The influence of physical activity and fractures on ultrasound parameters in elderly people

In this cross-sectional study we investigated the relationship between ultrasound measurements in the calcaneus versus daily physical activity and fractures sustained in the past in elderly subjects. Ultrasound measurements were performed at both heels, which enabled us to examine determinants of differences between contralateral heels. Participants were 132 men and 578 women, aged 70 years and over (mean age and standard deviation (SD): 83 ± 6 years), living in homes for the elderly (n = 343) or apartment houses for the elderly (n = 367). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured in the right and left calcaneus. The median difference (and interquartile range) between the two heels for BUA and SOS, expressed as a percentage of the mean value for each individual, was 9.6% (4.2-15.7%) and 1.0% (0.4-1.7%), corresponding to 25% and 40% of the study population SDI respectively. Greater differences in BUA between the two heels were associated with variables indicating poorer functional status, such as past fractures at the lower extremities. The level of daily physical activity was obtained by means of a questionnaire regarding household and leisure activities. Subsequently sumscores were calculated for daily physical activity and a subscore indicating weight-bearing physical activity. After adjustment for age, gender, residence, and body weight, physical activity scores were positively linearly related to both BUA and SOS. Each 5 point increase on the weight-bearing physical activity score, corresponding to, for example, walking for 2.5 h per week, was associated with a difference in BUA of 4.7 dB/MHz and in SOS of 5.1 m/s, which is similar to the differences associated with 10 kg higher body weight, or 10 years younger age. After the age of 50 years 47 subjects had fractured a hip, 61 subjects had sustained another lower extremity fracture, 104 subjects a wrist fracture, and 62 subjects another upper extremity fracture. After adjusting for age, gender and residence, odds ratios for all fracture types in the lowest terciles of BUA and SOS versus the highest terciles ranged from 1.9 to 3.8. This study showed significant differences in ultrasound measurements between the left and the right heel, indicating that measurements at both sides are necessary for optimal evaluation of bone strength. Furthermore, after careful adjustments, ultrasound parameters had higher values with higher daily physical activity in elderly subjects and discriminated subjects with a history of fracture from those without

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3) - Operational Guidelines for ICT-supported Integrated Care and Independent Living

The guidelines in this report have been developed as part of the Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3) project. Twenty-four ICT-supported integrated care initiatives in the EU were identified which supported integrated care and/or independent living and were either deployed or promising large scale pilots. The aim of this report is to define a set of recommendations to guide the process of developing and implementing ICT-supported integrated care and independent living, based on the experiences made in these 24 initiatives. The intended audience for this guidance document are those who work on the development and implementation of initiatives at an operational level, such as professionals, managers in healthcare organisations, regional managers of health or social care, health insurers, professionals’ organisations, etc.JRC.J.3-Information Societ

The effectiveness of disease management programmes: a review of the literature

Onderzoek toont aan dat disease-managementprogramma's een positief effect hebben op de behandeling van chronisch zieken. In deze programma's wordt de zorg door verschillende behandelaars en instellingen beter op elkaar afgestemd. De zorg rond chronisch zieken is gefragmenteerd waardoor het risico bestaat dat chronisch zieken geen optimale zorg krijgen. Om de zorg voor chronisch zieken te optimaliseren en de groeiende zorglast door de vergrijzing het hoofd te kunnen bieden, zijn maatregelen nodig om de kwaliteit van de zorg voor chronisch zieken te verbeteren. Disease-managementprogramma's kunnen hieraan bijdragen. Op basis van een inventarisatie van de internationale literatuur is onderzocht wat het effect is van disease-managementinitiatieven voor chronisch zieken in het algemeen en voor de specifieke ziekten COPD (Chronic Obstructive Pulmonary Disease), chronisch hartfalen, depressie en diabetes. Hierbij is onderzocht wat het effect is van deze programma's op de ernst van de ziekte, sterfte, kwaliteit van leven, de zorgverlening en de tevredenheid van patienten. Tussen de verschillende studies is veel variatie in de activiteiten die in het kader van disease- managementprogramma's worden uitgevoerd. Disease-managementinitiatieven met meerdere activiteiten lijken effectiever dan initiatieven met slechts een activiteit. Daarnaast blijken multidisciplinaire teams, preventie, en medicatievoorschriften door casemanagers regelmatig deel uit te maken van effectieve initiatieven. Hoewel de variatie in de onderzochte studies groot was, concluderen we dat disease-managementprogramma's in het algemeen een positief effect kunnen hebben voor chronisch zieken.Studies have shown that disease management programmes have a positive effect on the treatment of chronically ill patients. In these programmes, health care by different professionals and in different institutions is better tuned and coordinated. Health care for chronically ill patients is fragmented into different care episodes, which increases the risk of sub-optimal care. To optimize the health care for the chronically ill, disease management programmes have been used to improve the coordination of care delivery. In this study we included scientific publications on the effect of disease management in chronically ill patients in general, and in specific chronic conditions: COPD (Chronic Obstructive Pulmonary Disease), congestive heart failure, depression and diabetes. We studied the effectiveness of disease management on severity of the disease, mortality, quality of life, care processes and patient satisfaction. Activities within the disease management programmes varied considerably among the included studies. Disease management programmes with several activities tend to be more effective compared to programmes with a focus on a single activity. Effective programmes often comprised the use of multidisciplinary teams, activities on prevention, and medication prescription by case managers. Although the variety among the disease management programmes was substantial, we conclude that disease management programmes in general can contribute to better care for the chronically ill.VW

