Body mass index in nursing home residents during the first year after admission

La desnutrición, que comprende tanto la desnutrición como el sobrepeso, debe ser abordada en el seguimiento médico de los adultos mayores debido a las consecuencias negativas para el estado funcional y la salud general. Aún así, se sabe poco sobre el estado nutricional de los residentes de hogares de ancianos (NH), especialmente con respecto al aumento o la pérdida de peso después de la admisión a NH. Por lo tanto, este estudio tiene como objetivo evaluar los cambios en el índice de masa corporal (IMC) durante el primer año posterior al ingreso a NH y explorar las características demográficas y clínicas relacionadas con los cambios en el IMC. Métodos Se combinaron los datos de dos estudios prospectivos que reclutaron participantes al ingreso a NH. Las características demográficas y clínicas, incluido el IMC, se evaluaron al inicio y después de un año. Se estimó un modelo de regresión lineal para explorar el impacto de las características demográficas y clínicas en el cambio del IMC. Resultados La cohorte del estudio constaba de 1044 participantes con una edad media de 84,3 años (DE 7,6) al inicio del estudio; El 64,2% eran mujeres. Al inicio del estudio, el 33% de los residentes de NH tenían desnutrición severa a moderada, mientras que el 10% eran obesos. Durante el primer año de su estadía en NH, los residentes con desnutrición severa a moderada tuvieron un aumento promedio en el IMC de 1,3 kg/m2 (DE 2,2; p < 0,001), mientras que los cambios de peso fueron muy pequeños o no significativos en los otros grupos de IMC . Las características relacionadas con el aumento de peso fueron una edad más joven y menos agitación. Conclusión La desnutrición es un desafío de salud común al momento de la admisión a NH, con un tercio de los residentes de NH con un peso bajo moderado a severo y un 10% con obesidad. Sin embargo, durante el primer año de estancia en NH, hubo una evolución favorable para los residentes de NH con bajo peso, ya que aumentaron su IMC, y el 43,6% cambió a una clasificación de mayor peso, mientras que no observamos cambios en el IMC en los residentes con obesidad. Dado que los residentes de NH se encuentran en la última fase de sus vidas, las intervenciones para prevenir la desnutrición o el sobrepeso deben iniciarse mientras aún viven en el hogar y luego continuar en los hogares de ancianos.Q2Q2Malnutrition - comprising both undernutrition and overweight - has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes. Methods Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI. Results The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation. Conclusion Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes.https://orcid.org/0000-0001-5832-0603https://scholar.google.com/citations?user=MrICwaMAAAAJ&hl=enhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001429659Revista Internacional - IndexadaS

Economic aspects of Parkinson’s disease

Background: Next to Alzheimer’s disease, Parkinson’s disease (PD) is the second most neurodegenerative disease. As the population structure in the industrialized and industrializing countries is changing, an increasing prevalence of diseases typical for the elderly is projected within the next decades. The burden of disease, cost driving factors and the effectiveness of disease management options are therefore important information, as health and social care systems must prepare for a rising demand for economic resources and trained personnel within the health care sector. Objectives: The objective of this thesis was to describe different aspects of the economic burden of PD as drug costs, institutional care, hospitalization and the cost-effectiveness of the disease management. Subjects: In the first study we evaluated a group of 286 consecutive patients with PD searching free advice in a German counseling program and a group of 152 consecutive Norwegian patients with PD being followed at the outpatient clinic of the Stavanger University Hospital. In the second and third study we included the 108 patients with PD from a population-based prospective longitudinal study in Southern Rogaland, Norway, who were living in the municipality of Stavanger at baseline. Through the National registry we identified eight control subjects for every patient with PD that matched in sex and age and were living in Stavanger at baseline. In the fourth study we included 199 patients participating in a population-based prospective longitudinal study of patients with incident PD from Western and Southern Norway. Among relatives and acquaintances of the patients 205 controls were recruited. We included a subset of 172 control individuals who provided the best possible group match regarding sex, age and education and complete information about their health status. Methods: In the first study data about disease duration, disease severity as measured by Hoehn and Yahr (HY) stage, and drug use were collected for both patient groups in a crosssectional study design. In the second study, for patients with PD data about disease duration, disease severity as measured by HY stage, cognitive functioning as measured by the Mini Mental State Examination (MMSE), date of permanent admission to a nursing home and date of death were collected from the patient files and the municipality’s registration systems during a 12-year observation period. For controls, data about age, date of admission to a nursing home and date of death were collected from the municipality’s registration systems and the National registry. In the third study data about hospital admissions, length of stay and diagnoses at discharge were collected from the files of the Stavanger University Hospital for patients and controls over a 12-year observation period. In the fourth study, for the patients with PD data about disease severity as measured by HY stage and the Unified Parkinson’s Disease Rating Scale (UPDRS), health status as measured by the Short form 36 (SF-36) and drug use was registered during the first year of medical treatment. For controls independency in daily living as measured by the UPDRS part II and the SF-36 were registered during the same period. To evaluate health state values, the data of the SF-36 were converted to the Short Form-6D (SF-6D). Results: We found that drug expenses rose with disease duration and disease severity both in the German and the Norwegian study cohort. However, expenses were markedly higher in the German cohort with Euro 5.78 versus Euro 3.92 per patient and day, partly due to an earlier switch from mono- to multi-drug therapy during the course of the disease. Patients with PD had a five-fold higher risk for living in a nursing home as compared to controls. Based on 2007 prices, the incremental costs for institutional care were Euro 14 897 per person year of survival. There was no significant difference between patients with PD and controls regarding the number of individuals being admitted to hospital, numbers of admission, or length of stay. However, we found that patients with PD were more often admitted for trauma, while cardio-vascular diseases and cancer were markedly more common in control individuals. Patients with PD had significantly lower health state values as compared to controls. Patients starting on antiparkinsonian drugs had an improvement in utility scores of 0.039 from 0.667 to 0.706. The incremental cost-effectiveness ratio (ICER) was Euro 45 259 per quality adjusted life year (QALY) during the first year of treatment, of which two thirds were caused by drugs and one third by costs for clinical consultations. Conclusion: We could show that the use of control cohorts adds valuable information to the evaluation of the burden of disease and helps to discern costs related to a certain disease from costs caused by general age-related morbidity. We could further show that prescription habits may differ markedly from country to country and that the ICER during the first year of treatment is high. Therefore, disease management should be monitored carefully to provide an optimal quality of treatment as well as cost-effectiveness. However, more research is necessary to evaluate the full burden of PD and to explore efficacy and effectiveness of the different disease management options

