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Background: Emergency medicine is a complex setting for healthcare delivery which relies on communication, negotiation, teamwork, trust, and shared dialog. The nature of the work comprises dealing with emotionally challenging situations and acting under uncertainty. For healthcare staff this poses the need to be adaptive and open to change. Psychological safety is an important component of productive teamwork and learning in such contexts. Edmondson's model of team psychological safety highlights factors which contribute to the development of psychological safety for staff groups and the mediating role this has for team performance.Aim: The aim of the study was explore the link between psychological safety and improvement work. The research question was: Do the aspects covered in the Edmondson model fully describe healthcare workers' perceptions of psychological safety and are all aspects in the model needed to describe these perceptions during testing of new work procedures in an emergency department?"Methods: Using a mixed-method approach we investigated a change programme with interviews, a questionnaire and a workshop in an emergency department of a hospital in the Capital Region of Denmark. Thematic analysis of qualitative data and descriptive statistics of questionnaire data were undertaken.Results: Data indicate the Edmondson model is useful to help understand and identify important antecedent and outcome factors during a period of testing new work-flow processes. The model could not capture all aspects in this study's data material, and was updated as a result. The main modifications were explicitly integrating the physical aspects of the work setting into the considerations of psychological safety, the inclusion of an additional antecedent factor relating to perceptions of care quality and adopting bi-directional links between the antecedent and consequence elements in the model.Conclusions: Although limited in scale, the study supports Edmondson's model of psychological safety as appropriate in describing many of the dynamics experienced by staff engaged in testing new work process. However, additional factors, not included in Edmondson's model and potential adaptations to the model are proposed. [ABSTRACT FROM AUTHOR]

The promotion of successful ageing (SA) has become a strategy. But there has been little examination of the dimensions that are associated with SA from an integrative perspective that takes into account potential particularities among indigenous older adults. This study explores the predictors of SA for a sample of 800 older Chilean adults. The results show that demographic, health and psychosocial variables are associated with SA, with resilience being of particular note. The findings of this study underline the importance of assessing SA, using multidimensional approaches and emphasising heterogeneity and the particularities of indigenous cultural contexts. [ABSTRACT FROM AUTHOR]

Persons with dementia have high rates of hospitalization, and along with their caregivers commonly experience negative hospital outcomes. The recruitment and retention of acutely ill older adults with dementia and caregivers can pose a challenge to investigators and threaten the validity of findings. The challenges encountered in an ongoing cluster randomized clinical trial in dyads of hospitalized persons with dementia and family care partners are described. The trial tests the efficacy of a nurse–family partnership model that aims to improve the following: (a) the physical and cognitive recovery in hospitalized persons with dementia, and (b) caregiver preparedness and anxiety. Strategies that address challenges include careful preplanning and preparation with the hospital site, strong communication with dyads and between team members, and honoring preferences and needs related to communication. [ABSTRACT FROM AUTHOR]

(1) Background: It is important to evaluate the attention in the basic activities of daily life in the early hours of the day to evaluate the quality of care and to be able to increase the attention of human resources in case of observing an increase in dependency. The purpose was to improve healthcare quality in nursing homes, correctly identifying the work burden and incidents of daily planning, and completing the work plan by nursing assistant staffing. (2) Methods: The sample is based on 70 elderly people. The analysis used an observational trial every workday over a six-month period. An ad hoc sheet was prepared to collect socio-demographic data on each participant, and the Barthel Index was applied to the study subjects. A daily record of three basic activities of daily living (BADL), such as dressing, bathing, and eating, was kept. (3) Results: Our results showed a significant evolution in both units, but it was in the psychogeriatric unit in which higher compliance with the schedule and higher maintained stability was reached. (4) Conclusions: The use of some BADL registers helped us address situations of imbalance in terms of user assistance and establish an interdisciplinary communication with the nursing team as a way of achieving better organization and compliance with care protocols. [ABSTRACT FROM AUTHOR]

Background: Dignity is a multidimensional construct that includes perception, knowledge, and emotions related to competence or respect. Attitudes to aging are a comprehensive personal view of the experience of aging over the course of life, which can be influenced by various factors, such as the levels of health and self-sufficiency and social, psychological, or demographic factors. Aim: The purpose of this study was to explore the attitudes to aging of home-dwelling and inpatient older adults, and whether dignity and other selected factors belong among the predictors influencing attitudes to aging in these two different groups of older adults. Research design: Cross-sectional study using a set of questionnaires: Patient Dignity Inventory, Attitudes to Aging Questionnaire, and Barthel Index. Pearson and Spearman correlation analyses and multivariable linear regression were used for statistical processing. Participants and research context: 233 inpatients and 237 home-dwelling older adults participated in the research in two regions of the Czech Republic. Ethical considerations: Institutional Review Board approval was received from the authors' university. Findings: The inpatients had more negative attitudes to aging (M = 74.9±10.9; P <0.0001). The predictors of their attitudes to aging were gender and dignity. Women (β = −2.969, P = 0.045) and inpatients with poor dignity ratings (β = −0.332, P <0.0001) had more negative attitudes to aging. The predictors for home-dwelling older adults were education, living arrangement, and dignity. More negative attitudes to aging were found in older adults with lower levels of education (β = 2.716, P = 0.007) who lived alone (β = 2.163, P = 0.046) and rated their dignity as low (β = −0.325, P <0.0001). Discussion and Conclusions: The results of this study add to the understanding that a sense of dignity is an important predictor of attitudes to aging for both home-dwelling older adults and inpatients. [ABSTRACT FROM AUTHOR]

Background: There is incomplete information regarding evolution of antibody titers against SARS‐CoV‐2 after a two‐dose strategy vaccination with BNT162b2 in older adults in long‐term care facilities (LTCFs) with frailty, disability, or cognitive impairment. We aimed to determine IgG antibody titer loss in older adults in LTCFs. Methods: This is a multicenter longitudinal cohort study including 127 residents (90 females and 37 males) with a mean age of 82.7 years (range 65–99) with different frailty and disability profiles in two LTCFs in Albacete, Spain. Residents received two doses of BNT162b2 as per label, and antibody levels were determined 1 and 6 months after the second dose. Age, sex, previous history of coronavirus disease 2019 (COVID‐19), comorbidity (Charlson Index), performance in activities of daily living (Barthel Index), frailty (FRAIL instrument), and cognitive status were assessed. Results: The mean antibody titers 1 and 6 months after the second vaccine dose were 32,145 AU/ml (SD 41,206) and 6182 AU/ml (SD 13,316), respectively. Across all participants, the median antibody titer loss measured 77.6% (interquartile range [IQR] 23.8%). Notably, the decline of titers in individuals with pre‐vaccination COVID‐19 infection was significantly lower than in those without a history of SARS‐CoV‐2 infection (72.2% vs. 85.3%; p < 0.001). The median titer decrease per follow‐up day was 0.47% (IQR 0.14%) and only pre‐vaccination COVID‐19 was associated with lower rate of antibody decline at 6 months (hazard ratio 0.17; 95% confidence interval 0.07–0.41; p < 0.001). Frailty, disability, older age, cognitive impairment, or comorbidity were not associated with the extent of antibody loss. Conclusions: Older adults in LTCFs experience a rapid loss of antibodies over the first 6 months after the second dose of BNT162b2 vaccine. Only pre‐vaccination COVID‐19 is associated with a slower rate of antibody decrease. Our data support immunization with a third dose in this vulnerable, high‐risk population. [ABSTRACT FROM AUTHOR]

Background: Intensive care unit acquired weakness (ICUAW), embraces an array of disorders labeled "critical illness polyneuropathy" (CIP), "critical illness myopathy" (CIM) or "critical illness polyneuromyopathy" (CIPNM). Several studies have addressed the various characteristics of ICUAW, but the recovery is still unclear.Objective: The present review investigated the recovery and the long-term functional outcome of subjects with ICUAW, whether the types of ICUAW have different outcomes and whether there is any supporting evidence.Methods: Literature search was performed from MEDLINE/PubMed, CINAHL, EMBASE, PeDro, Web of Science and Scopus. Inclusion criteria were: i) sample size including five or more subjects; ii) subjects who suffered from ICUAW and/or CIP, CIM and CIP/CIM; iii) ICUAW ascertained by EMG. Follow-ups longer than one year were defined as long-term.Results: Twenty-nine studies met the inclusion criteria. In total, 788 subjects with ICUAW were enrolled: 159 (20.1%) died and 588 (74.6%) were followed. Of all the included patients, 613 (77.7%) had CIP, 82 (10.4%) CIM and 56 (7.1%) CIP/CIM. Overall, 70.3% of the subjects with ICUAW fully recovered. Seven (24.1%) studies had a follow-up longer than 1 year (range 2-8) with 173 (21.9%) subjects enrolled globally and 108 followed. Of these subjects, 88.8% gained full recovery. Most of the studies did not use proper functional scales and only 4 and 3 studies employed the Barthel scale and the Functional Independence Measure (FIM) scale. Differentiation between the types of ICUAW was performed in 7 studies, but only 3 studies reported that subjects with CIM had a better prognosis and earlier recovery than subjects with CIP/CIM.Conclusions: Subjects with ICUAW could achieve good recovery and could improve at follow-up. However, the quality of the published studies due to short follow-ups and the paucity of defined outcome measures require confirms. [ABSTRACT FROM AUTHOR]

Background: Middle cerebral artery (MCA) ischemic stroke poses a major threat to human beings and prompts intravenous thrombolytic and/or thrombectomy management remains the gold standard treatment. However, not all MCA stroke patients fit in the inclusion and exclusion criteria that many patients only receive conventional medical therapy. We attempt to seek the baseline parameters that can effectively predict patients' long-term functionality, as well as hypothesizing that the carotid duplex derived resistance/pulsatility index might be capable of fulfilling this purpose. Methods: The 741 MCA ischemic stroke patients have been retrospectively recruited for the project. Under the initial screening, matching the inclusion and exclusion criteria, there are 471 participants to be enrolled in the study. The patients' basic information, along with outcome assessments, pre-admission Barthel index and NIHSS score, and pre- and post-treatment mRS are recorded. All statistical analyses were performed using R for Windows (version 3.6.3). The significance level was set at P < 0.05 for all analyses. Results: Of the 471 patients, 239 participants show a net mRS improvement, whereas the other 232 show deterioration. Hyperlipidaemia, chronic kidney disease, and dementia are related to long-term functionality improvement. The multivariate logistic regression analysis shows that right common carotid artery (CCA) resistance index (RI) and ischemic heart disease play a significant role in favourable outcome functionality. The ROC and Youden Index models are formulated, and it shows that Barthel Index and the NIHSS are most significant in the outcome measurement group (AUC: 0.675, 0.653; cut-off point: 57.5, 3.5, respectively). The right-side CCA RI is the solely important outcome predictor for the baseline carotid duplex study (AUC: 0.5; cut-off point: 0.785). Conclusion: The favourable long-term functionality of MCA ischemic stroke patients receiving conventional medical treatment seems to correlate fairly with pre-admission NIHSS and Barthel index scores. Underlying hyperlipidaemia, chronic kidney disease, and dementia are conversely associated with favourable long-term capability. Moreover, the value of CCA RI appears to significantly alter the long-term outcomes in this group of patients. [ABSTRACT FROM AUTHOR]

Objectives: Physical exercise is a promising intervention to improve cognitive function and reduce the risk of dementia and other related neurodegenerative disorders. The present study aimed to investigate the effectiveness of an upper limb-focused physical exercise intervention on cognitive function and daily living activities in older adults. Methods: Forty older residents of a nursing home participated in this clinical trial and were randomly assigned to the experimental (n=20) or the control (n=20) groups. Participants in the experimental group received a physical exercise intervention for six weeks. This intervention included resistance training of the upper limbs using free weights. Evaluations were performed at baseline and after three and six weeks of the resistance training. Stroop test and Barthel index were used to evaluate cognitive function and daily living activities, respectively. Results: Upper limb resistance training significantly improved cognitive function in the experimental group, but there was no significant difference between the groups in the ability to perform daily activities. Discussion: The present study revealed that resistance training of the upper limb can yield cognitive improvement in older adults. Upper limb strengthening seems to have the potential to improve cognitive performance in the elderly and can be recommended as a regular exercise activity. However, further studies with more comprehensive outcome measures are needed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study aims to further validate the Hessisch Oldendorf Risk of Falling Scale (HOSS) for neurological rehabilitation patients. Design: The overall scale performance and fall rate was calculated in a retrospective data analysis. Setting: The study was performed in a subacute care facility during inpatient neurological rehabilitation. Subjects: The study population (n = 512) included neurological and neurosurgical patients with heterogeneous levels of disability. Main measures: The HOSS total score and the suspected risk of falling were compared with the number of falls. Characteristics of fallers and non-fallers were compared using non-parametric group comparisons. Overall scale performance was assessed by calculating the area under the receiver operating characteristic curve of the HOSS as well as by calculating the sensitivity and specificity. Results: A total of 82 (16%) patients experienced at least one fall. Fallers were characterized by an older age, a longer length of stay, a more severe impairment in the activities of daily living upon admission, a hemiparesis, an orientation disorder, a need of a walking aid device and an urinary incontinence. The number of falls was associated with the HOSS total score. Sixty-four fallers and two hundred seventy-four non-fallers were correctly categorized leading to a sensitivity of 78.0% and a specificity of 63.7%. The area under the receiver operating characteristic curve of the HOSS was 0.778 ± 0.25 (CI = 0.729–0.828, P < 0.001). Conclusion: The scale performance of the HOSS showed a good sensitivity and an adequate specificity to identify neurological patients who are at high risk of falling during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Background: The primary purpose of Subacute Care Units (SCU) is to decongest acute hospital wards and facilitate the return of older patients to home. Aims: We analyzed the clinical characteristics and outcomes of patients admitted to an Italian SCU, and we explored factors associated with discharge to locations other than home (outcome). Methods: This retrospective observational cohort study was conducted at a medium-sized suburban hospital, enrolling all patients consecutively admitted to one SCU from October 2017 to February 2020. We collected demographics, cause of admission, comorbidities, cognition, Barthel Index (BI), nutritional status, Clinical Frailty Scale (CFS), length of stay, and discharge destination. Delirium was screened with the 4AT score. We adopted a multivariable conditional logistic regression model to identify the factors associated with the outcome. Results: Frail subjects accounted for 58.6% of 406 patients (mean age 78.2 years, SD 11.6), while 61% were classified as functionally dependent. More than half of patients had relevant comorbidity, approximately 80% had a poor nutritional status, and 25% had pre-existing dementia. The overall prevalence of delirium was 14.5%. Most patients came from a hospital setting; recurrent reasons for admission were infections (70.5%) and heart failure (12.7%). Having a urinary bladder catheter at discharge, being overtly frail (CFS > 8), and low BI score were factors independently associated with not being discharged home. Discussion and conclusion: The routine assessment of frailty, as expressed by the CFS, may help redirecting the patients eligible for SCU admission. [ABSTRACT FROM AUTHOR]

