OBJECTIVES: This study aimed to assess the effectiveness of Comprehensive Geriatric Assessment (CGA) compared to standard of care in improving pain, physical function, and stiffness in older adults with knee osteoarthritis (OA) over six months. Secondary outcomes included multidimensional frailty and quality of life. DESIGN: An exploratory, multicentre, randomized controlled trial (RCT). SETTING: Five European geriatric centres in Italy, Germany, Turkiye and the Czech Republic. PARTICIPANTS: Seventy older adults (mean age 76.1 ± 6.8 years; 80% female) with knee OA (Kellgren-Lawrence Grades 1-2) were randomized into two groups: CGA (n = 35) or standard of care (n = 35). INTERVENTION: The CGA group underwent a multidimensional geriatric assessment and intervention, identifying impairments and tailoring interventions accordingly, while the control group received standard of care. MAIN OUTCOME MEASURES: The primary endpoint was improvement in pain, stiffness, and functional limitations measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) over six months. Secondary outcomes included changes in multidimensional frailty (Multidimensional Prognostic Index, MPI), quality of life (SF-36), and adherence to interventions. RESULTS: The CGA group showed a non-significant improvement in total WOMAC scores (-4.49 ± 3.40, p = 0.19), with slight reductions in pain (-1.12 ± 0.96) and functional limitations (-3.26 ± 2.21). MPI slightly improved (-0.02 ± 0.04, p = 0.69), but no significant changes were observed in SF-36 scores. No falls, hospitalizations, or severe adverse events were reported. CONCLUSIONS: CGA may offer potential benefits for managing knee OA in older adults, particularly for pain and function, though statistical significance was not achieved. Larger studies with longer follow-up are warranted to confirm these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05659979.
- MeSH
- artróza kolenních kloubů * terapie patofyziologie diagnóza MeSH
- geriatrické hodnocení * metody MeSH
- kvalita života MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
Cíle: Cílem studie bylo vyhodnotit vliv vybraných demografických, socioekonomických a zdravotních determinant na míru pečovatelské zátěže neformálních pečovatelů. Teoretická východiska: Demografické trendy vývoje obyvatel poukazují na důležitost systémové podpory rodinného pečovatelství. Metody: Byla provedena průřezová dotazníková studie u 168 neformálních pečovatelů, kteří pečovali o starší blízkou osobu v Jihočeském kraji. Výsledky: Mírnou pečovatelskou zátěž uvedlo 48,2 %, značnou 39,3 % a velmi vysokou 3,6 % dotazovaných pečovatelů. Kladná lineární korelace byla identifikována mezi mírou pečovatelské zátěže a věkem, spánkem a fyzickou aktivitou pečovatelů. S vyšším věkem pečovatelů rostla i jejich pečovatelská zátěž. Zároveň změny ve kvalitě či délce spánku a fyzické aktivity predikovaly vyšší míru pečovatelské zátěže. Záporná korelace byla potvrzena mezi pečovatelskou zátěží, dostupností služeb ADP a subjektivním hodnocením zdraví. S nižší dostupností služeb ADP rostla zátěž pečovatelů. S vyšší mírou pečovatelské zátěže klesala spokojenost pečovatelů se svým zdravím. Pečovatelé žijící v rodinném svazku uváděli nižší míru pečovatelské zátěže než svobodní, rozvedení nebo ovdovělí. Implikace pro sociální práci: Výsledky potvrdily souvislosti mezi mírou pečovatelské zátěže a vybranými charakteristikami neformálních pečovatelů. Je potřebné systémovými intervencemi zátěž rodinných pečovatelů snižovat.
Objectives: The aim of this study was to assess the impact of selected demographic, socioeconomic and health determinants on the level of caregiving burden of informal caregivers. Theoretical bases: The demographic trends of inhabitant development point out the importance of systemic support of the support of informal family care. Methods: A cross-sectional study was conducted. The study population consisted of 168 informal caregivers in the South Bohemia Region. Outcomes: A positive linear correlation was identified between the level of caregiver burden and the age, sleep and physical activity of caregivers. As caregivers’ age increased, their caregiving burden increased. At the same time, changes in sleep quality and physical activity predicted higher levels of caregiver burden. A negative correlation was confirmed between caregiver burden, availability of ADP services, and subjective health ratings. Caregiver burden increased with lower availability of ADP services. Caregiver satisfaction with their health decreased with higher levels of caregiver burden. Caregivers living in a family union reported lower levels of caregiving burden than single, divorced, widowed caregivers. Social work implications: The results confirmed the associations between caregiving burden and selected characteristics of informal caregivers. There is a need of systemic interventions to reduce the burden of family caregivers.