Mortality in nursing home residents: A longitudinal study over three years

Objective: Nursing home (NH) stay is the highest level of formal care. With the expected demographic changes ahead, the need for NH placement will put an increasing socioeconomic strain on the society. Survival in NHs and factors predicting survival are important knowledge in order to evaluate NH admission policies and plan future NH capacity. Methods: We followed 690 NH residents included at admission to NH over a period of three years. Participants were examined at baseline (BL) and every six months. Demographic and clinical data were collected, including comorbidity, severity of cognitive impairment, dependency in activities of daily living (ADL) and neuropsychiatric symptoms. Median survival was calculated by the Kaplan-Meier analysis, and factors associated with mortality were identified by Cox models with baseline and time-dependent covariates. Results: Median survival in NH was 2.2 years (95% confidence interval [CI]: 1.9–2.4). Yearly mortality rate throughout the three-year observation period was 31.8%. Mortality was associated with higher age and comorbidity at BL, and more severe dementia, higher ADL-dependency, less severe psychotic symptoms, and a lower BMI throughout the study period. Of the organizational variables, living on a ward with more residents resulted in a higher risk of mortality. Conclusion: In conclusion, the NH mortality rate remained stable throughout the three-year study period with about one third of the residents deceasing each year. Individual resident characteristics appeared to be more important than organizational variables for predicting mortality risk. The finding of an association between ward size and mortality risk deserves further investigation in future studies

Mortality in nursing home residents: A longitudinal study over three years

OBJECTIVE: Nursing home (NH) stay is the highest level of formal care. With the expected demographic changes ahead, the need for NH placement will put an increasing socioeconomic strain on the society. Survival in NHs and factors predicting survival are important knowledge in order to evaluate NH admission policies and plan future NH capacity. METHODS: We followed 690 NH residents included at admission to NH over a period of three years. Participants were examined at baseline (BL) and every six months. Demographic and clinical data were collected, including comorbidity, severity of cognitive impairment, dependency in activities of daily living (ADL) and neuropsychiatric symptoms. Median survival was calculated by the Kaplan-Meier analysis, and factors associated with mortality were identified by Cox models with baseline and time-dependent covariates. RESULTS: Median survival in NH was 2.2 years (95% confidence interval [CI]: 1.9-2.4). Yearly mortality rate throughout the three-year observation period was 31.8%. Mortality was associated with higher age and comorbidity at BL, and more severe dementia, higher ADL-dependency, less severe psychotic symptoms, and a lower BMI throughout the study period. Of the organizational variables, living on a ward with more residents resulted in a higher risk of mortality. CONCLUSION: In conclusion, the NH mortality rate remained stable throughout the three-year study period with about one third of the residents deceasing each year. Individual resident characteristics appeared to be more important than organizational variables for predicting mortality risk. The finding of an association between ward size and mortality risk deserves further investigation in future studies

The use of direct care in nursing home residents : A longitudinal cohort study over 3 years

