Acceptance and compliance with external hip protectors: A systematic review of the literature

Hip fractures may be prevented by the use of external hip protectors, but compliance is often poor. Therefore, the objective of this study was to assess the determinants of compliance with hip protectors by systematically reviewing the literature. A literature search was performed in PubMed, Embase and the Cochrane Library. Primary acceptance with hip protectors ranged from 37% to 72% (median 68%); compliance varied between 20% and 92% (median 56%). However, in most studies it was not very clear how compliance was defined (e.g., average wearing time on active days and during waking hours, number of user-days per all available follow-up days, percentage falls with hip protector) and how it was measured. To provide more insight in the compliance percentages, the different methods of defining and measuring compliance were presented for the selected studies, when provided. Because of the heterogeneity in study design of the selected studies and the lack of quantitative data in most studies, results regarding the determinants of compliance could not be statistically pooled. Instead a qualitative summary of the determinants of compliance was given. The reasons most frequently mentioned for not wearing hip protectors, were: not being comfortable (too tight/poor fit); the extra effort (and time) needed to wear the device; urinary incontinence; and physical difficulties/illnesses. In conclusion, compliance is a very complex, but important issue in hip protector research and implementation. Based on the experiences of elderly people who wear the hip protectors, adjustments should be made to the protector and the underwear, while maintaining the force attenuation capacity. Furthermore, methods to improve the compliance should be developed, and their effectiveness tested. (aut.ref.

I'll stand next to them until they don't need me anymore'. :Voluntary work in debt counseling in Rotterdam

De schuldenproblematiek in Nederland neemt toe. Gemeenten en welzijnsorganisaties ontwikkelen daarom verschillende interventies gericht op vroegsignalering en het toeleiden van burgers met schulden naar professionele schuldhulpverlening. Vrijwilligers spelen een belangrijke rol in deze interventies. Dit artikel biedt inzicht in de waarde en worstelingen van vrijwilligerswerk in deschuldhulpverlening, door de bevindingen te presenteren van een casusonderzoek naar de ervaren effectiviteit van vrijwillige inzet bij een lokaal schuldhulpverleningsproject in Rotterdam. Uit het onderzoek blijkt dat de ervaren effectiviteit van vrijwillige inzet in het project bepaald wordt door zeven factoren: (1) tijd, (2) taal en cultuur, (3) positie als vrijwilliger, (4) warme overdracht, (5) sociale steun, (6) praktische hulp, (7) belangenbehartiging en bemiddeling. De aandachtspunten in het project zijn: (1) onduidelijke taak- en rolverdeling tussen vrijwilligers en beroepskrachten, (2) grensbewaking, (3) begeleidingsduur, (4) verantwoording werkzaamheden en aansturing vrijwilligers, (5) professionele ontwikkeling. De studie laat zien dat vrijwilligers mensen met schuldenproblemen in een vroeger stadium naar professionele schuldhulpverlening kunnen begeleiden en hen sociale en praktische steun bieden. Het begeleiden en ondersteunen van mensen met (ernstige) schuldenproblemen vraagt echter veel van de kennis, vaardigheden en houding van vrijwilligers. Vrijwillige inzet bij schuldhulpverlening is belangrijk, maar kan professionele schuldhulpverlening niet vervangen. TREFWOORDENSchuldhulpverlening, schulden, sociaal werk, vrijwilligers, vrijwilligerswerk, samenwerking beroepskrachten en vrijwilligersABSTRACTHousehold debt problems in the Netherlands are rising. Municipalities and social welfare organisations are developing interventions aimed at guiding people with debt problems to professional debt counselling at an early stage. Volunteers play an important role in these interventions. This article provides insight into the value and struggles of voluntary work in debt counselling, through presenting the findings of a case study into the perceived effectiveness of voluntary work in a debt counselling programme in Rotterdam. The findings show that the perceived effectiveness of voluntary work in the programme depends on seven factors: (1) time, (2) language and culture, (3) position as volunteer, (4) ‘warm transfer’, (5) social support, (6) practical help, (7) advocating and mediating. Bottlenecks in the programme are: (1) unclear task- and role divisions, (2) guarding boundaries, (3) duration of support, (4) accountability and managing volunteers, (5) professional development. The article shows that volunteers can guide people with debt problems to professional debt counselling at an earlier stage and can offer them much needed social and practical support. However, guiding and supporting people with (severe) debt problems requires a specific set of knowledge, skills and attitudes. Voluntary work is important, but should not replace professional debt counselling

