• Accidental injuries among older adults: An incidence study.

      Gudnadottir, Maria; Thorsteinsdottir, Thordis Katrin; Mogensen, Brynjolfur; Aspelund, Thor; Thordardottir, Edda Bjork; 1 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic address: maria.gudnadottir@gmail.com. 2 Research Institute in Emergency Care, Landspitali, The National University Hospital of Iceland, Iceland; Faculty of Nursing, University of Iceland, Reykjavik, Iceland. Electronic address: thordith@landspitali.is. 3 Research Institute in Emergency Care, Landspitali, The National University Hospital of Iceland, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland. Electronic address: brynmog@landspitali.is. 4 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Icelandic Heart Association, Iceland. Electronic address: thor@hi.is. 5 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic address: eddat@hi.is. (Elsevier, 2018-01-01)
      To date, the majority of studies assessing accidental injuries among the elderly have focused on fall injuries, while studies of other mechanisms of injuries have been lacking. Therefore, the main objective of this study was to investigate all injury-related visits among older adults to an emergency department and risk factors for injuries. Data were collected on all registered visits of adults, ≥67 years old, living in the capital of Iceland, to the emergency department of Landspitali, the National University Hospital, in 2011 and 2012. The yearly incidence rate for injuries was 106 per 1000 adults, ≥67 years old. Of all injuries (n = 4,469), falls were the most common mechanism of injury (78 per 1000), followed by being struck or hit (12 per 1000) and being crushed, cut or pierced (8 per 1000). Other mechanisms of injury, such as acute overexertion, foreign body in natural orifice, injuries caused by thermal and chemical effect and other and unspecified mechanism were less common (8 per 1000). Fractures were the most common consequences of injuries (36 per 1000). The most frequent place of injury was in or around homes (77 per 1000), with men being more likely than women to be injured outside of the home (60 per 1000 vs. 36 per 1000). Results indicate that falls are the main cause of accidental injuries, followed by being struck and hit injuries but other causes contributed to the rest. Falls constitute a major public health problem and fall-related injuries can have a substantial impact on the lives of older adults. As life expectancy continues to increase, fall risk is expected to increase. Since falls constitute a major impact on the lives of older adults and can lead to not only declines in physical activity and functional status, but to considerable health care costs, the health care system needs to intervene.
    • Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis

      Palmer, Katie; Villani, Emanuele R; Vetrano, Davide L; Cherubini, Antonio; Cruz-Jentoft, Alfonso J; Curtin, Denis; Denkinger, Michael; Gutierrez-Valencia, Marta; Gudmundsson, Adalsteinn; et al; et al. (Springer, 2019-02)
      PurposeTo investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa.MethodsA systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I-2 statistic and publication bias with Egger's and Begg's tests.ResultsThirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR=1.52; 95% CI 1.32-1.79) and frail persons (pooled OR=2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR=1.95; 95% CI 1.41-2.70) and frail (OR=6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR=1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty.ConclusionsPolypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals.Prospero registration numberCRD42018104756.
    • EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research.

      Seppala, L J; van der Velde, N; Masud, T; Blain, H; Petrovic, M; van der Cammen, T J; Szczerbińska, K; Hartikainen, S; Kenny, R A; Ryg, J; et al. (Adis International, 2019-04)
      Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.
    • Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects.

      Onder, Graziano; Giovannini, Silvia; Sganga, Federica; Manes-Gravina, Ester; Topinkova, Eva; Finne-Soveri, Harriet; Garms-Homolová, Vjenka; Declercq, Anja; van der Roest, Henriëtte G; Jónsson, Pálmi V; et al. (Springer, 2018-09-01)
      Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Exposure to interactions between drugs and geriatric syndromes was assessed by 2015 Beers criteria. 790/4023 (19.6%) residents in the Shelter Project and 179/1469 (12.2%) home care patients in the IBenC Project presented with one or more drug interactions with geriatric syndromes. In the Shelter project, 288/373 (77.2%) residents experiencing a fall, 429/659 (65.1%) presenting with delirium and 180/2765 (6.5%) with urinary incontinence were on one or more interacting drugs. In the IBenC project, 78/172 (45.3%) participants experiencing a fall, 80/182 (44.0%) presenting with delirium and 36/504 (7.1%) with urinary incontinence were on one or more interacting drugs. Drug-geriatric syndromes interactions are common in long-term care patients. Future studies and interventions aimed at improving pharmacological prescription in the long-term care setting should assess not only drug-drug and drug-disease interactions, but also interactions involving geriatric syndromes.
    • Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management.

      Gudnadottir, Gudny Stella; James, Stefan Karl; Andersen, Karl; Lagerqvist, Bo; Thrainsdottir, Inga Sigurros; Ravn-Fischer, Annica; Varenhorst, Christoph; Gudnason, Thorarinn; 1 Department of Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology and Cardiovascular Research Centre, Landspitali University Hospital, Reykjavik, Iceland; School of Health Sciences, University of Iceland, Reykjavik, Iceland. Electronic address: gudnystella@gmail.com. 2 Uppsala Clinical Research Centre (UCR); Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. 3 Department of Cardiology and Cardiovascular Research Centre, Landspitali University Hospital, Reykjavik, Iceland; School of Health Sciences, University of Iceland, Reykjavik, Iceland. 4 Department of Cardiology and Cardiovascular Research Centre, Landspitali University Hospital, Reykjavik, Iceland. 5 Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 6 Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Pfizer AB, Sollentuna, Sweden. (Mosby-Elsevier, 2019-05)
      The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs. We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidity and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography ≤14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack. We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65). Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.
    • Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries.

      van Lier, Lisanne I; van der Roest, Henriëtte G; Oosten, Babette Sh; Garms-Homolová, Vjenka; Onder, Graziano; Finne-Soveri, Harriet; V Jónsson, Pálmi; Ljunggren, Gunnar; Henrard, Jean-Claude; Topinkova, Eva; et al. (SAGE Publications, 2019-01-01)
      The objective was to identify predictors of societal costs covering formal and informal care utilization by older home care clients in 11 European countries. Societal costs of 1907 older clients receiving home care for 12 months from the Aged in Home care (AdHoc) study were estimated using the InterRAI Minimum Data Set for Home Care's (MDS-HC) resource use items. Predictors (medical, functional, and psychosocial domains) of societal costs were identified by performing univariate and multivariate generalized linear model analyses. Mean societal costs per participant were €36 442, ranging from €14 865 in Denmark to €78 836 in the United Kingdom. In the final multivariate model, country, being married, activities of daily living (ADL) dependency, cognitive impairment, limitations of going out, oral conditions, number of medications, arthritis, and cerebro vascular accident (CVA) were significantly associated with societal costs. Of the predictors, ADL dependency and limitations of going out may be modifiable. Developing interventions targeted at improving these conditions may create opportunities to curtail societal costs.
    • The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial: Case finding, screening and characteristics of eligible participants.

      Marzetti, Emanuele; Cesari, Matteo; Calvani, Riccardo; Msihid, Jérôme; Tosato, Matteo; Rodriguez-Mañas, Leocadio; Lattanzio, Fabrizia; Cherubini, Antonio; Bejuit, Raphaël; Di Bari, Mauro; et al. (Elsevier Science, 2018-11-01)
      The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees. The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding. During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy. PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods.