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

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

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

BackgroundThere is a lack of agreement about applicable instrument to screen frailty in clinical settings.AimsTo analyze the association between frailty and mortality in Finnish community-dwelling older people.MethodsThis 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.ResultsPrevalence 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]).DiscussionFrailty 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.ConclusionsFS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.</div

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Vuoden vuorovaikutusteko -palkinto: Johtajatulet

Prologos ry myönsi Vuoden vuorovaikutusteko -kunniamaininnan Suomen Partiolaisille Johtajatulet-metsäseminaarin järjestämisestä. Tapahtuma järjestettiin syksyllä 2019 Hämeenlinnan Evolla. Metsäseminaarin johtajat Paula Viikari ja Pekka Hankela kertovat, että nykymuotoisenaan tapahtumaa on järjestetty vuodesta 2015 lähtien joka toinen vuosi. Johtajatulilla on kuitenkin esikuva kauempana partion toiminnassa, johon tapahtuman nimikin viittaa: partionjohtajilla on ollut tapana kerääntyä yhdessä nuotiotulien äärelle keskustelemaan vertaisten kesken johtamisesta

Johtajatulet - vuorovaikutuksen äärellä nuotiopiirissä

Vuoden 2019 vuorovaikutusteko -kunniamaininta: Suomen Partiolaisten Johtajatulet-seminaari Prologos ry myönsi Vuoden vuorovaikutusteko -kunniamaininnan Suomen Partiolaisille Johtajatulet-metsäseminaarin järjestämisestä. Tapahtuma järjestettiin syksyllä 2019 Hämeenlinnan Evolla. Metsäseminaarin johtajat Paula Viikari ja Pekka Hankela kertovat, että nykymuotoisenaan tapahtumaa on järjestetty vuodesta 2015 lähtien joka toinen vuosi. Johtajatulilla on kuitenkin esikuva kauempana partion toiminnassa, johon tapahtuman nimikin viittaa: partionjohtajilla on ollut tapana kerääntyä yhdessä nuotiotulien äärelle keskustelemaan vertaisten kesken johtamisesta

Evaluating agri-environmental indicators (AEIs) : use and limitations of international indicators at national level

v2007okL-talon kirjasto(YHA). Yksikön huom.: MAA, MYKMY