Background: the World Health Organization estimates that more than one billion of the world's population are disabled. Disability is associated with increasing age and poverty, yet there are few reliable data regarding disability among the elderly in low-income countries. The aim of this study was to accurately document the prevalence of disability in those aged 70 years and over in a community-based setting in sub-Saharan Africa.Methods: we performed a community-based study of people aged 70 years and over in Hai, Tanzania. Participants underwent disability assessment using the culturally non-specific Barthel index (BI), and also clinical assessment for neurological disorders and memory problems.Results: in 2,232 participants, the age-adjusted prevalence of severe disability (BI < 15) was 3.7% (95% CI: 2.9–4.5) and the age-adjusted prevalence of moderate disability (BI: 15–18) was 6.2% [95% confidence interval (CI): 5.2–7.2]. Increasing age, female gender, memory problems and the presence of neurological disorders were all independent predictors of the presence of disability.Conclusion: in this study, the average disability level was lower than seen in most high-income countries. This may reflect increased mortality from disabling disease in low-income countries. Disability is likely to increase as the population of low-income countries ages and disease survival improves. [ABSTRACT FROM AUTHOR]

Copyright of Scienza Riabilitativa is the property of Associazione Italiana Fisioterapisti and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: After a stroke, a wide range of deficits can occur with varying onset latencies. As a result, assessing impairment and recovery are enormous challenges in neurorehabilitation. Although several clinical scales are generally accepted, they are time-consuming, show high inter-rater variability, have low ecological validity, and are vulnerable to biases introduced by compensatory movements and action modifications. Alternative methods need to be developed for efficient and objective assessment. In this study, we explore the potential of computer-based body tracking systems and classification tools to estimate the motor impairment of the more affected arm in stroke patients.Methods: We present a method for estimating clinical scores from movement parameters that are extracted from kinematic data recorded during unsupervised computer-based rehabilitation sessions. We identify a number of kinematic descriptors that characterise the patients' hemiparesis (e.g., movement smoothness, work area), we implement a double-noise model and perform a multivariate regression using clinical data from 98 stroke patients who completed a total of 191 sessions with RGS.Results: Our results reveal a new digital biomarker of arm function, the Total Goal-Directed Movement (TGDM), which relates to the patients work area during the execution of goal-oriented reaching movements. The model's performance to estimate FM-UE scores reaches an accuracy of [Formula: see text]: 0.38 with an error ([Formula: see text]: 12.8). Next, we evaluate its reliability ([Formula: see text] for test-retest), longitudinal external validity ([Formula: see text] true positive rate), sensitivity, and generalisation to other tasks that involve planar reaching movements ([Formula: see text]: 0.39). The model achieves comparable accuracy also for the Chedoke Arm and Hand Activity Inventory ([Formula: see text]: 0.40) and Barthel Index ([Formula: see text]: 0.35).Conclusions: Our results highlight the clinical value of kinematic data collected during unsupervised goal-oriented motor training with the RGS combined with data science techniques, and provide new insight into factors underlying recovery and its biomarkers. [ABSTRACT FROM AUTHOR]

Purpose. To compare the effectiveness of contralaterally controlled functional electrical stimulation (CCFES) versus neuromuscular electrical stimulation (NMES) on motor recovery of the upper limb in subacute stroke patients. Materials and Methods. Fifty patients within six months poststroke were randomly assigned to the CCFES group (n = 25) and the NMES group (n = 25). Both groups underwent routine rehabilitation plus 20-minute stimulation on wrist extensors per day, five days a week, for 3 weeks. Fugl-Meyer Assessment of upper extremity (FMA-UE), action research arm test (ARAT), Barthel Index (BI), and surface electromyography (sEMG) were assessed at baseline and end of intervention. Results. After a 3-week intervention, FMA-UE and BI increased in both groups (p < 0.05). ARAT increased significantly only in the CCFES group (p < 0.05). The changes of FMA-UE, ARAT, and BI in the CCFES group were not greater than those in the NMES group. The improvement in sEMG response of extensor carpi radialis by CCFES was greater than that by NMES (p = 0.026). The cocontraction ratio (CCR) of flexor carpi radialis did not decrease in both groups. Conclusions. CCFES improved upper limb motor function, but did not show better treatment effect than NMES. CCFES significantly enhanced the sEMG response of paretic extensor carpi radialis compared with NMES, but did not decrease the cocontraction of antagonist. [ABSTRACT FROM AUTHOR]

Background. Ginkgo biloba leaf preparations (GLPs) are widely used in ischemic stroke, and uncertainty remains regarding their clinical efficacy. To evaluate systematically the clinical efficacy and safety of GLPs in the treatment of ischemic stroke, we examine evidence from randomized controlled trials (RCTs). Methods. We examine studies published prior to November 2021 that were found from searching the following sources: PubMed, China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chongqing VIP (CQVIP) databases, and Chinese Biomedical Literature (CBM). We evaluated the quality of the included references according to the Cochrane Manual of Systematic Evaluation and Meta-analysis (MA) performed using RevMan 5.2 software. Results. We included a total of 13 RCTs with clinical therapeutic effects, the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), hemorheology index, and adverse reaction index as evaluation criteria. There were 631 cases in the observation group and 629 cases in the control group. MA results showed the following: NIHSS WMD = −3.89, 95% CI: [−4.22, −3.56], I2 = 19%, P < 0.00001. This index is often used with nerve injury and can also be used to judge the recovery of nerve function. A lower score means less nerve damage and a better chance of recovery. The BI results were WMD = 11.30, 95% CI: [9.83, 12.77], I2 = 7%, P < 0.00001. This index was used to assess patients' ability to take care of themselves, with a higher score indicating a stronger ability to live independently. Clinical effective rate results were WMD = 3.79, 95% CI: [2.49, 5.78], I2 = 0%, P < 0.00001, and this measure can be used to evaluate the effect of treatment clearly and objectively. Hemorheological index results show that plasma viscosity has WMD = −0.16, 95% CI: [−0.20, −0.12], I2 = 40%, P < 0.00001 and fibrinogen (FIB) has WMD = −1.13, 95% CI: [−1.23, −1.04], I2 = 0%, P < 0.00001. Plasma viscosity is mainly related to the amount of fibrinogen, and fibrinogen degradation is an important function of the fibrinolytic system. The imbalance of the fibrinolytic system plays an important role in the pathogenesis of cerebral infarction. Fibrinogen is a risk factor of ischemic cerebrovascular disease. Studies have shown that the infarct size of patients with secondary cerebral infarction after CEREBRAL infarction is correlated with their FIB level. In addition, FIB elevation is also one of the risk factors for early infarction after thrombolysis. Therefore, FIB can be used as a detection index for the prevention of cerebral infarction recurrence adverse reactions. Our MA results for FIB show WMD = 0.81, 95% CI: [0.38, 1.73], I2 = 0%, P = 0.58, and RR < 1. Conclusion. The existing clinical evidence shows that GLP has a good therapeutic effect on patients with ischemic stroke and can improve their hemorheology indices. In addition, GLP is shown to be relatively safe. [ABSTRACT FROM AUTHOR]

