Validation of the ADFICE_IT Models for Predicting Falls and Recurrent Falls in Geriatric Outpatients

Objectives: Before being used in clinical practice, a prediction model should be tested in patients whose data were not used in model development. Previously, we developed the ADFICE_IT models for predicting any fall and recurrent falls, referred as Any_fall and Recur_fall. In this study, we externally validated the models and compared their clinical value to a practical screening strategy where patients are screened for falls history alone. Design: Retrospective, combined analysis of 2 prospective cohorts. Setting and Participants: Data were included of 1125 patients (aged ≥65 years) who visited the geriatrics department or the emergency department. Methods: We evaluated the models' discrimination using the C-statistic. Models were updated using logistic regression if calibration intercept or slope values deviated significantly from their ideal values. Decision curve analysis was applied to compare the models’ clinical value (ie, net benefit) against that of falls history for different decision thresholds. Results: During the 1-year follow-up, 428 participants (42.7%) endured 1 or more falls, and 224 participants (23.1%) endured a recurrent fall (≥2 falls). C-statistic values were 0.66 (95% CI 0.63-0.69) and 0.69 (95% CI 0.65-0.72) for the Any_fall and Recur_fall models, respectively. Any_fall overestimated the fall risk and we therefore updated only its intercept whereas Recur_fall showed good calibration and required no update. Compared with falls history, Any_fall and Recur_fall showed greater net benefit for decision thresholds of 35% to 60% and 15% to 45%, respectively.Conclusions and Implications: The models performed similarly in this data set of geriatric outpatients as in the development sample. This suggests that fall-risk assessment tools that were developed in community-dwelling older adults may perform well in geriatric outpatients. We found that in geriatric outpatients the models have greater clinical value across a wide range of decision thresholds compared with screening for falls history alone.</p

Costs of falls in an ageing population: A nationwide study from the Netherlands (2007-2009)

Background: Falls are a common mechanism of injury in the older population, putting an increasing demand on scarce healthcare resources. The objective of this study was to determine healthcare costs due to falls in the older population. Methods: An incidence-based cost model was used to estimate the annual healthcare costs and costs per case spent on fall-related injuries in patients ≥65 years, The Netherlands (2007-2009). Costs were subdivided by age, gender, nature of injury, and type of resource use. Results: In the period 2007-2009, each year 3% of all persons aged ≥65 years visited the Emergency Department due to a fall incident. Related medical costs were estimated at €675.4 million annually. Fractures led to 80% (€540 million) of the fall-related healthcare costs. The mean costs per fall were €9370, and were higher for women (€9990) than men (€7510) and increased with age (from €3900 at ages 65-69 years to €14,600 at ages ≥85 year). Persons ≥80 years accounted for 47% of all fall-related Emergency Department visits, and 66% of total costs. The costs of long-term care at home and in nursing homes showed the largest age-related increases and accounted together for 54% of the fall-related costs in older people. Discussion: Fall-related injuries are leading to a high healthcare consumption and related healthcare costs, which increases with age. Programmes to prevent falls and fractures should be further implemented in order to reduce costs due to falls in the older population and to avoid that healthcare systems become overburdened

Emergency department visits due to vertebral fractures in the Netherlands, 1986-2008: Steep increase in the oldest old, strong association with falls

Background: Vertebral fractures are a common consequence of osteoporosis in older persons. With the ageing of the population, number

A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients

Publisher Copyright: © 2022, The Author(s).Background: Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods: A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results: Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion: This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients.Peer reviewe

Technologies in Long-Term Care and Nursing Homes

Long-term care is defined as a variety of services designed to meet a person’s health and personal care needs which help people live as independently and safely as possible when they can no longer perform everyday activities on their own. Depending on the needs and social context of the patient, long-term care can be provided in different places by different kinds of formal or informal caregivers, either at home or in an institutionalised setting, which from here on we will refer to as the nursing home. In all these fields, technology has an increasing role to play.</p

Potential influence of aspirin on neopterin and tryptophan levels in patients with a delirium

In an in vitro study, it was found that aspirin might decrease neopterin production and tryptophan degradation. The aim of the present study was to evaluate the possible association between aspirin use and mean neopterin and tryptophan levels in patients with and without a delirium and whether the use of aspirin is associated with a decreased prevalence of delirium. Neopterin and tryptophan levels were determined previously in acutely ill admitted patients aged ≥65 years. The possible influence of aspirin on mean levels of neopterin and tryptophan was investigated with univariate analysis of variance in adjusted models. Eighty-three patients were included; 22 had a delirium. In patients without a delirium (no aspirin (n = 31) versus aspirin (n = 27)), mean neopterin levels were 47.0 nmol/L versus 43.6 nmol/L (p = 0.645) and tryptophan levels were 33.1 μmol/L versus 33.9 μmol/L (p = 0.816). In patients with a delirium (no aspirin (n = 13) versus aspirin (n = 9)), mean neopterin levels were 77.8 nmol/L versus 71.1 nmol/L (p = 0.779) and tryptophan levels were 22.4 μmol/L versus 27.3 μmol/L (p = 0.439). No difference was found in the distribution of aspirin users between patients with and without a delirium. In this study, we found that the use of aspirin had no significant effect on mean levels of neopterin and tryptophan. However, the raw data suggest that there might be a potential influence in patients with a delirium. Aspirin use was not associated with a decreased prevalence of delirium

Disturbed Serotonergic Neurotransmission and Oxidative Stress in Elderly Patients with Delirium

Background: Oxidative stress and disturbances in serotonergic and dopaminergic neurotransmission may play a role in the pathophysiology of delirium. Aims: In this study, we investigated levels of amino acids, amino acid ratios and levels of homovanillic acid (HVA) as indicators for oxidative stress and disturbances in neurotransmission. Methods: Plasma levels of amino acids, amino acid ratios and HVA were determined in acutely ill patients aged ≥65 years admitted to the wards of Internal Medicine and Geriatrics of the Erasmus University Medical Center and the ward of Geriatrics of the Havenziekenhuis, Rotterdam, The Netherlands. Differences in the biochemical parameters between patients with and without delirium were investigated by analysis of variance in models adjusted for age, gender and comorbidities. Results: Of the 86 patients included, 23 had delirium. In adjusted models, higher mean phenylalanine/tyrosine ratios (1.34 vs. 1.14, p = 0.028), lower mean tryptophan/large neutral amino acids ratios (4.90 vs. 6.12, p = 0.021) and lower mean arginine levels (34.8 vs. 45.2 µmol/l, p = 0.022) were found in patients with delirium when compared to those without. No differences were found in HVA levels between patients with and without delirium. Conclusion: The findings of this study suggest disturbed serotonergic neurotransmission and an increased status of oxidative stress in patients with delirium