Vanhuksen toimintakyvyn arviointi akuuttisairaanhoidossa

Akuutisti sairaan iäkkään potilaan optimaalisen hoidon suunnittelu ja toteuttaminen edellyttävät paitsi sairauksien ja lääkehoidon selvittämistä, myös käsitystä potilaan toimintakyvystä ennen sairautta. Toimintakyky on hyvä kartoittaa järjestelmällisesti, ja apuna voidaan käyttää tarkoitusta varten kehitettyjä rakenteisia arviointilomakkeita. Käytännössä toimintakykyyn vaikuttavien tekijöiden selvittäminen onnistuu parhaiten tiimissä, johon kuuluu vähintään sairaanhoitaja ja lääkäri. Kerätyn tiedon perusteella muodostetaan käsitys potilaan toimintakyvystä sekä siitä, kuinka nopeasti ja miten se on vastaanottotilanteeseen johtaneen sairauden vaikutuksesta muuttunut. Toimintakyvystä saatua tietoa hyödynnetään muun muassa hoidon tavoitteiden määrittämisessä ja vuodeosastohoitoon liittyvien riskien minimoinnissa.</p

Eläköityvien terveyden edistämiseen kannattaa panostaa

Keskimääräisen eliniän pidentyessä myös eläkkeellä vietetyt vuodet lisääntyvät. Jotta nämä vuodet olisivat mahdollisimman terveitä ja toimintakykyisiä, terveyden edistämiseen tähtäävät toimet tulisi aloittaa riittävän varhain. Eläköityminen itsessään tarjoaa hyvän mahdollisuuden elintapojen tarkasteluun ja tarvittavien muutosten tekemiseen, koska työhön liittyvät kuormitustekijät poistuvat ja aikaa itsestä huolehtimiseen on enemmän. Ikääntyvän väestön terveyden edistämisen näkökulmasta eläköityminen on hyvä ajankohta vaikuttaa koko ikäryhmään. Toisaalta sairauksien ehkäisyn ja toimintakyvyn säilymisen kannalta erityisen tärkeää on tunnistaa ajoissa riskihenkilöt ja kohdentaa jatkotoimenpiteet heihin. Tutkimukset ovat osoittaneet ehkäisyn hyödyt erityisesti sydän- ja verisuonisairauksien hoidossa, kaatumisten ja murtumien ehkäisyssä sekä kognitiivisen ja fyysisen toimintakyvyn ylläpitämisessä. Terveysteknologia on avannut uusia mahdollisuuksia ehkäisyyn ja hoidon seurantaan myös ikäihmisten osalta. </p

Frailty and mortality : an 18-year follow-up study among Finnish community-dwelling older people

Background There is a lack of agreement about applicable instrument to screen frailty in clinical settings. Aims To analyze the association between frailty and mortality in Finnish community-dwelling older people. Methods This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. Results Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and FI (5.97 [4.13-8.64], and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). Discussion Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. Conclusions FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.Peer reviewe

Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study

Purpose To examine the effect of predictive factors on institutionalization among older patients. Methods The participants were older (aged 75 years or older) home-dwelling citizens evaluated at Urgent Geriatric Outpatient Clinic (UrGeriC) for the first time between the 1st of September 2013 and the 1st of September 2014 (n = 1300). They were followed up for institutionalization for 3 years. Death was used as a competing risk in Cox regression analyses. Results The mean age of the participants was 85.1 years (standard deviation [SD] 5.5, range 75-103 years), and 74% were female. The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The mean age for institutionalization was 86.1 (SD 5.6) years. According to multivariate Cox regression analyses, the use of home care (hazard ratio 2.43, 95% confidence interval 1.80-3.27, p = 95 vs. 75-84; 1.65, 1.03-2.62, p = 0.036), and falls during the previous 12 months (>= 2 vs. no falls; 1.54, 1.10-2.16, p = 0.012) significantly predicted institutionalization during the 3-year follow-up. Conclusion Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home.Key summary pointsAim To examine the effect of predictive factors on institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic during a 3-year follow-up. Findings The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The use of home care, dementia, higher age and falls during the previous 12 months significantly predicted institutionalization during the follow-up. Message Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home.</div

Hostile parenting, parental psychopathology, and depressive symptoms in the offspring : a 32-year follow-up in the Young Finns study

Background: Both hostile parenting and parental psychopathology have been shown to predict depression in the offspring. However, whether and how they interact in predicting the longitudinal course of depression from adolescence to adulthood remains unclear. Methods: Participants were from the prospective Cardiovascular Risk in Young Finns study, aged 3-18 years at baseline in 1980. We used multilevel modeling for repeated measurements to examine the associations of hostile parenting (i.e., parental intolerance and emotional distance) and parental history of psychopathology with trajectories of depressive symptoms across five study phases from 1992 to 2012. Results: On average, depressive symptoms decreased in a curvilinear pattern with age. A relatively steep decreasing trend was also observed among offspring of parents with a history of psychopathology but low intolerance. By contrast, among the offspring of parents with a history of psychopathology and high intolerance there was a rising trend in depressive symptoms starting from young adulthood. There was no similar interaction between parental history of psychopathology, emotional distance, and age. Limitations: Non-standardized, parental self-report scales were used to measure hostile parenting. The observed effects were small, and the depressive symptoms scale applied in the study may not be used for measuring clinical depression. Conclusions: Parental psychopathology might render individuals sensitive to the unfavorable characteristics of the caregiving environment. Intolerance towards the child can exacerbate the effects of parental psychopathology and have a long-term significance on the developmental trajectory of depressive symptoms over the life course.Peer reviewe

Urgent Geriatric Outpatient Clinic - Easy Access to Comprehensive Geriatric Assessment for Older Home-Dwelling Persons Living with Frailty

Background: Emergency departments (ED) are not designed to meet the complex medical and social needs of older people. An easy access Urgent Geriatric Outpatient Clinic (UrGeriC) was started in order to provide rapid and more appropriate care and assistance for frail older people struggling to manage at home.Methods: Participants were older Finnish home-dwelling citizens who had presented themselves in August 2015 to Turku City Hospital UrGeriC (n = 76) or ED of Turku University Hospital (n = 216) and who were discharged home.Results: UrGeriC patients were older (85.7 +/- 5.4) (mean age +/- SD) than ED patients (83.3 +/- 5.3) (p .001). No significant differences were found in staying at home four weeks (unadjusted OR 1.69 [95% CI 0.62-4.62], p = .305; adjusted 1.42 [0.50-4.01], p = .507) or one year (unadjusted 1.53 [0.69-3.41], p = .295; adjusted 1.51 [0.65-3.50], p = .339) after discharge between UrGeriC and ED patients.Conclusions: According to our preliminary results, UrGeriC could be a suitable way to support the home care of multimorbid geriatric patients struggling to live at home. Copyright (C) 2019, Taiwan Society of Geriatric Emergency & Critical Care Medicine

A Longitudinal Multilevel Study of the “Social” Genotype and Diversity of the Phenotype

Sociability and social domain-related behaviors have been associated with better well-being and endogenous oxytocin levels. Inspection of the literature, however, reveals that the effects between sociability and health outcomes, or between sociability and genotype, are often weak or inconsistent. In the field of personality psychology, the social phenotype is often measured by error-prone assessments based on different theoretical frameworks, which can partly explain the inconsistency of the previous findings. In this study, we evaluated the generalizability of “sociability” measures by partitioning the population variance in adulthood sociability using five indicators from three personality inventories and assessed in two to four follow-ups over a 15-year period (n = 1,573 participants, 28,323 person-observations; age range 20–50 years). Furthermore, we tested whether this variance partition would shed more light to the inconsistencies surrounding the “social” genotype, by using four genetic variants (rs1042778, rs2254298, rs53576, rs3796863) previously associated with a wide range of human social functions. Based on our results, trait (between-individual) variance explained 23% of the variance in overall sociability, differences between sociability indicators explained 41%, state (within-individual) variance explained 5% and measurement errors explained 32%. The genotype was associated only with the sociability indicator variance, suggesting it has specific effects on sentimentality and emotional sharing instead of reflecting general sociability