Objectives: To evaluate the trend in the use of direct care in a cohort of nursing home (NH) residents and explore its association with resident characteristics and organizational factors. Methods/design: A total of 696 NH residents from 47 Norwegian NHs were included at admissions at NH. In 537 residents, the use of direct care was assessed every 6 months over a course of 3 years. A multiple model was estimated to identify demographic, clinical, and organizational characteristics associated with the use of direct care time. Results: Six months after admission, on average, 76.2 hours of direct care were rendered to each resident per month, while this number was reduced to 50.3 hours per month at the end of the study period. Most residents (92%) showed a stable use of direct care time, while a small group of residents displayed a much higher and varying use of direct care time. Increasing dementia, neuropsychiatric symptoms, and decreasing function in activities of daily living were associated with higher use of direct care time. Direct care time constituted about 50% of the staff's working time. Conclusion: In Norwegian NHs, high use of direct care time was associated with younger age, more severe dementia, and severe neuropsychiatric symptoms. By identifying factors that impact on direct care time, preventive measures might be put in place to the benefit of the residents and possibly to improve resource use. Further research should explore the association between direct care time, quality of care, and the residents' quality of life

Long-Term Mortality in a Cohort of Home-Dwelling Elderly with Mild Alzheimer's Disease and Lewy Body Dementia

&lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; To study mortality in subjects with mild dementia in Norway with a special focus on patients with Lewy body dementia (LBD) compared to Alzheimer's disease (AD). &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; All referrals of mild dementia patients to dementia clinics in western Norway from March 2005 to March 2007 were included and followed until December 2012. Diagnoses were based on a comprehensive standardized assessment program. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Of 209 patients, 137 (66%) had AD and 53 (25%) had LBD. Dementia was associated with increased mortality (standardized mortality ratio = 1.8, AD 1.5, LBD 2.6). The median survival time was 6.2 years (95% CI 5.4-6.9). Predictors of mortality were age at diagnosis (HR 1.1 per year) and LBD diagnosis (HR 2.4). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Dementia patients had an increased mortality, particularly those with LBD.</jats:p

Informal and formal care among persons with dementia immediately before nursing home admission

Background Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network. Methods In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients’ files. Results A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver’s working situation. Good/excellent general health was associated with less formal care. Conclusion Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services

The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

Background Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees. Methods Retrospective analysis of data from a prospective observational study. Data was compared between the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. Logistic regression modelling was used to construct risk-adjusted variable-life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes. Results A total of 28,601 births were observed. The monthly number of births was reduced by 17.3% during the post-introduction period. Spontaneous vaginal deliveries were registered less frequently with a decrease of about 17/1000 births in non-cephalic presentations. Labour complications and caesarean sections increased with about 80/1000 births. There was a reduction in newborns with birth weight less than 2500 g. The observed changes were stable over time. For most variables, a significant change could be detected after a few weeks. Conclusion After the introduction of ambulance and delivery fees, an increase in labour complications and caesarean sections and a decrease in newborns with low birthweight were observed. This might indicate that women delay the decision to seek skilled birth attendance or do not seek help at all, possibly due to financial reasons. Lower rates of births in a safe health care facility like HLH is of great concern, as access to skilled birth attendance is a key requirement in order to further reduce perinatal mortality. Therefore, free delivery care should be a high priority.publishedVersio

Mortality in nursing home residents stratified according to subtype of dementia: a longitudinal study over three years

Background There are several subtypes of dementia caused by different pathophysiology and with different clinical characteristics. Irrespective subtype, the disease is progressive, eventually leading to the need for care and supervision on a 24/7 basis, often provided in nursing homes (NH). The progression rate and course of the disease might vary according to subtype. The aim of this study was to explore whether the mortality rate for NH residents varied according to the subtype of dementia. Methods NH residents were followed from admission to NH over a period of 36 months or until death with annual follow-up examinations. Demographic and clinical data were collected. The diagnosis of dementia and its subtype at baseline (BL) were set according to international accepted criteria. Kaplan-Meier analysis was performed to estimate median survival time. A Cox regression model was estimated to assess the impact of dementia diagnosis and demographic and clinical variables on mortality. Results A total of 1349 participants were included. When compared to persons with Alzheimer’s disease (AD), persons with frontotemporal dementia (FTD) and dementia with Lewy bodies or Parkinson’s disease dementia (DLB/PDD) were younger and had more neuropsychiatric symptoms. Median survival for the total sample was 2.3 years (95% confidence interval: 2.2–2.5). When compared to persons with AD, having no dementia or unspecified dementia was associated with higher mortality, while we found similar mortality in other subtypes of dementia. Higher age, male gender, poorer general health, higher dependency in activities of daily living, and more affective symptoms were associated with higher mortality. Conclusion Mortality did not differ across the subtypes of dementia, except in persons with unspecified dementia or without dementia, where we found a higher mortality. With a median survival of 2.3 years, NH residents are in the last stage of their lives and care and medical follow-up should focus on a palliative approach. However, identifying the subtype of dementia might help carers to better understand and address neuropsychiatric symptoms and to customize medical treatment

Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

ObjectiveThe Helping Babies Breathe" (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania.MethodsData about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW), the research department at HLH, and the manufacturer of the training material Lærdal Global Health.FindingsCosts per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY) averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide) 12 to 23, according to how DALYs were calculated.ConclusionThe HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness