioration in order to encourage functional activities.

scholarly journals 306Association between polypharmacy and mortality in the community-dwelling older population: a data linkage study

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Johan Van der Heyden ◽  
Finaba Berete ◽  
Brecht Devleesschauwer ◽  
Karin De Ridder ◽  
Olivier Bruyère ◽  
...  
Keyword(s):  
Older People ◽  
Functional Limitations ◽  
Critical Evaluation ◽  
Community Dwelling ◽  
Health Care Use ◽  
Mortality Data ◽  
Health Interview Survey ◽  
Health Interview ◽  
Interview Survey ◽  
The Impact

Abstract Background Literature findings on the association between polypharmacy and mortality in older people are not consistent. Appropriate tools, making use of linkages, are helpful to investigate this further. Methods Data of participants of the Belgian Health Interview Survey 2013 aged ≥ 65 years (n = 1950) were linked with billing data and 5 year’s mortality follow-up information. Polypharmacy was defined as concomitant use of ≥ 5 medicines in the past 24 hours or ≥ 5 recent prescriptions of reimbursed medicines. The impact of polypharmacy on mortality was assessed through mortality rate ratios (MRR) from a Poisson regression model adjusting for gender, age, multimorbidity, functional limitations and health care use, and including interactions. Results The prevalence of polypharmacy was 38,3%. Age and disability status were effect modifiers in the association between polypharmacy and mortality. Whereas polypharmacy was significantly associated with mortality among people aged 65-79 years (MRR 2.52; 95% CI 1.67-3.80), this was not so for the 80 + (MRR 1.46; 95% CI 0.93-2.29). Polypharmacy was a mortality predictor among people with no/moderate functional limitations (MRR 2,29; 95% CI 1.61-3.25), but not for those with severe functional limitations (MRR 1,22; 95% CI 0.67-2.34). Conclusions By linking health interview survey, billing and mortality data further insights can be gained on the association between polypharmacy and mortality. Key messages A critical evaluation of polypharmacy in older people below 80 years and in people without severe functional limitations may reduce mortality in these population groups.

scholarly journals Responses and Interventions to Delusions Experienced by Community-Dwelling Older Persons With Dementia

2021 ◽  
pp. 089198872110429
Author(s):  
Jiska Cohen-Mansfield ◽  
Hava Golander
Keyword(s):  
Family Caregivers ◽  
Relative Frequency ◽  
Older Persons ◽  
Community Setting ◽  
Community Dwelling ◽  
Structured Interviews ◽  
Guidance Programs ◽  
The Impact ◽  
Qualitative Analyses

We examined how family caregivers react, and what interventions they use in response to delusions exhibited by relatives with dementia in a community setting. Structured interviews were conducted with 68 family caregivers whose relatives were described as experiencing delusions based on the BEHAVE-AD or the NPI. Quantitatively, we cross-tabulated the type of response to delusion by the type of person providing the response and by the type of delusion manifested. Qualitatively, we analyzed open-ended responses to understand the types of caregivers’ responses to delusions, the contextual circumstances, and the impact of the responses. Caregiver responses to delusions included “Explaining that the delusion was wrong” (34% of responses), “Trying to calm down” (27%), “Agreeing with the delusion” (13%), “Distracting” (12%), and “Ignoring” (10%). Responses including “Anger, yelling or scolding,” were rare. The vast majority of reactions were by family caregivers of the persons with dementia. The relative frequency of the type of reaction tended to be consistent across delusion types. The qualitative analyses added some categories of reactions, but mostly highlighted issues to be considered when examining responses and their efficacy, including the use of multiple responses, and the manner and mood in which responses are conveyed. To cope with delusions, family caregivers develop intuitive intervention techniques. Understanding those interventions and reactions by caregivers and their relative efficacy can inform guidance programs for family caregivers. Improved support for family caregivers has the potential to positively influence the behavior of caregivers and older adults with dementia and improve their respective quality of life.

La douleur arthritique, les limites et les incapacités fonctionnelles chez les personnes âgées

2006 ◽  
Vol 25 (4) ◽  
pp. 401-412
Author(s):  
Paul Bourque ◽  
Joëlle Dionne ◽  
Sarah Pakzad ◽  
Dolores Pushkar ◽  
François Béland
Keyword(s):  
Older Persons ◽  
Functional Limitations ◽  
Perceived Health ◽  
Chronic Illnesses ◽  
Personnes Âgées ◽  
Gender Education ◽  
French Speaking ◽  
The Impact

ABSTRACTThe impact of arthritic pain, depression, and perceived health on functional limitations and disability in older persons is not clear. This study investigated the role of arthritic pain in functional limitations and disability in older persons. The sample consisted of 1,211 French-speaking persons aged 65 or older. Approximately 32 per cent of the subjects reported having arthritic pain, of whom 13 per cent reported considerable functional limitations. The results show that arthritic pain, age, gender, education, chronic illnesses, perceived health, and depression explained 28 per cent of the variance in functional limitations and 30 per cent of the variance in disability. The present results have implications for the prevention and management of functional limitations and disability in older persons.

scholarly journals Kidney function and other factors and their association with falls

2020 ◽  
Vol 20 (S1) ◽  
Author(s):  
Sabine Britting ◽  
◽  
Rada Artzi-Medvedik ◽  
Paolo Fabbietti ◽  
Lisanne Tap ◽  
...  
Keyword(s):  
Kidney Function ◽  
Older Persons ◽  
Community Dwelling ◽  
Health Concern ◽  
Cross Sectional ◽  
Link Type ◽  
Injurious Falls ◽  
Increased Risk ◽  
Risk Of Falls ◽  
The Impact

Abstract Background Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls. Methods The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving community-dwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment. The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUTS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects. Results Our series consisted of 2256 SCOPE participants (median age = 79.5 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment. CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79–1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81–1.28 for eGFR< 45; OR = 1.08, 95%CI = 0.74–1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67–1.24 for eGFR< 60; OR = 0.93, 95%CI = 0.63–1.37 for eGFR< 45; OR = 1.19, 95%CI = 0.62–2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 1.56, 95%CI = 1.29–1.89) and injurious falls (OR = 1.58, 95%CI = 1.14–2.19), and such associations were confirmed in all multivariable models. Conclusions Cross-sectional data suggest that CKD may not be associated with history of falls or injurious falls, whereas LUTS is significantly associated with the outcomes. Trial registration This study was registered on 25th February 2016 at clinicaltrials.gov (NCT02691546).

Changes in depressive symptoms and functional disability among community-dwelling depressive older adults

2012 ◽  
Vol 24 (10) ◽  
pp. 1633-1641 ◽  
Author(s):  
Ma Shwe Zin Nyunt ◽  
May Li Lim ◽  
Keng Bee Yap ◽  
Tze Pin Ng
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Functional Ability ◽  
Older Persons ◽  
Functional Disability ◽  
Depression Scale ◽  
Community Dwelling ◽  
Baseline Score ◽  
Change Scores ◽  
The Impact

ABSTRACTBackground: Previous studies have shown that the presence of depressive symptoms among older persons was evidently associated with subsequent physical and functional decline. However, few studies have directly examined the impact of changes in depressive symptoms or depressed mood on changes in functional ability. The present prospective study examined whether changes in the levels and remission of depressive symptoms were associated with changes in functional ability among community-living older persons who were treated for depressive symptoms in a primary care setting.Methods: Older persons aged 60 and above with depressive symptoms (N = 267) were followed up in a primary care treatment program over 12 months. Geriatric Depression Scale (GDS-15), and instrumental and basic activities of daily living (IADL and ADL) were measured at baseline and at 12-month follow-up. The associations of GDS change scores and conversion to non-depressed status with ADL and IADL change scores, controlling for baseline covariates including chronic medical comorbidity and Mini-Mental State Examination (MMSE), were examined in multiple regression analyses.Results: An improvement in GDS scores (baseline score minus 12-month score) was significantly associated with improvement (12-month score minus baseline score) in ADL (β = 0.355, p < 0.001) and IADL scores (β = 0.165, p = 0.018) after adjusting for baseline functional status, MMSE, chronic medical comorbidities, and other variables. In particular, conversion in GDS status to “non-depressive” state (GDS ≤4) was associated with an improvement in ADL change scores (β = 0.281, p = 0.019).Conclusion: In depressed older persons, an improvement in depressive symptoms was associated with improved functional ability.

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