To evaluate the short- and long-term therapeutic effect and possibility of decompressive craniectomy (DC) for patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Patients suffering from aSAH (Hunt–Hess grades IV, V) who underwent DC from January 2008 to April 2016 were enrolled in this study, and a sample-matched control group was set up. Information regarding participants' demography, clinical characteristics, and neuroimaging findings was systematically established. The outcome of a 6-month to 3-year follow-up was assessed according to the Glasgow outcome scale (GOS), modified Rankin Scale (mRS) and Barthel Index (BI). Patients who had DC (21) experienced a statistically significant decrease in short-term mortality compared with those without DC (24, p < 0.05) and showed a decrease in intracranial pressure (ICP) after surgery. However, there was no significant difference in the long-term assessment (GOS/mRS/BI) between the two groups. Some critical patients who have refractory ICP after poor-grade aSAH would benefit from DC for prolonging life in the short term if performed early. Nevertheless, the overall outcome for the long term remains disappointing, larger and longer prospective studies are urgently needed to investigate this issue. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify the predicting factors of quality of life (QoL) from a set of psychosocial, sociodemographic and clinical variables amongst older adults in a long‐term care setting. Design: A cross‐sectional, descriptive correlational study. Method: The study was conducted in a nursing home and a day care centre from July to December 2019. Two hundred older adults were recruited. Guided by the salutogenic model, the sense of coherence (SOC) scale, Connor–Davidson resilience scale, de Jong Gierveld loneliness scale and World Health Organization quality of life instrument‐older adults (WHOQOL‐OLD) were used. The sociodemographic and clinical profiles of participants were collected. Descriptive statistics, Pearson product‐moment correlation coefficient, independent‐samples t test, one‐way analysis of variance and stepwise regression were utilised in the analysis. Results: The mean score for WHOQOL‐OLD was 94.42 ± 19.55. The highest mean score was observed in the "Death and Dying" facet, while the lowest mean scores were reflected in the "Autonomy" and "Intimacy" facets of QoL. Regardless of resident type, most QoL scores were similar across different variables. Based on the stepwise regression, higher manageability and meaningfulness in SOC, higher resilience, lower social loneliness, lower emotional loneliness and hearing impairments are significantly associated with higher QoL. Conclusion: Manageability, meaningfulness and resilience should be enhanced while ameliorating feelings of loneliness to improve the QoL amongst older adults receiving long‐term care. Age, marital status, educational level, care arrangement, body mass index, performance in activities of daily living, comorbidities and hearing and mobility impairments could influence QoL and thus warrant more attention. Impact: Future interventions can be conducted in group sessions to facilitate social interaction and alleviate loneliness. More resources should be allocated to enhance older adults' care arrangements and coping mechanisms to provide them with the support, as they face challenges in daily life due to mobility impairment and other restrictions. [ABSTRACT FROM AUTHOR]

Aim: To assess pain management nursing practice in older adults with dementia through electronic health records (EHR). Design: Retrospective study. Methods: Data were collected from EHR related to pain management in older adults with dementia treated at the Acute Geriatrics Unit (AGU) of a university hospital in early 2018. Results: EHR related to the pain of 111 patients were reviewed. Pain intensity was assessed at admission in 88% of patients and a median of 1.9 times per day of stay. A disproportionate number of the assessments (39%) occurred during the late shift. A median of 1 drug per day was administered. Pain was recorded in 28% of patients' care plans, and non‐pharmacological interventions were recorded in 12%. In conclusion, exist variability in pain management nursing practice in older adults with dementia. Admission diagnosis correlated with the analgesic administration schedule, the number of drugs administered and the number of pain nursing annotations. [ABSTRACT FROM AUTHOR]

Aim: To explore the best non‐pharmaceutical interventions for improving the behavioural and psychological symptoms in elders with dementia. Design: Bayesian network meta‐analysis. Methods: A comprehensive electronic literature search was performed in five English databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) that were published up to 31 October 2019. Results: A total of 41 RCTs were included in this network meta‐analysis involving 5 different non‐pharmacological interventions: therapeutic recreation (TC), reminiscence therapy (RT), behaviour therapy (BT), massage therapy (MT) and individualized nursing (IN).The results of network meta‐analysis showed that individualized nursing was the best in improving depression, cognitive function, and activities of daily living of behavioural and psychological symptoms of dementia. Behaviour therapy was the best in improving anxiety symptoms. Reminiscence therapy was the best in improving neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]

In recent years, neurological diseases have become a standout amongst all the other diseases and are the most important reasons for mortality and morbidity all over the world. The current study's aim is to conduct a pilot study for testing the prototype of the designed glove-wearable technology that could detect and analyze the heart rate and EEG for better management and avoiding stroke consequences. The qualitative, clinical experimental method of assessment was explored by incorporating use of an IoT-based real-time assessing medical glove that was designed using heart rate-based and EEG-based sensors. We conducted structured interviews with 90 patients, and the results of the interviews were analyzed by using the Barthel index and were grouped accordingly. Overall, the proportion of patients who followed proper daily heart rate recording behavior went from 46.9% in the first month of the trial to 78.2% after 3–10 months of the interventions. Meanwhile, the percentage of individuals having an irregular heart rate fell from 19.5% in the first month of the trial to 9.1% after 3–10 months of intervention research. In T5, we found that delta relative power decreased by 12.1% and 5.8% compared with baseline at 3 and at 6 months and an average increase was 24.3 ± 0.08. Beta-1 remained relatively steady, while theta relative power grew by 7% and alpha relative power increased by 31%. The T1 hemisphere had greater mean values of delta and theta relative power than the T5 hemisphere. For alpha (p < 0.05) and beta relative power, the opposite pattern was seen. The distinction was statistically significant for delta (p < 0.001), alpha (p < 0.01), and beta-1 (p < 0.05) among T1 and T5 patient groups. In conclusion, our single center-based study found that such IoT-based real-time medical monitoring devices significantly reduce the complexity of real-time monitoring and data acquisition processes for a healthcare provider and thus provide better healthcare management. The emergence of significant risks and controlling mechanisms can be improved by boosting the awareness. Furthermore, it identifies the high-risk factors besides facilitating the prevention of strokes. The EEG-based brain-computer interface has a promising future in upcoming years to avert DALY. [ABSTRACT FROM AUTHOR]

