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Jorunn L Helbostad - One of the best experts on this subject based on the ideXlab platform.

  • the long term effect of comprehensive Geriatric Care on gait after hip fracture the trondheim hip fracture trial a randomised controlled trial
    Osteoporosis International, 2016
    Co-Authors: Pernille Thingstad, Olav Sletvold, Kristin Taraldsen, Ingvild Saltvedt, Beatrix Vereijken, Sarah E Lamb, Jorunn L Helbostad
    Abstract:

    At present, most hip fracture patients are treated in orthopaedic wards. This study showed that a relatively short hospital intervention based on principles of comprehensive Geriatric assessment resulted in safer and more efficient gait as long as 1 year following the fracture as compared to conventional orthopaedic treatment. Hip fracture patients are frail, and the fracture is usually followed by substantial decline in gait function. Few studies have assessed gait characteristics other than gait speed and knowledge about the effect of early intervention on long-term gait outcome is sparse. The purpose of this study was to evaluate the long-term effect of pre- and post-surgery Comprehensive Geriatric Care (CGC) on ability to walk, self-reported mobility and gait characteristics in hip fracture patients. Two armed, parallel group randomised controlled trial comparing CGC to conventional Orthopaedic Care (OC) in pre- and early post-surgery phase. Hip fracture patients (n = 397), community-dwelling, age >70 years and able to walk at time of the fracture were included. Spatial and temporal gait characteristics were collected using an instrumented walkway (GAITRite® system) 4 and 12 months post-surgery. Participants who received CGC had significantly higher gait speed, less asymmetry, better gait control and more efficient gait patterns, more participants were able to walk and participants reported better mobility 4 and 12 months following the fracture as compared to participants receiving OC. Pre- and post-surgery CGC showed an effect on gait as long as 1 year after hip fracture. These findings underscore the importance of targeting the vulnerability of these patients at an early stage to prevent gait decline in the long run. As presently, most hip fracture patients are treated in orthopaedic wards with larger focus on the fracture than on frailty, these results are important to inform new models for hip fracture Care.

  • comprehensive Geriatric Care for patients with hip fractures a prospective randomised controlled trial
    The Lancet, 2015
    Co-Authors: Anders Prestmo, Gunhild Hagen, Olav Sletvold, Jorunn L Helbostad, Pernille Thingstad, Kristin Taraldsen, Stian Lydersen, Vidar Halsteinli, Turi Saltnes
    Abstract:

    Summary Background Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive Geriatric Care in a dedicated Geriatric ward versus the usual orthopaedic Care. Methods We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive Geriatric Care or orthopaedic Care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the Care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. Findings We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive Geriatric Care and 199 to orthopaedic Care. At 4 months, 174 patients remained in the comprehensive Geriatric Care group and 170 in the orthopaedic Care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive Geriatric Care and 4·38 (SE 0·20) for orthopaedic Care (between-group difference 0·74, 95% CI 0·18–1·30, p=0·010). Interpretation Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive Geriatric Care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic Care. The results suggest that the treatment of older patients with hip fractures should be organised as orthoGeriatric Care. Funding Norwegian Research Council, Central Norway Regional Health Authority, St Olav Hospital Trust and Fund for Research and Innovation, Liaison Committee between Central Norway Regional Health Authority and the Norwegian University of Science and Technology, the Department of Neuroscience at the Norwegian University of Science and Technology, Foundation for Scientific and Industrial Research at the Norwegian Institute of Technology (SINTEF), and the Municipality of Trondheim.

  • physical behavior and function early after hip fracture surgery in patients receiving comprehensive Geriatric Care or orthopedic Care a randomized controlled trial
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2014
    Co-Authors: Kristin Taraldsen, Olav Sletvold, Pernille Thingstad, Stian Lydersen, Ingvild Saltvedt, M H Granat, Jorunn L Helbostad
    Abstract:

