preventing functional decline in the elderly

Kleinpell, R.M., Fletcher, K., & Jennings, B. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Aging Health 1995;7:497-528, 8. Dependency could be delayed by preventing one of its major determinants: falls. Can Geriatr J. Although traditional RT has proven effective, muscle power training (i.e., RT performed dynamically and at high speeds) should be preferably performed when possible. Aerobic exercise should also be prescribed whenever possible to reduce the loss of cardiovascular capacity associated with disuse periods. The benefits of the intervention were observed largely among persons with moderate (as opposed to severe) frailty. Department of Health and Human Services. PREVENTING Cascade Iatrogenesis in Hospitalized Elders: AN IMPORTANT ROLE FOR NURSES, Journal … We worked with 33 Victorian health services to implement the international End PJ paralysis movement to to encourage older patients to get changed out … Back to basics: Importance of nursing interventions in the elderly critical care patient. Ten participants died during the 12-month follow-up period. Generalized linear models. AU - Fleury, Julie. It is not clear why the participants with severe physical frailty did not benefit from the intervention. Which Genes for Hereditary Breast Cancer? We also evaluated the effect of the intervention within prespecified subgroups. In the first, potential participants were screened for physical frailty during routine office visits; in the second, potential participants were identified from a roster of patients and were screened for physical frailty in their homes. FASEB J. programs to prevent functional decline in the elderly remain equivocal, although most of the literature to date has focused on the restoration of func-tion in disabled elderly following an acute medical event. 2012. J Psychiatr Res 1975;12:189-198, 16. Table 1 summarizes the features of our home-based intervention program, which has been described in detail elsewhere.17 A physical therapist assessed each participant for potential impairments in physical abilities and assessed the participant's home environment. 12. Critical Care Nursing Clinics of North America, 26(4), 433-446. Am J Cardiol 1988;61:628-631, 19. Further evaluation is needed to determine the cost effectiveness of this program and to identify means by which it exerts a beneficial effect. Nutritional strategies to attenuate muscle disuse atrophy. Grimmer, K., Milanese, S., Beaton, K., & Atlas, A. Author information: (1)Department of Geriatric Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore 159964. yan_hoon_ang@alexhosp.com.sg INTRODUCTION: This study aims to determine if risk factors present on admission to the nursing home could be … BEST PRACTICE APPROACHES TO PREVENT FUNCTIONAL DECLINE IN THE OLDER PERSON ACROSS THE ACUTE, SUB-ACUTE AND RESIDENTIAL AGED CARE SECTORS ix Figure 2: Prevention of functional decline framework. We randomly assigned 188 persons 75 years of age or older who were physically frail and living at home to undergo a six-month, home-based intervention program that included physical therapy and that focused primarily on improving underlying impairments in physical abilities, including balance, muscle strength, ability to transfer from one position to another, and mobility, or to undergo an educational program (as a control). The pathophysiology is not fully understood, but delirium may be due to inflammatory mechanisms and a cholinergic neurotransmitter deficiency in the brain. This resource is the third edition of the Best care for older people everywhere: the toolkit. J Am Geriatr Soc 1995;43:603-609, 12. Quality indicators for assessing care of vulnerable elders. The disability scores in the intervention and control groups were 2.3 and 2.8, respectively, at base line; 2.0 and 3.6 at 7 months (P=0.008 for the comparison between the groups in the change from base line); and 2.7 and 4.2 at 12 months (P=0.02). Folstein MF, Folstein SE, McHugh PR. Overall, participants in the intervention group had less disability than participants in the control group at 3, 7, and 12 months (Figure 1A). Nutr Rev. As part of the program, they were required to undertake initiatives to minimise the risk of functional decline in older patients and improve the provision of care in four areas: Among the participants randomly assigned to the control group, 78 (83 percent) completed the program; 7 (7 percent) discontinued the program, after a mean of 1.3±1.5 visits, because of death or a move after an acute illness or injury; and 9 (10 percent) withdrew from the program after a mean of 1.8±1.1 visits. Institutionalization is generally a consequence of functional decline driven by physical limitations, cognitive impairments, and/or loss of social supports. Most important, the impracticality of masking group assignments may have biased the participants' reports of disability. Preventing Functional Decline in the Elderly Allan S. Brett, MD reviewing Gill TM et al. Washington, D.C.: Government Printing Office, 1990. Two recruitment strategies for a clinical trial of physically frail community-living older persons. Singapore Med J. J Chronic Dis 1987;40:481-489, 5. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. Functional decline is experienced by 30–60% of the older hospitalized patients, resulting in decreased independence and other adverse health outcomes. The nurses underwent intensive training and followed standardized procedures, which were outlined in a detailed manual. Eligible persons who declined to participate did not differ significantly from those who did agree to participate in terms of age, sex, level of physical frailty (moderate or severe), or recruitment strategy (during an office visit or from a roster).  |  N Engl J Med 1995;332:556-561, 11. McKinlay JB, Crawford SL, Tennstedt SL. Base-line and follow-up assessments were completed by a team of four research nurses who had no role in the intervention and who were unaware of the study hypothesis and of the participants' group assignments. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Copyright © 2018 Elsevier B.V. All rights reserved. The authorized source of trusted medical research and education for the Chinese-language medical community. 2020 Aug 27;12(9):2607. doi: 10.3390/nu12092607. 5. In this trial, Yale researchers randomized 188 frail, community-dwelling elders (age, 75 or older) to 2 groups: Participants in the intervention group underwent 6-month home-based programs that included about 16 visits by physical therapists, who focused on minimizing environmental hazards and … The hierarchical relationship between activities of daily living and instrumental activities of daily living. 1. All the data were collected on standardized forms. At this stage, intervention to reverse functional losses is often too late. Interventional strategies to combat muscle disuse atrophy in humans: focus on neuromuscular electrical stimulation and dietary protein. Little reliable consensus-based diagnostic criteria exist for cognitive decline, MCI, and AD; what does exist hasn’t been uniformly applied. A two-part model, adjusted for recruitment strategy and level of physical frailty, was used for the assessment of secondary outcomes.23 First, logistic regression was used, with admission or no admission to a nursing home as a binary outcome. Second, data from participants who were admitted to a nursing home were analyzed by ordinary least-squares regression, with the number of days spent in the nursing home as the outcome. The extent to which our results can be generalized is enhanced by our inclusion criteria for entry and by the high participation rate. Landis JR, Koch GG. Difficulty and dependence: two components of the disability continuum among community-living older persons. The finding that participants who lived alone benefited from the intervention, whereas those who lived with others did not, may be attributable to the lower rates of severe frailty and cognitive impairment and the higher rate of program completion among those who lived alone (data not shown). 22. In addition to data on physical frailty and cognitive status,15 self-reported information was collected at base line with regard to 10 physician-diagnosed chronic conditions13 and eight activities of daily living: walking, bathing, upper- and lower-body dressing, transferring from a chair to a standing position, using the toilet, eating, and grooming.13 On the basis of previous research,16 performance on each task was scored as follows: 0, if the participant had not needed help with the task and had not had difficulty with it during the preceding month; 1, if he or she had had difficulty but had not needed help; and 2, if he or she had needed help, regardless of the difficulty of the task. It is underpinned by the principles of person-centred practice. Among the participants randomly assigned to the intervention group, 61 (65 percent) completed the program, and 20 (21 percent) withdrew from the program prematurely, after a mean (±SD) of 9.5±4.1 home visits; the remaining 13 participants in this group (14 percent) did not receive the intervention at all, primarily because of worsening personal health or illness in a family member. Annu Rev Public Health 1999;20:125-144, 24. 4. Could nursing homes (NHs) transform from settings in which many residents dwell to settings in which the NH residents and those living in neighboring communities benefi… In summary, the results of our study indicate that functional decline among physically frail, elderly persons who live at home can be slowed, if not prevented. Government Leaders and Prioritization of SARS-CoV-2 Vaccines, Vaccinating Children against Covid-19 — The Lessons of Measles, Beyond Tuskegee — Vaccine Distrust and Everyday Racism, Covid-19 Vaccine Injuries — Preventing Inequities in Compensation, Addressing Child Hunger When School Is Closed — Considerations during the Pandemic and Beyond. Functional decline of the elderly in a nursing home. This randomized clinical trial provides evidence that a home-based “prehabilitation” program is effective in preventing functional decline among physically frail, elderly persons who live at home. J Appl Physiol (1985). 2020 Sep 17;17:14. doi: 10.1186/s11556-020-00247-5. The possibility that our findings are attributable to the attention received rather than to the training program itself is diminished by our use of an active control, which consisted of an educational program that included up to 12 personal visits or telephone calls and that had a high completion rate. 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