Levenswaardering bij ouderen (LWO): de validering van een meetinstrument

De doelstelling van dit onderzoek is de aanpassing en validering van een door Lawton en collega’s ontwikkelde schaal “Valuation of Life”, door ons vertaald als Levenswaardering. Lawton et al. ontwikkelden deze schaal om te laten zien dat naast de gezondheidsgerelateerde kwaliteit-van-leven (GKvL) er een andere kwaliteitsdimensie is die inzicht kan verschaffen in de subjectieve gezondheidsutiliteit op latere leeftijd, waaronder opvattingen over de gewenste levensduur en/of over levensverlenging en –beëindiging. Na een geautoriseerde vertaling is de schaal geïmplementeerd in de vierde waarneming van de LASA studie (2001-2002). In totaal hebben 1139 respondenten van 65-95 jaar de schaal ingevuld. Uitgebreide structuuranalyses leidden tot de conclusie dat de oorspronkelijke 19-item schaal tot een schaal van Levenswaarderingbij- Ouderen van 12 items kan worden gereduceerd, welke op te delen valt in drie subschalen: Veerkracht, Ambitie en Levenslust. Er blijkt nauwelijks overlap te zijn met de GKvL terwijl de overlap met min of meer objectieve gezondheidsmaten (discriminante validiteit) beperkt blijft. Er blijkt wel een verwantschap met de zg. positieve zelfbelevingsmaten (concurrente validiteit). We concluderen dan ook dat de LWO-schaal de waardering meet die iemand aan het leven hecht, waarbij er in de schaal-items geen enkele expliciete verwijzing is naar gezondheidsaspecten. De uiteindelijke toets voor het belang van de LWO-schaal zal moeten blijken in de onafhankelijke voorspellende kracht van de gezondheidsutiliteit die in een volgend artikel nader onderzocht gaat worden

Clinical osteoarthritis of the hip and knee and fall risk: The role of low physical functioning and pain medication

Objective: Several studies have found an increased fall risk in persons with osteoarthritis (OA). However, most prospective studies did not use a clinical definition of OA. In addition, it is not clear which factors explain this risk. Our objectives were: (1) to confirm the prospective association between clinical OA of the hip and knee and falls; (2) to examine the modifying effect of sex; and (3) to examine whether low physical performance, low physical activity and use of pain medication are mediating these relationships. Methods: Baseline and 1-year follow-up data from the European Project on OSteoArthritis (EPOSA) were used involving pre-harmonized data from five European population-based cohort studies (ages 65 85, n = 2535). Clinical OA was defined according to American College of Rheumatology (ACR) criteria. Falls were assessed using self-report. Results: Over the follow-up period, 27.7% of the participants fell once or more (defined as faller), and 9.8% fell twice or more (recurrent faller). After adjustment for confounding, clinical knee OA was associated with the risk of becoming a recurrent faller (relative risk=1.55; 95% confidence interval: 1.10 2.18), but not with the risk of becoming a faller. No associations between clinical hip OA and (recurrent) falls were observed after adjustment for confounding. Use of opioids and analgesics mediated the associations between clinical OA and (recurrent) falls, while physical performance and physical activity did not. Conclusion: Individuals with clinical knee OA were at increased risk for recurrent falls. This relationship was mediated by pain medication, particularly opioids. The fall risk needs to be considered when discussing the risk benefit ratio of prescribing these medicationsSources of support: The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports (grant no 311669, grant recipient D.J.H. Deeg). The Pe~nagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (grant no FIS PI 05/1898; FIS RETICEF RD06/0013/1013 and FIS PS09/02143, grant recipients A. Otero, M.V. Castell). The Hertfordshire Cohort Study is supported by the Medical Research Council of Great Britain, Versus Arthritis, the British Heart Foundation and the International Osteoporosis Foundation (grant no MRC_MC_UP_A620_1014, grant recipients C. Cooper, E. Dennison). The Italian cohort was supported by the National Research Council of Italy (CNR), Research Project “Aging: molecular and technological innovations for improving the health of the elderly population" (Prot. MIUR 2867, grant recipient: S. Maggi). The Swedish Twin Registry is managed by Karolinska Institutet and receives funding through the Swedish Research Council (grant no 2017-00641, grant recipient Karolinska Institutet

The role of plasma concentrations and drug characteristics of beta-blockers in fall risk of older persons

Beta-blocker usage is inconsistently associated with increased fall risk in the literature. However, due to age-related changes and interindividual heterogeneity in pharmacokinetics and dynamics, it is difficult to predict which older adults are more at risk for falls. Therefore, we wanted to explore whether elevated plasma concentrations of selective and nonselective beta-blockers are associated with an increased risk of falls in older beta-blocker users. To answer our research question, we analyzed samples of selective (metoprolol, n = 316) and nonselective beta-blockers (sotalol, timolol, propranolol, and carvedilol, n = 179) users from the B-PROOF cohort. The associations between the beta-blocker concentration and time to first fall were assessed using Cox proportional hazard models. Change of concentration over time in relation to fall risk was assessed with logistic regression models. Models were adjusted for potential confounders. Our results showed that above the median concentration of metoprolol was associated with an increased fall risk (HR 1.55 [1.11–2.16], p =.01). No association was found for nonselective beta-blocker concentrations. Also, changes in concentration over time were not associated with increased fall risk. To conclude, metoprolol plasma concentrations were associated with an increased risk of falls in metoprolol users while no associations were found for nonselective beta-blockers users. This might be caused by a decreased β1-selectivity in high plasma concentrations. In the future, beta-blocker concentrations could potentially help clinicians estimate fall risk in older beta-blockers users and personalize treatment.</p

Development of a clinical prediction model for the onset of functional decline in people aged 65-75 years: Pooled analysis of four European cohort studies

Background: Identifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65-75 years old. Methods: Four population-based cohort studies were pooled for the analysis: ActiFE-ULM (Germany), ELSA (United Kingdom), InCHIANTI (Italy), LASA (Netherlands). Included participants were 65-75 years old at baseline and reported no limitations in functional ability in ADL at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Participants who reported at least some limitations at three-year follow-up on any of the five items were classified as experiencing functional decline. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation by alternating the data from the four cohort studies to assess the discrimination and calibration across the cohorts. Results: Two thousand five hundred sixty community-dwelling people were included in the analyses (mean age 69.7 ± 3.0 years old, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model included 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. The calibration intercept was 0.06 and the calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts. Conclusions: Based on pooled cohort data analyses we were able to show that the onset of functional decline in ADL in three years in older people aged 65-75 years can be predicted by specific physical performance measures, age, body mass index, presence of depressive symptoms, and chronic conditions. The prediction model showed good discrimination and calibration, which remained stable across the four cohorts, supporting external validity of our findings

Impact of prevalent and incident vertebral fractures on utility: results from a patient-based and a population-based sample

Data are scarce on the impact of vertebral fractures (VFX) on utility. The objective of this study was to assess the impact of prevalent and incident VFX on utility in both a patient-based and population-based sample. Data from the Multiple Outcomes of Raloxifene Evaluation (MORE) study (n = 550 for prevalent VFX and n = 174 for incident VFX) and the European Prospective Osteoporosis Study (EPOS) (n = 236) were used. Utility was assessed by the index score of the EQ-5D. In the MORE study, highly statistically significant associations were found between utility and the presence of prevalent VFX (p < 0.001), number of prevalent VFX (p < 0.001), severity of prevalent VFX (p < 0.001), the combination of number and severity of prevalent VFX (p = 0.001) and location of prevalent VFX (p = 0.019). The mean utility was significantly lower among women who suffered an incident VFX (utility = 0.67) than among women who did not (utility = 0.77) (p = 0.005), although utility loss was not significantly different between the two groups (p = 0.142). In EPOS, the combination of number and severity of incident VFX was significantly related to utility (p = 0.030). In conclusion, utility is lower among persons with prevalent and incident VFX, especially in a patient-based sample. Utility loss was not significantly different between women without and with incident VFX

Peak expiratory flow rate shows a gender-specific association with vitamin D deficiency

Context: To our knowledge, no previous studies examined the longitudinal relationship between vitamin D status and pulmonary function in a population-based sample of older persons. Objective: Our objective was to examine the cross-sectional as well as the longitudinal relationship between vitamin D status and peak expiratory flow rate (PEFR) in a representative sample of the Dutch older population. Design, Setting, and Participants: Participants included men and women in the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people. Main Outcome Measure: PEFR was measured using the mini-Wright peak flow meter. Results: Men with serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (25 nmol/liter) had a significantly lower PEFR in the cross-sectional analyses, and men with serum 25-OHD levels below 20 ng/ml (50 nmol/liter) had a significantly lower PEFR in the longitudinal analyses as compared with men with serum 25-OHD levels above 30 ng/ml (75 nmol/liter) (cross-sectional: β = -47.0, P = 0.01 for serum 25-OHD<10 ng/ml; longitudinal: β = -45.0, P<0.01 for serum 25-OHD<10 ng/ml; and β = -20.2, P = 0.03 for serum 25-OHD = 10-20 ng/ml in the fully adjusted models). Physical performance (β = -32.5, P = 0.08 for serum 25-OHD<10 ng/ml) and grip strength (β = -40.0, P = 0.03 for serum 25-OHD <10 ng/ml) partly mediated the cross-sectional associations but not the longitudinal associations. In women, statistically significant associations between 25-OHD and PEFR were observed in the cross-sectional analyses after adjustment for age and season of blood collection but not in the fully adjusted models or in the longitudinal analyses. Conclusions: A strong relationship between serum 25-OHD and PEFR was observed in older men, both in the cross-sectional as well as longitudinal analyses, but not in older women. The association in men could partly be explained by physical performance and muscle strength. Copyright © 2012 by The Endocrine Society

Sunlight exposure or vitamin D supplementation for vitamin D-deficient non-western immigrants: a randomized clinical trial

Summary: Vitamin D deficiency is very common in non-western immigrants. In this randomized clinical trial, vitamin D 800 IU/day or 100,000 IU/3 months were compared with advised sunlight exposure. Vitamin D supplementation was more effective than advised sunlight exposure in improving vitamin D status and lowering parathyroid hormone levels. Introduction: Vitamin D deficiency (25-hydroxyvitamin D [25(OH)D]<25 nmol/l) is common among non-western immigrants. It can be treated with vitamin D supplementation or sunlight exposure. Methods: To determine whether the effect of vitamin