    Physical activity refers to what you actually do during a day. Physical activity changes with increasing age and functional level, as following injuries or diseases. For older persons the link between physical activity and function is important, where living a physically active life will be important for independence in daily life activities. Older persons with mobility limitations could be at risk of further functional declines because of their low levels of physical activity. Thus, after periods of bed-rest caused by disease or surgeries, physical activity would be extra important.Physical activity over longer periods can now be measured by use of small, wearable, accelerometer-based activity monitors. This enables collection of objective information about how physically active older persons actually are during their daily life. Activity monitors have typically been developed and validated in younger and healthy samples. Thus, before taken into use in older persons and older persons with mobility limitations both in clinical research and in practice, assessment of reliability and validity of these methods are needed.The aim of this thesis, which includes one literature review, two method studies and one clinical study, was fourfold;1) to systematically review the literature on physical activity variables derived from bodyworn sensors during long term monitoring in healthy and in-Care older persons;2) to assess accuracy of single-axis accelerometer-based activity monitors in recognizing postures and transitions and counting steps compared to video recordings, in different samples of older patients: in the acute phase after a stroke, following a hip fracture, and in a Geriatric hospital ward, compared to healthy younger adults;3) to evaluate the precision of estimated upright time during the day in hip-fracture patients, using different numbers and combinations of recording days; and4) to assess if there are differences in time in upright position the 4th day after surgery between hip-fracture patients treated with comprehensive Geriatric Care as compared to orthopedic Care, and secondary to assess differences in upright events, lower extremity function, and need for help during ambulation.The systematic literature search revealed 134 studies with different outcomes from activity monitoring for older healthy persons and patient groups. There were large inter-study variability in activity outcomes and great variety in activity monitoring methods, which makes it difficult to compare results across studies and populations.The studies on validation of physical activity monitoring in older people with mobility limitations demonstrated very good accuracy for the outcomes upright time and number of transitions from sitting to standing, but inaccuracy for step counts during walking, especially at low gait speeds. Furthermore, we found upright time in older hip-fracture patients to vary largely between persons and days. Based on the results, we suggest that activity monitoring should be performed for a minimum of four days in order to give a valid estimate of upright time during a week. Studying physical activity early after a hip fracture, we found more upright time and better physical function in patients treated with comprehensive Geriatric Care in a Geriatric ward compared to orthopedic Care in an orthopedic ward, suggesting that mobilization should be part of a systematic approach when treating older persons after hip fracture.This thesis provides new knowledge about physical activity in older persons, particularly in older persons with mobility limitations. It pinpoints the need for reliable outcomes and that reliability needs to be assessed in this particular population. Results from this thesis also highlight that physical activity should be included in caring models. Based on the results of physical activity in hip fracture patients early after surgery, the suggestion is to make the most out of daily life activities in order to increase physical activity. Physical activity in older persons early after hip fracture is dependent of the settings where it is being performed. Development of treatment models where systematical approaches for physical activity are included in treatment procedures is therefore warranted.Activity monitoring is a relative new field of research. The results from this thesis demonstrate the need for consensus on methodological aspects related to activity monitoring, including outcome measures when used in older persons.

Richard J Gelles - One of the best experts on this subject based on the ideXlab platform.

  • screening and detection of elder abuse research opportunities and lessons learned from emergency Geriatric Care intimate partner violence and child abuse
    Journal of Elder Abuse & Neglect, 2016
    Co-Authors: Scott R Beach, Chris Carpenter, Tony Rosen, Phyllis W Sharps, Richard J Gelles
    Abstract:

    ABSTRACTThis article provides an overview of elder abuse screening and detection methods for community-dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency Geriatric Care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The article provides descriptions of emerging screening and detection methods and technologies from the emergency Geriatric Care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, Caregivers, providers, and the health Care system, and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among ke...

  • screening and detection of elder abuse research opportunities and lessons learned from emergency Geriatric Care intimate partner violence and child abuse
    Journal of Elder Abuse & Neglect, 2016
    Co-Authors: Scott R Beach, Chris Carpenter, Tony Rosen, Phyllis W Sharps, Richard J Gelles
    Abstract:

    This article provides an overview of elder abuse screening and detection methods for community-dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency Geriatric Care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The article provides descriptions of emerging screening and detection methods and technologies from the emergency Geriatric Care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, Caregivers, providers, and the health Care system, and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among key stakeholders should also be conducted.

Gabriele Meyer - One of the best experts on this subject based on the ideXlab platform.

  • development of an international classification of functioning disability and health icf based standard set to describe the impact of joint contractures on participation of older individuals in Geriatric Care settings
    Archives of Gerontology and Geriatrics, 2015
    Co-Authors: Gabriele Meyer, Gabriele Bartoszek, Uli Fischer, Stephan Clarmann Von Clarenau, Eva Grill, W Mau, Ralf Strobl, Rudiger Thiesemann
    Abstract:

    Abstract Introduction Joint contractures are characterized as impairment of the physiological movement of joints due to deformity, disuse or pain and have major impact especially for older individuals in Geriatric Care. Some measures for the assessment of the impact of joint contractures exist. However, there is no consensus on which aspects should constantly be measured. Our objective was to develop a standard-set based on the ICF for describing functioning and disability in older individuals with joint contractures in Geriatric Care settings, giving special emphasis to activities and participation. Methods The ICF-based standard set was developed in a formal decision-making and consensus process and based on an adapted version of the protocol to develop ICF Core Sets. These are sets of categories from the ICF, serving as standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. Results Twenty-three experts from Germany and Switzerland selected 105 categories of the ICF component Activities and Participation for the ICF-based standard set. The largest number of categories was selected from the chapter Mobility (50 categories, 47.6%). Conclusions The standard set for older individuals with joint contractures provides health professionals with a standard for describing patients’ activity limitations and participation restrictions. The standard set also provides a common basis for the development of patient-centered measures and intervention programs. The preliminary version of the ICF-based standard set will be tested in subsequent studies with regard to its psychometric properties.

  • Attitudes of nurses towards the use of physical restraints in Geriatric Care: a systematic review of qualitative and quantitative studies.
    International journal of nursing studies, 2013
    Co-Authors: Ralph Möhler, Gabriele Meyer
    Abstract:

    Abstract Objectives To examine nurses' attitudes towards the use of physical restraints in Geriatric Care. Design Systematic review and synthesis of qualitative and quantitative studies. Data sources The following databases were searched: Medline, CINAHL, EMBASE, Psyndex, PsychInfo, Social SciSearch, SciSearch, Forum Qualitative Social Research (1/1990 to 8/2013). We performed backward and forward citation tracking to all of the included studies. Review methods We included in the present review all qualitative and quantitative studies in English and German that investigated nurses' attitudes towards the use of physical restraints in Geriatric Care. Two independent reviewers selected the studies for inclusion and assessed the study quality. We performed a thematic synthesis for the qualitative studies and a content analysis of the questionnaires' items as well as a narrative synthesis for the quantitative surveys. Results We included 31 publications in the review: 20 quantitative surveys, 10 qualitative and 1 mixed-method study. In the qualitative studies, nurses' attitudes towards the use of physical restraints in Geriatric Care were predominately characterised by negative feelings towards the use of restraints; however, the nurses also described a perceived need for using restraints in clinical practice. This discrepancy led to moral conflicts, and nurses described several strategies for coping with these conflicts when restraints were used. When nurses were in doubt regarding the use of restraints, they decided predominantly in favour of using restraints. The results of the quantitative surveys were inconsistent regarding nurses' feelings towards the use of restraints in Geriatric Care. Prevention of falls was identified as a primary reason for using restraints. However, the items of the questionnaires focussed primarily on the reasons for the use of restraints rather than on the attitudes of nurses. Conclusions Despite the lack of evidence regarding the benefits of restraints and the evidence on the adverse effects, nurses often decided in favour of using restraints when in doubt and they used strategies to cope with negative feelings when they used restraints. A clear policy change in Geriatric Care institutions towards restraint-free Care seems to be warranted to change clinical practice. The results of this review should also be considered in the development of interventions aimed at reducing the use of restraints.