Objective. This research aimed at investigating the efficacy of edaravone combined with clopidogrel on acute cerebral infarction (ACI) and its influence on the neurological deficit and life function. Methods. Totally, 154 ACI cases were included and then divided into the control group (CG) (n = 71) and research group (RG) (n = 83) according to the treatment methods. Patients in the CG were treated with clopidogrel alone, and those in the RG were under edaravone-clopidogrel combination therapy. The efficacy, adverse reactions, NIHSS score, cerebral hemodynamic indexes, and Fugl-Meyer scale (FMA) and Barthel index (BI) of activities of daily living (ADL) scores were observed. Results. Compared with before treatment, the symptoms of both groups were improved after treatment: the NIHSS scores decreased, FMA and ADL scores increased, and cerebral hemodynamic indexes were improved. Compared with the CG, the efficacy and cerebral hemodynamic indexes of the RG were better, the adverse reactions were equivalent, the NIHSS score was lower, and the ADL and FMA scores were higher. Conclusion. Edaravone combined with clopidogrel can effectively treat ACI and improve the neurological deficit and life function of patients. [ABSTRACT FROM AUTHOR]

This longitudinal study was designed to evaluate the association between acute pre‐stroke stress and the severity stroke and its outcomes including mortality, recurrence, disability and functional dependency. Patients with first‐ever stroke (FES) were recruited from the Mashhad Stroke Incidence Study. Patients were asked about any acute severe pre‐stroke stress in the 2 weeks prior to index stroke. Disability and functional disability were defined using modified the Rankin Scale and Barthel Index, respectively. We used logistic and ordinal regression tests to assess the association between acute pre‐stroke stress and study outcomes. Among 624 patients with FES, 169 reported acute pre‐stroke stress. Patients with acute pre‐stroke stress were younger than those without stress (60.7 ± 14.4 vs. 66.2 ± 14.7; p < 0.001). The frequency of traditional vascular risk factors was not different in patients with and without acute pre‐stroke stress. We did not find any association between acute pre‐stroke stress and stroke outcomes. Although acute stress was common in our cohort, our results did not support an association between acute pre‐stroke stress and the severity of stroke at admission and long‐term stroke outcomes. [ABSTRACT FROM AUTHOR]

Background: Informal caregivers of patients with multiple chronic conditions are socially good, promoting the sustainability of a large part of home care provision. However, this very demanding activity causes health problems that increase their own need for health services. This study analyses the use of health services by informal carers, comparing it with the use made by the general population with similar characteristics. Methodology: Cross‐sectional analytical study carried out in the Malaga‐Valle Guadalhorce Primary Health Care District (Spain). Healthcare demand and perceived health were measured in the family caregivers, compared to the general population. Strobe Statement for observational studies has been used to strength the report of the results. Results: Final sample consisted of 314 family caregivers together with a subsample of 2.290 non‐caregivers taken from data of the National Health Survey. This subsample was paired by gender with our sample. Formal caregivers make fewer annual visits to the health services, with respect to the general population, regardless of the perceived level of health. The difference of the means between those who perceive their health as very poor was 0.11 (95% CI: 0.01 to 0.20) consultations with the family doctor, 0.21 (95% CI: 0.15 to 0.26) consultations with medical specialists and 1.70 (95% CI: 1.52 to 1.87) emergency room attention. Three independent factors were identified that predispose to the increased use of health services: background of greater education achievement (OR 8.13, 95% CI: 1.30 to 50.68), non‐cohabitation with the care recipient (OR 3.57, 95% CI: 1.16 to 11.11) and a more positive physical quality of life component (OR 1.06; 95% CI: 1.03 to 1.09). Discussion and Implications: Intrinsic components of the caregiver reveal their independent relationship with the provision of informal care and the use of health services. A broader vision is needed for the factors that influence the health of these caregivers to develop multipurpose interventions and improve the consistency and effectiveness of the health services offered to the caregiver. [ABSTRACT FROM AUTHOR]

Background: Greenland is facing an ageing population, and little is known about the characteristics of the elderly population in Greenland. This study offers both a comparison and a description of the demographics, causes of admission, comorbidities and medication of the residents in care homes in the capital, major and minor towns in four of the five administrative regions of Greenland.Methods: The study was conducted from 2010 to 2016 as a descriptive questionnaire-based cross-sectional study. Data from eligible residents from eight care homes were collected from the regular care staff. Data were categorised into three groups based on town size for analysis.Results: 244 (100 %) of eligible residents participated in the study. Nearly 100 % were of Greenlandic ethnicity based on parents' place of birth, and 62 % were women. The median age at admission/study was 69/71 years for men and 77/79 years for women (both p = 0.001). The median Body Mass Index was 25.6 kg/m2, more than half of the population were previous- or never-smokers and less than ten per cent consumed more than ten drinks of alcohol per week. The most common causes of admission were dementia (25.4 %), stroke (19.3 %) and social causes (11.1 %), while stroke (30.7 %), dementia (29.5 %) and musculoskeletal diseases (25.8 %) were the most common diagnoses at the time of the study. The Barthel Index was used to estimate the residents' level of independence, and residents in smaller towns were found to have a higher level of independence than residents in the capital. The median number of prescribed medications was five, and more residents in the capital were prescribed more than ten medications than elsewhere in Greenland.Conclusions: This study is the first to describe care home residents in Greenland. We found a population younger than residents in comparable Danish care homes and that women were older than men at admission. In addition, care home residents in the capital had a lower level of independence and a higher number of prescribed medications, which could relate to differences in morbidity, access to health care services and differences in social circumstances influencing the threshold for care home admission. [ABSTRACT FROM AUTHOR]

Background: Limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) reduce the independence of the elderly and compromise the quality of life. Objective: This study examined the prevalence and factors affecting the ADL and IADL limitations of elderly. Methods: In this community based cross-sectional study, a representative sample (n=723) of elderly aged >65 years was obtained by multi-stage cluster sampling. ADL and IADL were assessed using validated Sinhala versions of 10-item Barthel Index and Lawton IADL scales respectively. Simple and multiple logistic regression analyses were conducted to find the factors associated with ADL/IADL limitations. Results: Mean±SD age was 72.23±6.3 years. Mean±SD ADL and IADL scores were 94.42±17.08 (out of 100) and 6.58±2.3 (out of 8) respectively. Of the elderly, 16.9% and 39.4% had more than one ADL and IADL limitations respectively. Out of the ADL limited elderly, 91.8% had IADL limitations. Most of the ADL (80.3%) and IADL (76.5%) limited elderly had more than one chronic disease. Age (75-84 years odds ratio [OR]=3.03, p<0.001; >85 years OR=3.80, p<0.001), male gender (OR=1.79, p<0.05), history of a stroke (OR=6.12, p<0.001) and arthritis (OR=1.96, p>0.05) showed significant positive associations with ADL limitations in adjusted model. IADL limitations positively associated with age (75-84 years OR=2.91, p<0.001; >85 years OR=3.93, p<0.001), having more than one disease condition (OR=1.67, p<0.05) and history of a stroke (OR=5.53, p<0.001) in the adjusted model. Conclusion: The mean scores for ADL and IADL are high in this sample indicating a low disability level. Almost all elderly with ADL limitations also had IADL limitations. The odds of having ADL and IADL were greatest for the elderly who are over 75 years and has had a stroke. It is recommended that comorbidities are managed optimally in order to minimize activity limitations among elderly in informal caregiving settings. [ABSTRACT FROM AUTHOR]