- MeSH
- dlouhodobá péče statistika a číselné údaje MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- osoby pečující o pacienty * statistika a číselné údaje MeSH
- průzkumy a dotazníky MeSH
- regresní analýza MeSH
- senioři MeSH
- socioekonomické faktory MeSH
- zátěž pečovatele * epidemiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
PURPOSE: Incident delirium is a frequent complication among hospitalized older people with COVID-19, associated with increased length of hospital stay, higher morbidity and mortality rates. Although delirium is preventable with early detection, systematic assessment methods and predictive models are not universally defined, thus delirium is often underrated. In this study, we tested the role of the Multidimensional Prognostic Index (MPI), a prognostic tool based on Comprehensive Geriatric Assessment, to predict the risk of incident delirium. METHODS: Hospitalized older patients (≥ 65 years) with COVID-19 infection were enrolled (n = 502) from ten centers across Europe. At hospital admission, the MPI was administered to all the patients and two already validated delirium prediction models were computed (AWOL delirium risk-stratification score and Martinez model). Delirium occurrence during hospitalization was ascertained using the 4A's Test (4AT). Accuracy of the MPI and the other delirium predictive models was assessed through logistic regression models and the area under the curve (AUC). RESULTS: We analyzed 293 patients without delirium at hospital admission. Of them 33 (11.3%) developed delirium during hospitalization. Higher MPI score at admission (higher multidimensional frailty) was associated with higher risk of incident delirium also adjusting for the other delirium predictive models and COVID-19 severity (OR = 12.72, 95% CI = 2.11-76.86 for MPI-2 vs MPI-1, and OR = 33.44, 95% CI = 4.55-146.61 for MPI-3 vs MPI-1). The MPI showed good accuracy in predicting incident delirium (AUC = 0.71) also superior to AWOL tool, (AUC = 0.63) and Martinez model (AUC = 0.61) (p < 0.0001 for both comparisons). CONCLUSIONS: The MPI is a sensitive tool for early identification of older patients with incident delirium.
- MeSH
- COVID-19 * komplikace epidemiologie diagnóza MeSH
- delirium * diagnóza epidemiologie MeSH
- geriatrické hodnocení * metody MeSH
- hodnocení rizik MeSH
- hospitalizace * statistika a číselné údaje MeSH
- incidence MeSH
- lidé MeSH
- prognóza MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- SARS-CoV-2 MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. OBJECTIVE: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. METHODS: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. RESULTS: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. CONCLUSIONS: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.
- MeSH
- COVID-19 * MeSH
- farmakoterapie COVID-19 MeSH
- geriatrické hodnocení metody MeSH
- křehkost * farmakoterapie MeSH
- lidé MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. DESIGN: Longitudinal, multicenter study. SETTINGS AND PARTICIPANTS: 502 older people hospitalized for COVID-19 in 10 European hospitals. METHODS: MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). RESULTS: Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. CONCLUSIONS AND IMPLICATIONS: MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.
- MeSH
- COVID-19 * terapie MeSH
- geriatrické hodnocení metody MeSH
- lidé MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- umělé dýchání MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Pacienti s fibrilací síní se zvýšeným rizikem CMP a tromboembolických komplikací profitují z antikoagulační léčby. U geriatrických nemocných nad 80 let věku s přidruženou nemocností, omezením v sebeobsluze, s geriatrickými syndromy a křehkostí není dostatek důkazů o jejím přínosu/rizicích. Evropská studie EUROSAF (The EURopean study of Older Subjects with Atrial Fibrillation), probíhající ve 12 evropských zemích, sleduje účinnost antikoagulancií na celkovou mortalitu a jejich bezpečnost. V tomto článku prezentujeme demografické a klinické charakteristiky nemocných propouštěných z lůžek akutní geriatrie s dokumentovanou nevalvulární fibrilací síní v ČR ve dvou centrech (N = 383) a analyzujeme preskripci antikoagulancií s ohledem na geriatrickou křehkost. Průměrný věk nemocných činil 82,3 (± 5,9) roku, 83 % bylo starších 75 let. Potvrdili jsme vysoký stupeň komorbidit (CIRS skóre 1,87 ± 0,30), omezení soběstačnosti v denních činnostech, kognitivní omezení, riziko malnutrice a pádů. Vysoká byla i rizika CHA2DS2-VASc (průměr skóre 5,0 6 ± 1,19) a HAS-BLED (2,84 ± 0,87). Ve sledovaném souboru nebyla antikoagulační léčba předepsána polovině pacientů. Nová perorální antikoagulancia DOAC dostávalo pouze 13 % pacientů. Zvýšené mortalitní riziko / křehkost bylo reflektováno nižší preskripcí antikoagulancií (ve skupině s nejvyšším mortalitním rizikem bylo perorálními antikoagulancii léčeno pouze 17,6 % nemocných oproti 41,3 % ve skupině s nízkým rizikem, p < 0,05). Mezi nejčastějšími důvody nepředepsání byly uváděny v sestupném pořadí: vysoké riziko pádů, non-compliance, odmítnutí léčby pacientem a krvácení v anamnéze. Je třeba dalších studií zahrnujících i vysokověké křehké klinicky komplexní seniory, které by podpořily oprávněnost nepředepisování antikoagulační léčby nebo naopak přinesly důkazy o jejím přínosu v této rizikové populaci.