  • interventions for preventing and reducing the use of physical restraints in long term Geriatric Care
    Cochrane Database of Systematic Reviews, 2011
    Co-Authors: Ralph Möhler, Tanja Richter, Sascha Kopke, Gabriele Meyer
    Abstract:

    Background Physical restraints (PR) are commonly used in Geriatric long-term Care. Restraint-free Care should be the aim of high quality nursing Care. Objectives To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people who require long-term nursing Care (either in community nursing Care or in residential Care facilities). Search methods The Cochrane Dementia and Cognitive Improvement Group’s Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, a number of trial registers and grey literature sources were searched on 7 September 2009. The following search terms were used: "physical restraint*", bedrail*, bedchair*, "containment measure*, elderly, "old people", Geriatric*, aged, "nursing home*", "Care home*", "Geriatric Care", "residential facilit*". Selection criteria Individual or cluster-randomised controlled trials comparing an intervention aimed at reducing the use of physical restraints with usual Care in long-term Geriatric Care settings. Data collection and analysis Two reviewers independently assessed the retrieved articles for relevance and methodological quality and extracted data. Critical appraisal of studies addressed risk of bias through selection bias, performance bias, attrition bias, and detection bias, as well as critera related to cluster designa. We contacted study authors for additional information where necessary. PR were defined heterogeneously throughout the studies. Not all studies offered sufficient data for aggregated data meta-analysis, and therefore study results are presented in a narrative form. Main results Five cluster-randomised controlled studies met the inclusion criteria. All of them investigated educational approaches. Two studies offered consultation in addition and two other studies offered guidance for nursing staff in addition. Four studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Three studies included only one or two nursing homes per study condition. Overall, methodological quality of studies was low. The studies revealed inconsistent results. One study in the nursing home setting documented an increase of PR use in both groups after eight months, while the other three studies found reduced use of PR in the intervention groups after seven and 12 months of follow up respectively. The single study examining residents in group dwelling units found no change in PR use in the intervention group after six months whereas PR use increased significantly in the control group. Authors' conclusions There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in Geriatric long-term Care.

E M Damsgaard - One of the best experts on this subject based on the ideXlab platform.

  • impact of Geriatrician performed comprehensive Geriatric Care on medication use and cognitive function in older adults referred to a non hospital based rehabilitation unit
    The American Journal of Medicine, 2019
    Co-Authors: Dmitri Zintchouk, Merete Gregersen, Torsten Lauritzen, E M Damsgaard
    Abstract:

    Abstract Background and Purpose Eighty-eight percent of older adults referred to Danish non-hospital-based rehabilitation units used ≥5 regular drugs per day at the beginning of rehabilitation. The aim of the study was to explore whether Geriatrician-performed comprehensive Geriatric Care had an impact on medication use and cognitive function in older adults after a 90-day follow-up. Methods There were 368 individuals aged ≥65 years recruited from 2 Danish non-hospital-based rehabilitation units and randomized to Geriatric Care (the intervention group) or usual Care (the control group). The medication adjustment was the key element of the Geriatric intervention. The control group received standard rehabilitation with general practitioners as back-up. The outcomes were prevalence of hyperpolypharmacy (≥10 regular medications prescribed concurrently), the change in medication profile, and cognitive function measured using the Mini-Mental State Examination. Results In the intervention group, fewer persons were exposed to hyperpolypharmacy (odds ratio 0.5; 95% confidence interval, 0.3-0.9) compared with the control group after 90 days. The prevalence of use of proton pump inhibitors, loop diuretics, or antiasthmatic inhalers was lower, while the prevalence of cholecalciferol use was higher in the intervention group compared with the control group. The prevalence of other drug use and cognitive function between groups were not different. Conclusions Geriatrician-performed comprehensive Geriatric Care may reduce the prevalence of hyperpolypharmacy and optimize the medication profile in older adults referred to a non-hospital-based rehabilitation. No impact on cognitive function was found.

  • Geriatrician performed comprehensive Geriatric Care in older adults referred to an outpatient community rehabilitation unit a randomized controlled trial
    European Journal of Internal Medicine, 2018
    Co-Authors: Dmitri Zintchouk, Merete Gregersen, Torsten Lauritzen, E M Damsgaard
    Abstract:

    Abstract Background Older adults make increasing demands on all sectors of the healthCare system. We investigated the effect of Geriatrician-performed comprehensive Geriatric Care (CGC) in older adults referred to a community rehabilitation unit. Design Randomized controlled trial. Setting Two Danish non-hospital based rehabilitation units. Participants Persons aged 65 or older admitted from home or hospital. Intervention CGC performed by a Geriatrician at the rehabilitation unit. Outcomes Primary outcome was number of hospital admissions and emergency department (ED) visits. Secondary outcomes were number of ambulatory contacts, general practitioner (GP) contacts, activities of daily living (ADL) and overall quality of life (OQoL). Outcomes were measured within 90 days of admission to the rehabilitation units. Results 368 persons were randomized: 185 to the intervention group (IG) vs 183 to the control group (CG). Groups were comparable at baseline. The number of hospital admissions and ED visits, ambulatory contacts and out of hour GP visits or phone calls did not differ between the groups. The number of daytime GP consultations and visits or phone and email consultations was lower in the IG (P  Conclusion Geriatrician-performed CGC in older adults in a community rehabilitation unit had no effect on the secondary healthCare utilization, but may reduce primary healthCare utilization and improve OQoL during the 90-day follow-up period. Trial registration ClinicalTrials.gov NCT01506219 .

Chris Carpenter - One of the best experts on this subject based on the ideXlab platform.

  • screening and detection of elder abuse research opportunities and lessons learned from emergency Geriatric Care intimate partner violence and child abuse
    Journal of Elder Abuse & Neglect, 2016
    Co-Authors: Scott R Beach, Chris Carpenter, Tony Rosen, Phyllis W Sharps, Richard J Gelles
    Abstract:

    ABSTRACTThis article provides an overview of elder abuse screening and detection methods for community-dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency Geriatric Care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The article provides descriptions of emerging screening and detection methods and technologies from the emergency Geriatric Care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, Caregivers, providers, and the health Care system, and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among ke...

  • screening and detection of elder abuse research opportunities and lessons learned from emergency Geriatric Care intimate partner violence and child abuse
    Journal of Elder Abuse & Neglect, 2016
    Co-Authors: Scott R Beach, Chris Carpenter, Tony Rosen, Phyllis W Sharps, Richard J Gelles
    Abstract:

    This article provides an overview of elder abuse screening and detection methods for community-dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency Geriatric Care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The article provides descriptions of emerging screening and detection methods and technologies from the emergency Geriatric Care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, Caregivers, providers, and the health Care system, and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among key stakeholders should also be conducted.

  • optimal older adult emergency Care introducing multidisciplinary Geriatric emergency department guidelines from the american college of emergency physicians american Geriatrics society emergency nurses association and society for academic emergency medicine
    Academic Emergency Medicine, 2014
    Co-Authors: Chris Carpenter, Audrey Chun, Marilyn Bromley, Jeffrey M Caterino, Lowell W Gerson, Jason Greenspan, Ula Hwang, David P John, William L Lyons, Timothy F Plattsmills
    Abstract:

    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency Care to aging adults is challenging crowded emergency departments (EDs) and a strained health Care system. In response, Geriatric emergency medicine (EM) clinicians, educators, and researchers collaborated with the American College of Emergency Physicians (ACEP), American Geriatrics Society (AGS), Emergency Nurses Association (ENA), and the Society for Academic Emergency Medicine (SAEM) to develop guidelines intended to improve ED Geriatric Care by enhancing expertise, educational, and quality improvement expectations; equipment; policies; and protocols. These "Geriatric Emergency Department Guidelines" represent the first formal society-led attempt to characterize the essential attribute of the Geriatric ED and received formal approval from the boards of directors for each of the four societies in 2013 and 2014. This article is intended to introduce EM and Geriatric health Care providers to the guidelines, while providing proposals for educational dissemination, refinement via formal effectiveness evaluations and cost-effectiveness studies, and institutional credentialing.

  • optimal older adult emergency Care introducing multidisciplinary Geriatric emergency department guidelines from the american college of emergency physicians american Geriatrics society emergency nurses association and society for academic emergency medicine
    Journal of the American Geriatrics Society, 2014
    Co-Authors: Chris Carpenter, Audrey Chun, Marilyn Bromley, Jeffrey M Caterino, Lowell W Gerson, Jason Greenspan, Ula Hwang, David P John, William L Lyons
    Abstract:

    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency Care to aging adults is challenging crowded emergency departments (EDs) and strained healthCare systems. In response, Geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED Geriatric Care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the Geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and Geriatric healthCare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.