Daily physical activity and the use of a walking aid in relation to falls in elderly people in a residential care setting

Physical activity is usually considered as an important com0ponent of a healthy lifestyle, including a preventive effect on the risk of falls in the elderly. The relationship between physical activity and falls is complex: physical activity is a prerequisite to maintain neuromuscular functioning, necessary to keep balance and to react to a fall, but a higher level of physical activity also implies a greater exposure to environmental threats, possibly leading to a fall. Related to this greater exposure to threats, the use of a walking aid may protect against falls in those who have impaired mobility. In this cross-sectional study we investigated the relationship between daily physical activity and falls and the use of a walking aid in elderly subjects. Participants were 131 men and 563 women, aged 70 years and over (mean age and standard deviation: 82 ± 6 years), living in homes for the elderly (n = 335) and apartment houses for elderly (n = 359). Data on baseline characteristics and falls in the previous year were obtained using a questionnaire. The level of daily physical activity in the previous year was obtained by means of a questionnaire regarding household and leisure activities. Subjects with a lower extremity fracture in the previous year were excluded from the analyses. Data were analysed using multiple logistic regression, adjusted for age, gender, and residence. In the past year, 40% of the participants fell at least one time, and 19% of the participants fell two times or more. Since falls and recurrent falls were nonlinearly related to the level of daily physical activity, the physical activity score was grouped into quartiles: the highest quartile corresponding to the highest activity level. Odds ratios (and 95% confidence intervals) for falls and recurrent falls for subjects in the highest quartile contrasted with those in the lowest quartile were 0.5 (0.3-0.9) and 0.3 (0.2-0.6), respectively. The risk of falls and recurrent falls was not lower for those with intermediate levels of daily physical activity. The use of a walking aid protected against falls in those with intermediate high activity levels (third quartile). It was suggested that the exposure to environmental hazards, due to some degree of physical activity may have been responsible for the nonlinear relationship between daily physical activity and falling. We conclude that a high activity level and the use of a walking aid may protect against falls

Ultrasound measurements for the prediction of osteoporotic fractures in elderly people

In this prospective study we investigated the predictive value of quantitative ultrasound (QUS) measurements and other potential predictors of osteoporotic fractures in the elderly. During a I-year period, 710 participants (132 men and 578 women), aged 70 years and older (mean age ± SD: 82.8 ± 5.9), were recruited from seven homes and apartment houses for the elderly. QUS measurements (broadband ultrasound attenuation (BUA) and speed of sound (SOS)) were assessed with a clinical bone densitometer. A structured questionnaire was used to collect information on other potential predictors. Follow-up of fractures was done each half year by telephone interviews. During the study period (median follow-up 2.8 years, maximum 3.7 years), 30 participants had a first hip fracture and 54 suffered from a first other nonspinal fracture. Cox regression analyses, adjusted for age and sex, showed that the relative risk (RR) of hip fracture for each standard deviation reduction was 2.3 (95% CI, 1.4-3.7) for BUA and 1.6 (95% CI, 1.1-2.3) for SOS. Slightly weaker relationships were found for any fracture (BUA: RR, 1.6; 95% CI, 1.2-2.1; SOS: RR, 1.3; 95% CI, 1.0-1.6). Multivariable analyses identified low BUA values and immobility as the strongest predictors for hip fractures and any fracture. Female gender proved to be the strongest predictor for other nonspinal fractures. It can be concluded that QUS measurements can predict the risk for hip fracture and any fracture in elderly people

A risk profile for identifying community-dwelling elderly with a highrisk of recurrent falling: results of a 3-year prospective study

Introduction: The aim of the prospective study reported here was to develop a risk profile that can be used to identify community-dwelling elderly at a high risk of recurrent falling. Materials and methods: The study was designed as a 3-year prospective cohort study. A total of 1365 community-dwelling persons, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam participated in the study. During an interview in 1995/1996, physical, cognitive, emotional and social aspects of functioning were assessed. A follow-up on the number of falls and fractures was conducted during a 3-year period using fall calendars that participants filled out weekly. Recurrent fallers were identified as those who fell at least twice within a 6-month period during the 3-year follow-up. Results: The incidence of recurrent falls at the 3-year follow-up point was 24.9% in women and 24.4% in men. Of the respondents, 5.5% reported a total of 87 fractures that resulted from a fall, including 20 hip fractures, 21 wrist fractures and seven humerus fractures. Recurrent fallers were more prone to have a fall-related fracture than those who were not defined as recurrent fallers (11.9% vs. 3.4%; OR: 3.8; 95% CI: 2.3-6.1). Backward logistic regression analysis identified the following predictors in the risk profile for recurrent falling: two or more previous falls, dizziness, functional limitations, weak grip strength, low body weight, fear of falling, the presence of dogs/cats in the household, a high educational level, drinking 18 or more alcoholic consumptions per week and two interaction terms (high educationx18 or more alcohol consumptions per week and two or more previous falls x fear of falling) (AUC=0.71). Discussion: At a cut-off point of 5 on the total risk score (range 0-30), the model predicted recurrent falling with a sensitivity of 59% and a specificity of 71%. At a cut-off point of 10, the sensitivity and specificity were 31% and 92%, respectively. A risk profile including nine predictors that can easily be assessed seems to be a useful tool for the identification of community-dwelling elderly with a high risk of recurrent falling. © International Osteoporosis Foundation and National Osteoporosis Foundation 2006