Vanhoista vanhimpien elämänlaatu

Tutkimuksen tarkoituksena oli arvioida 95-vuotiaiden koettua elämänlaatua sekä tyytyväisyyttä elämänlaadun fyysiseen, psyykkiseen, sosiaaliseen ja elinympäristöön liittyvään elämänlaadun ulottuvuuteen. Tutkimuksessa kohdejoukkona olivat turkulaiset kotona tai laitoshoidossa asuneet vuonna 1920 syntyneet (n=58). Elämänlaatua arvioitiin WHOQOL-Bref-mittarilla. Tulosten mukaan 52:stä (49 %) elämänlaatukyselyyn vastanneesta melkein kolme neljäsosaa (73 %) koki elämänlaatunsa hyväksi tai erittäin hyväksi ja oli melko tai erittäin tyytyväinen terveyteensä. Vastaajat kokivat elämänlaatunsa ulottuvuuksista parhaaksi elinympäristöön liittyvän ulottuvuuden (keskiarvopisteet 77,8) ja heikommaksi psyykkisen ulottuvuuden (60,9). Siitä huolimatta, että psyykkinen ulottuvuus koettiin heikoimmaksi elämänlaadun ulottuvuudeksi, yli puolet vastaajista koki nauttivansa elämästä ja kaksi kolmasosaa koki elämänsä vähintään kohtuullisen merkitykselliseksi. Tämän tutkimuksen tulokset vahvistavat tietoa siitä, että parhaiten pärjäävällä osalla hyvin iäkkäistä elämänlaatu säilyy pääsääntöisesti hyvänä korkeaan ikään saakka

Psychosocial resources related to survival among non-robust community-dwelling older people : an 18-year follow-up study

Purpose Psychosocial resources have been considered to be associated with survival among frail older adults but the evidence is scarce. The aim was to investigate whether psychosocial resources are related to survival among non-robust community-dwelling older people. Methods This is a prospective study with 10- and 18-year follow-ups. Participants were 909 non-robust (according to Rockwood's Frailty Index) older community-dwellers in Finland. Psychosocial resources were measured with living circumstances, education, satisfaction with friendship and life, visiting other people, being visited by other people, having someone to talk to, having someone who helps, self-rated health (SRH) and hopefulness about the future. To assess the association of psychosocial resources for survival, Cox regression analyses was used. Results Visiting other people more often than once a week compared to that of less than once a week (hazard ratio 0.61 [95% confidence interval 0.44-0.85], p = 0.003 in 10-year follow-up; 0.77 [0.62-0.95], p = 0.014 in 18-year follow-up) and good SRH compared to poor SRH (0.65 [0.44-0.97], p = 0.032; 0.68 [0.52-0.90], p = 0.007, respectively) were associated with better survival in both follow-ups. Visiting other people once a week (compared to that of less than once a week) (0.77 [0.62-0.95], p = 0.014) was only associated with better 18-year survival. Conclusions Psychosocial resources, such as regularly visiting other people and good self-rated health, seem to be associated with better survival among non-robust community-dwelling Finnish older people. This underlines the importance of focusing also on psychosocial well-being of frail older subjects to remain or promote their resilience. Key summary pointsAim To investigate whether psychosocial resources are associated with survival among non-robust community-dwelling older Finnish people during an 18-year follow-up. Findings Psychosocial resources, such as good self-rated health and regularly visiting other people, were significantly associated with better survival of non-robust older people. Message It is important to focus also on psychological well-being, together with physical activity and nutrition, of frail older people to remain or promoting their capacity.Peer reviewe

Ideal cardiovascular health in adolescents and young adults is associated with alexithymia over two decades later : Findings from The Cardiovascular Risk in Young Finns Study: Department: Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland

We evaluated the association of cardiovascular health in adolescence and young adulthood with alexithymia 25 years later. The study sample (n=1122) participated in evaluations conducted in 1986 (baseline) and in 2011−2012 (T2). Baseline health factors and behaviors were assessed utilizing seven ideal cardiovascular health metrics (ICH index) including blood pressure, cholesterol and glucose levels, smoking, physical activity, body-mass-index, and diet. The stability of the ICH index was evaluated with corresponding assessments in 2007 (T1). At T2, alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). The main analyses were conducted using ANCOVA and adjusted for depression, age, and present social and lifestyle factors. TAS-20 subscales, Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally Oriented Thinking, were analyzed separately. The ICH index was significantly associated with the TAS-20 total score, as well as both with DIF and DDF. A less ideal cardiovascular health was associated with higher alexithymia scores. However, regarding the separate factors, only the association between non-ideal dietary habits and DIF was significant in the multivariate analyses. The baseline ICH index score was stable from baseline to T1. We conclude that non-ideal cardiovascular lifestyle habits in adolescence and young adulthood are significantly associated with later alexithymia.Peer reviewe