Patients with atrial fibrillation with higher risk of stroke and thromboembolic complications benefit from anticoagulants treatment. However, there is not enough evidence if such benefit is present in geriatric patients aged 80 years and over with concomitant morbidity, functional limitations in selfcare, with geriatric syndromes and frailty. The aim of the EURopean study of Older Subjects with Atrial Fibrillation (EUROSAF) currently running in 12 European countries is to analyse efficacy of anticoagulants on overall mortality and safety. In this paper we present baseline demographic and clinical characteristics of patients with documented nonvalvular atrial fibrillation discharged from two geriatric centres in CR (N = 383). Further, we analyse the prescription of anticoagulants stratified by geriatric frailty level. The mean age of the sample was 82,3 (± 5,9) years, 83 % was 75 years and older. We confirmed high degree of comorbidities (CIRS score 1.7 ± 0.30), limitations in ADL activities, cognitive impairments, risk of malnutrition and falls. We wound both high risk in CHA2DS2-VASc (mean score 5.06 ± 1.19) as well as HAS-BLED (2.84±0.87). In our sample a half of patients did not receive anticoagulant medication. Novel direct oral antikoagulants DOAC were prescribed only in 13 % of patients. Higher mortality risk/frailty was reflected in lower anticoagulants prescription (in the group with the highest mortality risk MPI-III only 17.6 % received OAK compared to 41.3 % in the group with lowest mortality risk MPI-I, p < 0.05). The most frequent reasons for non-prescribing were in decreasing order: high risk of falls, non- -compliance, treatment refusal and past bleeding. Further studies are needed which would include the oldest old (80+), frail, clinically complex seniors to justify the underprescribing of anticoagulants or confirm their benefit in this high-risk population.
- Klíčová slova
- studie EUROSAF,
- MeSH
- antikoagulancia * terapeutické užití MeSH
- cévní mozková příhoda prevence a kontrola MeSH
- fibrilace síní farmakoterapie MeSH
- křehký senior MeSH
- lidé MeSH
- pozorovací studie jako téma MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
PURPOSE: Sarcopenic obesity (SO) as a new diagnostic entity defined by presence of obesity in combination with sarcopenia represents serious health condition negatively affecting quality of life in old age. Despite the rapidly increasing incidence of SO associated with demographic aging, clear diagnostic criteria for SO have not yet been established. We describe here the applicability of the EWGSOP2 and EWGSOP1 diagnostic criteria in identifying sarcopenia and SO and the development of a refinement algorithm for SO detection. METHODS: In total 156 subjects were pre-screened, 126 had a complete dataset and were included, 20.6% (n = 26) were men and 79.4% (n = 100) women, mean age 81 ± 6.3 years in tertiary hospital, Prague, Czech Republic. Testing of physical performance (hand-grip test, 400 m walk test, chair stand test, gait speed), anthropometric measures and SARC-F, SPPB and MNA-SF were used to determine physical, functional, and nutritional status, while muscle mass and fat mass were measured by DXA scans to confirm sarcopenia and SO diagnosis. RESULTS: The prevalence of sarcopenia (BMI adjusted ALM < 0.789 for men, < 0.512 for women) was 26.2% (n = 33), SO in 20.6% (n = 26). 78.8% of all sarcopenic subjects fulfilled the criteria of SO (FM > 27% for men and > 38% for women; waist circumference > 90 cm for men and > 85 cm for women). EWGSOP1 criteria for diagnosing sarcopenia showed better sensitivity of 97.0% than the EWGSOP2 66.7%, while specificity reached 100% for both criteria. According to DXA measurement, EWGSOP1 identified 3.0% cases (1 out of 33) as false negative meanwhile EWGSOP2 identified 33.3% cases as false negative and this difference was statistically significant (McNemar's test, p < 0.001). An algorithm for SO was developed (which uses sex, BMI, height, waist circumference and SPPB) with sensitivity and specificity of 88.5 and 91.0%, respectively. CONCLUSION: High prevalence of obesity among elderly people and rather low sensitivity of current diagnostic criteria for SO call for ongoing research. Broader international consensus for SO diagnostic criteria, screening and diagnosis algorithm are crucial for early detection of SO in older people in clinical practice so that optimal multi-component therapy can be initiated.
- MeSH
- algoritmy MeSH
- kvalita života MeSH
- lidé MeSH
- obezita komplikace diagnóza epidemiologie MeSH
- sarkopenie * diagnóza epidemiologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- síla ruky fyziologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Topinková E, Jurašková B, Hrkal J, Zvolský M, Sládková P. Hodnocení disability s využitím nástroje WHODAS 2.0 u geriatrických pacientů. Pilotní studie WHODAS-GERI. Východiska. Disabilita ve stáří narůstá se zvyšujícím se věkem, polymorbiditou a geriatrickými syndromy, negativně ovlivňuje zdravotní stav a kvalitu života a má negativní sociální i ekonomické dopady. Proto je třeba vyhledávat v populaci seniory s disabilitou a kvantifikovat míru postižení. V ČR proběhla pilotní studie ověřující využitelnost mezinárodního dotazníkového nástroje WHODAS 2.0 u ambulantních geriatrických pacientů (WHODAS-GERI projekt) ve spolupráci ÚZIS ČR a České gerontologické a geriatrické společnosti ČLS JEP. Pacienti a metody. Prospektivní hodnocení 104 pacientů geriatrických ambulancí v 9 centrech, posouzení míry disability s využitím WHODAS 2.0 (36 otázek), posouzení soběstačnosti testy ADL, IADL, posouzení kognice testem MMSE a doplňující dotazníkové šetření u vyšetřujících geriatrů. Výsledky. Rozsah a závažnost celkové disability i 6 domén vycházejících z dotazníku WHODAS 2.0 dobře koreluje s celkovým skóre funkčních testů ADL, IADL a MMSE, rutinně používaných v rámci komplexního geriatrického hodnocení. V některých oblastech je doplňují i o údaje běžně nedostupné (vztahy s lidmi, participace na společenských aktivitách). To potvrdilo i hodnocení testujících lékařů, avšak z jejich hodnocení vyplývají také omezení použití tohoto dotazníku – náročnost vyplnění pro mnohé geriatrické pacienty, nízká specifičnost v některých oblastech a nemožnost jeho využití pro potřeby posudkové služby. Závěry. WHODAS 2.0 je validním nástrojem pro posouzení míry disability u ambulantních geriatrických pacientů. Jeho využití je vhodné za situací, kdy není prováděno komplexní geriatrické zhodnocení funkčního stavu, u vybraných specifických skupin geriatrických pacientů s chronickými stavy a pro zachycení širší oblasti kvality jejich života. Je vhodné provedení rozsáhlejších populačních studií u osob vyššího věku k získání normativních dat, údajů o prevalenci a charakteru disability a využití těchto znalostí pro tvorbu preventivních programů k omezení míry závislosti u seniorské populace.
Topinková E, Jurašková B, Hrkal J, Zvolský M, Sládková P. The assessment of disability using WHODAS 2.0 tool at geriatric patients. A pilot study WHODAS-GERI. Background. Disability in elderly people increases with advancing age, polymorbidity and presence of geriatric syndromes. It negatively influences health status, quality of life and has negative social and economic consequences. Therefore, seniors with disability should be identified and their disability quantified. In the Czech Republic a pilot study with international WHODAS 2.0 tool was conducted for the first time evaluating feasibility and usability of this tool in ambulatory geriatric out-patients in a WHODAS-GERI joint project of the Institute of Health Information and Statistics of the Czech Republic and Czech Society of Gerontology and Geriatrics, Czech Medical Association. Patients and methods. Prospective assessment of 104 patients of geriatric clinics in 9 centres, evaluation of disability level using WHODAS 2.0 questionnaire (36 items), self-sufficiency and independence using ADL and IADL tests and cognitive impairment using MMSE test; complementing questionnaire survey in geriatricians performing the assessment. Results. Extent and severity of the overall disability and of the 6 WHODAS 2.0 based domains correlate well with a total scores of functional tests ADL, IADL and MMSE, routinely used as part of comprehensive geriatric assessment. In some domains (interactions with other people, participation in social activities) WHODAS 2.0 provides information which are unknown/not routinely collected. This finding was supported by responses of participating physicians. However, their view on usability is rather cautious as for some patients completion of questionnaire was difficult, for low specificity of some domains and limits for direct use of the results for social allowances eligibility. Conclusions. WHODAS 2.0 seems to be a valid instrument for disability level in geriatric out-patients. Its use is supported when the comprehensive geriatric assessment and evaluation of the functional status and limitations cannot be performed, in selected groups of seniors with chronic conditions and if broader evaluation of quality of life is beneficial. In the future, larger epidemiologic population studies in seniors are needed to gain normative WHODAS 2.0 data, disability prevalence and for use of these information to design preventive programs to reduce dependency level of dependence in older people
- Klíčová slova
- WHODAS 2.0,
- MeSH
- činnosti denního života MeSH
- diagnostické sebehodnocení * MeSH
- geriatrie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mezinárodní klasifikace funkčních schopností, disability a zdraví MeSH
- prospektivní studie MeSH
- průzkumy a dotazníky MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
