Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study

Introduction Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. Methods This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). Results Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. Conclusion 40% of older people using European emergency care had CFS 5 + . Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning

Health status and functional profile at admission to nursing homes : A population based study over the years 2003-2014: comparison between people with and without diabetes

Background & Aims. Prevalence of diabetes in adults has been increasing in the last decades. Diabetes increases demand for nursing homes admission which is expensive for public and private finances. The aims of the study were to examine the prevalence of diabetes at admission to nursing homes in Iceland over 12 years, and to compare overall health, functioning, medication and medical diagnosis of residents with diabetes to those without diabetes.  Methods. A retrospective study of data obtained from the Minimum Data Set records at admission to nursing homes in Iceland during the years 2003-2014. Statistical analysis was carried out using a Chi-square-test, unpaired Student´s t-test, linear regression and logistic regression. Results. In total 5242 residents were assessed within 180 days from admission, 730 had diabetes (13.9%). Prevalence of diabetes increased from 9.4% in 2003 to 15% in 2014, with a peak of 19.1% in 2013. Mean age was 81.0 (SD 8.2) and 82.7 (SD 8.7) years for residents with and without diabetes, respectively (p < 0.001). Comorbidities like hypertension, congestive heart-failure, kidney-failure, arthritis, ulcers and amputations were more common among residents with diabetes, whereas cognitive diseases were more common in the other group.  Conclusions. The prevalence of diabetes in Icelandic nursing homes is increasing. Residents with diabetes are younger and have better cognitive performance, but suffer more physical disability and serious comorbidities than others. Nursing homes’ staff need to be current in diabetes management to provide quality care

Health status and functional profile at admission to nursing homes : A population based study over the years 2003-2014: comparison between people with and without diabetes

Background & Aims. Prevalence of diabetes in adults has been increasing in the last decades. Diabetes increases demand for nursing homes admission which is expensive for public and private finances. The aims of the study were to examine the prevalence of diabetes at admission to nursing homes in Iceland over 12 years, and to compare overall health, functioning, medication and medical diagnosis of residents with diabetes to those without diabetes.  Methods. A retrospective study of data obtained from the Minimum Data Set records at admission to nursing homes in Iceland during the years 2003-2014. Statistical analysis was carried out using a Chi-square-test, unpaired Student´s t-test, linear regression and logistic regression. Results. In total 5242 residents were assessed within 180 days from admission, 730 had diabetes (13.9%). Prevalence of diabetes increased from 9.4% in 2003 to 15% in 2014, with a peak of 19.1% in 2013. Mean age was 81.0 (SD 8.2) and 82.7 (SD 8.7) years for residents with and without diabetes, respectively (p < 0.001). Comorbidities like hypertension, congestive heart-failure, kidney-failure, arthritis, ulcers and amputations were more common among residents with diabetes, whereas cognitive diseases were more common in the other group.  Conclusions. The prevalence of diabetes in Icelandic nursing homes is increasing. Residents with diabetes are younger and have better cognitive performance, but suffer more physical disability and serious comorbidities than others. Nursing homes’ staff need to be current in diabetes management to provide quality care

Changes in home care clients' characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Policymakers advocate extended residence in private homes as people age, rather than relocation to long-term care facilities. Consequently, it is expected that older people living in their own homes will be frailer and have more complex health problems over time. Therefore, community care for aging people is becoming increasingly important to facilitate prevention of decline in physical and cognitive abilities and unnecessary hospital admission and transfer to a nursing home. The aim of this study was to examine changes in the characteristic of home care clients and home care provided in five European countries between 2001 and 2014 and to explore whether home care clients who are most in need of care receive the care required. Methods: This descriptive study used data from two European research projects, Aged in Home Care (AdHOC; 2001-2002) and Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care (IBenC; 2014-2016). In both projects, the InterRAI-Home Care assessment tool was used to assess a random sample of home care clients 65 years and older in five European countries. These data facilitate a comparison of physical and cognitive health and the provided home care between countries and study periods. Results: In most participating countries, both cognitive (measured on the Cognitive Performance Scale) and functional ability (measured on the Activities of Daily Living Hierarchy scale) of home care clients deteriorated over a 10-year period. Home care provided increased between the studies. Home care clients who scored high on the physical and cognitive scales also received home care for a significantly higher duration than those who scored low. Conclusion: Older people in several European countries remain living in their own homes despite deteriorating physical and cognitive skills. Home care services to this group have increased. This indicates that the government policy of long-term residence at own home among older people, even in increased frailty, has been realised. Keywords: AdHOC; Elderly; Formal care; Health care policy; Home care; IBenC; interRAI-home care.University of Iceland Research Fund Foundation of St. Josef's Hospital Icelandic Gerontological Research Center, National University Hospital of Icelan

Fast and simple screening for nutritional status in hospitalized, elderly people

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: Undernutrition has been frequently reported among hospitalized elderly patients. The aim of this study was to evaluate the mini nutrition assessment (MNA) and a screening sheet for malnutrition (SSM) by full nutritional assessment (FNA) in elderly people, and to construct a shorter screening method by combining important questions from MNA and SSM. Having a screening tool as fast and simple as possible could increase its use in clinical routines. METHODS: FNA, MNA and SSM were carried out on 60 hospitalized patients (>65 years). Sensitivity and specificity for MNA and SSM were calculated in comparison with FNA. In order to construct a short and simple screening tool, questions from the two screening tools, which differed significantly between mal- and well-nourished patients, were used in a multivariate, stepwise linear regression. The regression model was simplified to be suitable in clinical routines. RESULTS: Malnourishment was diagnosed by FNA in 58.3% of the elderly patients, with no gender difference. Body mass index, unintended weight loss, recent surgery and loss of appetite were predictors of malnutrition in the regression model (R(2) = 60.1%). The sensitivity and specificity of the simplified regression model were 89 and 88%, respectively, which was more precise than MNA (77 and 36%) and SSM (89 and 60%). CONCLUSION: According to FNA, malnutrition is frequent in elderly hospitalized patients. Four questions are sufficient to conduct precise nutritional screening for malnutrition in elderly hospitalized patients. This new screening tool should be verified in other samples

Clinical features and genotype of adenine phosphoribosyltransferase deficiency in iceland

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe purpose of this study was to characterize the clinical, diagnostic, and prognostic features of adenine phosphoribosyltransferase (APRT) deficiency in Icelandic patients, as well as determine their genotype. Medical records of all known patients in Iceland were reviewed. Urinalysis and polymerase chain reaction-based DNA mutation analysis were performed in all patients, siblings, and living parents of index cases. Twenty-three individuals homozygous for type I APRT deficiency were identified in 16 families from 1983 to 1998. There were 12 males and 11 females, and the median age at diagnosis was 37 years (range, 0.5 to 62 years). Seventeen patients were index cases and 6 patients were diagnosed during screening of first-degree relatives. Eighteen patients had symptomatic disease, 15 of whom experienced nephrolithiasis; 4 patients had mild to moderate renal insufficiency, 1 patient had advanced renal failure, and 1 patient died of uremic complications. Six patients experienced recurrent urinary tract infections and 3 infants had a history of reddish-brown diaper stains. Five patients were asymptomatic; 3 of these patients were diagnosed during routine urinalysis and 2 patients were identified during family screening. Urinary 2,8-dihydroxyadenine crystals were detected in all cases, except for the patient who died of end-stage renal failure. All 23 patients were homozygous for the same mutation (D65V) in the APRT gene. Allopurinol therapy successfully prevented further stone formation and significantly improved renal function in most patients with renal insufficiency. Our results suggest that APRT deficiency may be more common than previously recognized and can lead to severe renal failure if left untreated

Yura Lazovsky as The Barman (standing front left), Vanda Grossen as The Barman's Assistant (sitting centre), and artists of the company, in Union Pacific, Covent Garden Russian Ballet, Australian tour, His Majesty's Theatre, Melbourne, November 1938 [picture] /

From: Union Pacific : an American ballet in one act and four scenes / libretto by Archibald MacLeish ; music by Nicolas Nabokoff based on folk songs of the period 1860.; Inscription: "W26".; Part of the collection: Hugh P. Hall collection of photographs, 1938-1940.; Choreography by Leonide Massine ; scenery by Albert Johnson, executed by Valentine Kashuba ; costumes by Irene Sharaff, executed by B. Karinska.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.pic-vn4179081. One of a collection of photographs taken by Hugh P. Hall of 28 ballet productions performed by the Covent Garden Russian Ballet (toured Australia 1938-1939) and the Original Ballet Russe (toured Australia 1939-1940). These are the second and third of the three Ballets Russes companies which toured Australasia between 1936 and 1940. The photographs were taken from the auditorium during a live performance in His Majesty's Theatre, Melbourne and mounted on cardboard for display purposes. For conservation and storage, the photographs have been demounted. The original arrangement of the photographs has been recorded, and details are available from the Pictures Branch of the National Library