Objectives: The objective is to assess the role of functional, clinical, and analytic parameters in predicting mortality in older patients hospitalized due to COVID-19. Design: Cohort study with a mean follow-up of 12.8 days. Setting: Public university hospital (Madrid, Spain). Participants: 499 patients 80 and above consecutively admitted to a Spanish public university hospital between 4 March 2020 and 16 May 2020. Measurements: Mortality was the main outcome. Data of sociodemographic variables (age, sex, living), comorbidities, polypharmacy, functional status, date of hospital admission and length of stay was recorded. Clinical symptoms, laboratory and X-ray findings were collected at time of admission. For multivariant analysis, logistic regressions were performed to identify risk factors for death. RESULTS: Mean age was 86.7±4.4 with 37% of death. Mortality was associated with male gender [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.01–2.24], with a 5-points increase on Barthel Index [OR 1.01 (95%CI 1.00–1.02)], higher Charlson Index score [OR 1.13 (95%CI 1.02–1.26)] and comorbidities [OR 1.28 (95%CI 1.06–1.53)], hyperpolipharmacy [OR 2.00 (95%CI 1.04–3.82)], unilateral pneumonia [OR 1.83 (95%CI 1.01–3.30)], higher levels of C-reactive protein [OR 1.09 (95%CI 1.06–1.12)] and creatine [OR 1.48 (95%CI 1.15–1.89)]. Higher oxygen levels were a protective factor [OR 0.92 (95%CI 0.89–0.95)]. Conclusions: Functional status, being male, a higher burden of comorbidities, hyperpolipharmacy, unilateral pneumonia and some laboratory parameters predict in-hospital mortality in this older population. The knowledge of these mortality risk factors should be used to improve the survival of older hospitalized patients. [ABSTRACT FROM AUTHOR]

Aim. This study is intended to highlight how important and what benefits does kinesiotherapy have for patients with secondary-progressive multiple sclerosis. Methods of research: The study was conducted on a 45-year-old patient diagnosed with multiple sclerosis, who underwent a complex kinetic program, aimed at maintaining mobility under functional parameters, muscle strength, balance, gait, coordination, effort capacity and the quality of life in general. The kinetic program comprised of: massage, dynamic kinetic techniques, exercises on HUBER platform, walking, exercises on machines. In order to assess the subject's progress, the following were used: Barthel Index, Doloplus scale, Osserman scale, Pichot's fatigue scale and Berg scale. Results: Dynamic analysis revealed improvement in the functional parameters aimed at, thus making the patient feel more comfortable both physically, and mentally in all daily living activities. Conclusions: The conclusion can be reached, after following the patient's progress throughout the study's carry out, that kinesiotherapy for patients with multiple sclerosis is a key requirement in order to preserve their autonomy for as long as possible. [ABSTRACT FROM AUTHOR]

Background: Acupuncture may be a promising complementary therapy for vascular cognitive impairment (VCI) and has been extensively applied in China. However, its potential effects remain uncertain, and the clinical findings are inconsistent. This review aimed to systematically appraise the overall effectiveness and safety of acupuncture in treating VCI. Methods: To investigate the effects of acupuncture on VCI from inception to February 28, 2021 using randomized clinical trials (RCTs), seven electro-databases [Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang] were searched. Two independent investigators identified the eligible RCTs and extracted data into predesigned forms. The risk of bias (ROB) within each individual trial was evaluated using the Cochrane Collaboration's tool. Meta-analyses were conducted for calculating comparative effects in the RevMan software (version 5.3). The strength of attained evidence was rated using the online GRADEpro approach. Results: A total of 48 RCTs involving 3,778 patients with VCI were included. The pooled data demonstrated that acupuncture was more beneficial for a global cognitive function [mean difference (MD) 1.86, 95% CI 1.19–2.54, p < 0.01] and activities of daily living (MD −3.08, 95% CI −4.81 to −1.35, p < 0.01) compared with western medicine (WM). The favorable results were also observed when acupuncture was combined with WM (MD 2.37, 95% CI 1.6–3.14, p < 0.01) or usual care (UC, MD 4.4, 95% CI 1.61–7.19, p = 0.002) in comparison with the corresponding control conditions. Meanwhile, the subgroup analysis did not indicate a statistical effect difference between manual acupuncture (MA) and electroacupuncture (EA) (inter-group I 2 < 50% and p > 0.1) when comparing acupuncture with WM. There were no significant differences in the occurrence of adverse events (AEs) between the acupuncture group and the control group (p > 0.05). Owing to the poor methodological quality and considerable heterogeneity among studies, the certainty of the evidence was low or very low. Conclusions: This review suggests that acupuncture as a monotherapy or an adjuvant therapy may play a positive role in improving the cognition and daily performance of VCI patients associated with few side effects. The difference in styles may not significantly influence its effectiveness. More rigorously designed and preregistered RCTs are highly desirable to verify the therapeutic benefits and determine an optimal acupuncture paradigm. The methodological and reporting quality of future researches should be enhanced by adhering to authoritative standardized statements. Systematic Review Registration: [PROSPERO], identifier [No. CRD42017071820]. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the effects of the robot–assisted gait training on cortical activation and functional outcomes in stroke patients. METHODS: The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n = 30); conventional physiotherapy (control group; n = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index–Lower (MI–Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). RESULTS: Thirty-six subjects were analyzed, 18 in the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P = 0.017), gait speed (P = 0.043), BBS (P = 0.010), and MI–Lower (P = 0.047) scores. CONCLUSION: Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients. [ABSTRACT FROM AUTHOR]

Background: During the period of hospitalization, patients can develop functional decline. The main aim of our study was to assess the natural trajectory of each activity of daily living (ADL) and to assess how in-hospital exercise could influence short-term trajectory of ADLs.Method: Acutely hospitalized patients (n = 297, 56.5% women) were randomly assigned to the intervention or control (usual care) group within the first 48 hours of admission. An exercise training program was prescribed in 2 daily sessions (morning and evening) of 20 minutes duration during 5-7 consecutive days for the intervention group. The primary endpoint was the change in every ADL (assessed with the Barthel Index) from 2 weeks before admission to hospital discharge.Results: Acute hospitalization per se led to significant in-patient's functional ability impairment in ADLs during hospitalization, whereas the exercise intervention reversed this trend (3.7 points; 95% CI: 0.5-6.8 points). After analyzing the trajectory of each one of the ADLs, patients in the control group significantly worsened all activities, but with a different degree of loss. For the between-group analysis, significant differences were obtained in many ADLs including bathing, dressing, grooming, bladder control, toilet use, transfers, mobility, and climbing stairs (p < .05). The control group had the greatest impairment in all domains analyzed (ie, feeding, bathing, dressing, grooming, bowel control, bladder control, toilet use, transfers, mobility, and climbing stairs; p < .05).Conclusions: An individualized multicomponent exercise training program in older adults is effective to reverse the loss of specific ADLs that frequently occurs during hospitalization. Each patient profile should receive an individualized prescription of exercise during hospitalizations.Clinical Trials Registration Number: NCT02300896. [ABSTRACT FROM AUTHOR]

To examine how patients spend their time in stroke rehabilitation units in England. We recruited 144 patients within a month after stroke from four stroke rehabilitation units and observed their activity type, interactions and location. Each participant was observed for 1 min every 10-minutes, for a total of 20 h, over three consecutive days. Multilevel modelling was performed to assess differences across sites. Across the four sites a total of 12,248 observations were performed. Patients spent on average 37% of the observed time inactive and 60% alone. A health care professional was present for 18% of the observations and patients' most frequent contact was with family members (19%). Patients were mainly physically active in the presence of therapists, but they practiced self-care activities of daily living most frequently in the presence of nursing staff. There were limited opportunities for activity away from the bedside. Significant differences were found between the units, including patients' level of contact with rehabilitation assistants and nursing staff, but not in their time with occupational therapists and physiotherapists. Stroke patients in England spend a large proportion of their day inactive and alone. Opportunities to promote a rehabilitation focused environment may include: a) enhancing the role of rehabilitation assistants, b) supporting nursing staff in maximising opportunities for the practice of activities of daily living and c) involving family members in the rehabilitation process. Clinicians need to consider stroke patients' activity levels and rehabilitation experience outside formal therapy. The role of rehabilitation assistants and nursing staff can be key in promoting patient activity and practice of self-care ADL tasks. Pragmatic strategies to encourage family involvement in the rehabilitation process need to be developed. [ABSTRACT FROM AUTHOR]

Background Predicting expected survival time in acutely hospitalised older patients is a clinical challenge. Objective To examine if activities of daily living (ADL) assessed by Barthel-Index-100 (Barthel-Index) at hospital admission adds useful information to clinicians on expected survival time in older patients. Methods A nationwide population-based cohort study was used. All patients aged ≥65 years in the National Danish Geriatric Database from 2005 to 2014 were followed up until death, emigration or study termination (31 December 2015). Individual data were linked to national health registers. Barthel-Index was categorised into five-point subcategories with a separate category of Barthel-Index = 0. Kaplan–Meier analysis was used to assess crude survival proportions (95% CI) and Cox regression to examine association of Barthel-Index and mortality adjusting for age, Charlson comorbidity index, medication use, BMI, marital status, prior hospitalisations and admission year. Results In total, 74,589 patients (63% women) aged (mean (SD)) 82.5(7.5) years with Barthel-Index (median (IQR)) 54(29-77) were included. In patients with Barthel-Index = 100-96 crude survival was 0.96(0.95-0.97) after 90-days, 0.88(0.87-0.89) after 1-year, and 0.79(0.78-0.80) after 2-years. Corresponding survival in patients with Barthel-Index = 0 was 0.49(0.47-0.51), 0.35(0.34-0.37) and 0.26(0.24-0.27). Decreasing Barthel-Index was associated with increasing mortality in the multivariable analysis. In women with Barthel-Index = 0, the mortality risk (HR (95% CI)) was 14.74(11.33-19.18) after 90-days, 8.40(7.13-9.90) after 1-year and 6.22(5.47-7.07) after 2-years using Barthel-Index = 100-96 as reference. In men, the corresponding risks were 11.36(8.81-14.66), 6.22(5.29-7.31) and 5.22(4.56-5.98). Conclusions ADL measured by Barthel-Index provides useful, easily accessible and independent information to clinicians on expected survival time in patients admitted to a geriatric department. [ABSTRACT FROM AUTHOR]

Background: Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better. Aims: We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome. Methods: We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24–48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24–48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between "discrepant cases" – those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV – and "non-discrepant cases". Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome. Results: Among 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement (p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age (p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS (p = 0.007) and post-stroke complications (p = 0.026). Absence of vascular risk-factors (p = 0.004), CT-based lentiform nucleus sparing (p = 0.002), lower 24-hour NIHSS (p = 0.001), and absence of complications (p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results. Conclusions: Discrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT01778335. [ABSTRACT FROM AUTHOR]

Purpose: Estimating the probability of readmission following hospitalization using prediction scores can be complex. Quality of life (QoL) may provide an easy and effective alternative. Methods: Secondary analysis of the prospective "TRIAGE" cohort. All medical in-patients admitted to a Swiss tertiary care institution (2016–2019) ≥18 years with a length of stay of ≥2 days (23,309 patients) were included. EQ-5D VAS, EQ-5D index, and Barthel index were assessed at a single telephone interview 30-day after admission. Patients lost to follow-up were excluded. Readmission was defined as a non-elective hospital stay at our institution >24 h within 1 year after discharge and assessed using area under the curve (AUC) analysis with adjustment for confounders. Results: 12,842 patients (43% females, median age 68, IQR 55–78) were included. Unadjusted discrimination was modest at 0.59 (95% CI 0.56–0.62) for EQ-5D VAS. Partially adjusted discrimination (for gender) was identical. Additional adjustment for insurance, Charlson comorbidity index, length of stay, and native language increased the AUC to 0.66 (95% CI 0.63–0.69). Results were robust irrespective of time to event (12, 6 or 3 months). A cut-off in the unadjusted model of EQ-5D VAS of 55 could separate cases with a specificity of 80% and a sensitivity of 30%. Conclusion: QoL at day 30 after admission can predict one-year readmission risk with similar precision as more intricate tools. It might help for identification of high-risk patients and the design of tailored prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives: To describe the activity and evaluate the quality of the Japanese sarcopenic dysphagia database. Design: Cohort registry study. Setting: 19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team. Participants: 467 dysphagic patients, aged 20 years and older. Measurements: The following indices were assessed at baseline: age, sex, main disease, sarcopenic dysphagia, whole body sarcopenia, Food Intake Level Scale (FILS), malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria, oral status assessed by the Revised Oral Assessment Guide or the Oral Health Assessment Tool, activities of daily living assessed by the Functional Independence Measure (FIM) or the Barthel Index (BI), Charlson comorbidity index, C-reactive protein and serum albumin levels, dysarthria, hoarseness, aphasia, pressure ulcers, bladder, bowel, and kidney function, respiratory status, polypharmacy, number of drugs, and involvement of health care professionals and rehabilitation nutrition team. FILS, FIM or BI, and outcome including discharge destination were assessed at follow-up. A simple comparison of cases and evaluation of the quality of data were performed. Results: The mean age was 80.4 ± 11.4 yr. The variable input error was 0. The number of patients with missing data was high for estimated glomerular filtration rate, C-reactive protein, serum albumin, skeletal mass index, and tongue pressure. The prevalence of either probable, possible, or no sarcopenic dysphagia was 105 (23%), 182 (39%), or 179 (38%), respectively. Doctors including physiatrists, nurses, physical therapists, and registered dietitians were involved with most patients, while the rehabilitation nutrition team was involved in only 16% of patients. Conclusions: The quality of the database was relatively high. Sarcopenic dysphagia is common in patients with dysphagia. [ABSTRACT FROM AUTHOR]

Background: Body movement-controlled video games involving physical motion and visual attention may have the potential to train both abilities simultaneously. Our purpose was to determine the associations between performance in these games and visual attention, balance and mobility in a group of older adults. The long-term goal is to identify the optimal type of interactive games with regards to training potential.Methods: Fifty healthy adults aged 65+ years participated in this cross-sectional study. Visual attention was measured with static and dynamic versions of a useful field of view (UFV) and a multiple object tracking (MOT) test. Balance was measured with a force plate in bi-pedal quiet stance test (QST) and one-legged stance (OLST). Gait variability and walking speed were assessed with the Five Meter Walk Test (5MWT). Four Microsoft™ Xbox® 360 Kinect™ interactive video games were chosen based on the apparent levels of visual attention demand.Results: Visual attention (UFV and MOT) was significantly associated with performance in Xbox® Kinect™ games that appeared to have a high visual attention demand (p < 0.05), while there was minimal or no significant association with games with apparent low visual attention demand. Balance and mobility show correlations with visual attention, and with Xbox games.Conclusion: The results suggest that there are relationships between visual attention, balance, mobility and Xbox® Kinect™ game performance. Since different Xbox® games were associated with different balance, mobility and visual attention scores, a variety of such games, rather than a single game, may be most effective for training for falls prevention. [ABSTRACT FROM AUTHOR]

Aim: Although the glycemic target in older diabetes patients is based on cognition, activities of daily living and multimorbidity in the Japanese guideline, evidence of the relationships is limited. Thus, we aimed to assess the relationship between functional category and mortality in older people with diabetes. Methods: We evaluated the data of 843 older diabetes patients in a 6‐year prospective study, and the association between functional categories and all‐cause mortality. The patients were divided into three functional categories based on cognition, instrumental activities of daily living and basic activities of daily living using the Mini‐Mental State Examination, Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index at baseline, respectively (model 1). Those with multimorbidity (≥4 of 8 morbidities) were classified into category III (model 2). The functional category assessed using eight items from the Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index was also constructed (model 3). Hazard ratios and 95% confidence intervals were calculated in the Cox regression analysis using age, sex, body mass index, glycated hemoglobin level, total cholesterol level, estimated glomerular filtration rate and frequency of severe hypoglycemia as covariates. Results: During the 6‐year follow up, 64 incident mortalities occurred. The hazard ratios for mortality in categories II and III (as the reference of category I) were 1.83 (95% confidence interval 1.06–3.14, P = 0.030) and 3.05 (95% confidence interval 1.12–8.26, P = 0.029) after adjustment for covariates, respectively (model 1). Models 2 and 3 showed similar associations between functional category and mortality. Conclusions: The functional categories predicted all‐cause mortality in older adults with diabetes. Geriatr Gerontol Int 2021; 21: 512–518. [ABSTRACT FROM AUTHOR]

This study was conducted in order to determine factors that influence self-transcendence and meaning in life in the elderly receiving institutional care. This descriptive and analytic study was conducted on 72 elderly individuals living in a nursing home in Turkey. Data were collected with the Barthel Index of Activities of Daily Living (ADL), the Lawton&Brody Instrumental Activities of Daily Living (IADL), the Meaning in Life Questionnaire (MLQ) and the Self-Transcendence Scale (STS). The mean score of STS is 48.17 ± 6.67 at the intermediate level, and the mean scores of presence and search subscales of the MLQ are 28.07 ± 6.55 and 24.06 ± 7.73 above the intermediate level. The STS mean score is poorly correlated with the ADL (r = 0.277) and the IADL scale (r = 0.343). Increased perception of general health status of the elderly improved self-transcendence (ST) level (p = 0.04) and search for meaning in life (ML) level (p = 0.02). These findings show that the health perceptions of the elderly must be improved in the first place. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are high risk and high-impact events in the elderly population; despite orthopedic hip surgery, the disability and mortality rate remains significant. The National Health Insurance Agency in Taiwan established a fragility fracture PAC rehabilitation program to provide functional recovery for these patients after the surgery. However, the current literature on PAC rehabilitation is outdated, and there is an urgent need for the re-evaluation of the program.Methods: This is a retrospective cohort study that enrolled 159 patients in the PAC rehabilitation program, followed by hip repair surgery. Outcome measures were the differences in participants' pre- and post-PAC scores in 1) Barthel index, 2) Numerical Rating Scale (NRS), and 3) Harris Hip Scores (HHS) as surrogate indicators of the functional status, followed by the analysis of subgroups, including sex, age, site of the fracture, type of procedure, and the number of comorbidities.Results: After completing PAC rehabilitation, 86.2% of the patients successfully returned to the community with either home or out-patient rehabilitation. The re-admission rate was 3.1% and 3.8% in 14-days and in 30-days follow up, respectively. The difference in pre- and post-Barthel index, NRS, and HHS showed significant improvement (p<0.001), without significant variations between the subgroups. Additionally, the Barthel index showed a positive correlation to HHS and a negative correlation to NRS.Conclusion: This study revealed that the current form of post-surgery fragility fracture PAC program effectively improves functional status, reduces the re-admission rate, and facilitates the patient transition back to the community. The results should improve patients' and physicians' confidence in such a program. [ABSTRACT FROM AUTHOR]

This study examined the nature and characteristics of sleep‐disordered breathing, including obstructive sleep apnea and central sleep apnea, in patients with post‐stroke dysphagia, to determine the demographic, anthropometric and clinical variables that were associated with sleep‐disordered breathing. Thirty‐nine patients diagnosed with acute stroke (28 males and 11 females with a mean age of 72.3 ± 10.0 years) underwent overnight polysomnography (within 3.9 ± 1.6 days after admission). Sleep‐disordered breathing was described by the apnea–hypopnea index and its obstructive and central components by the obstructive apnea–hypopnea index and central apnea–hypopnea index, respectively. Severity of dysphagia was assessed using the Mann Assessment of Swallowing Ability score. Severity of stroke and functional dependence were assessed by the National Institute of Health Stroke Scale and the modified Barthel index, respectively. Most of the cohort (87%) had moderate‐to‐severe dysphagia (Mann Assessment of Swallowing Ability of 143.2 ± 19.9). Sleep‐disordered breathing (apnea‐hypopnea index ≥ 5 events/hr) was present in 38 participants (97%) with a mean apnea–hypopnea index of 37.5 ± 24.4 events/hr. Sleep‐disordered breathing was predominantly obstructive in nature, with a mean obstructive apnea–hypopnea index and central apnea–hypopnea index of 19.6 ± 15.7 and 11.4 ± 17.6 events/hr, respectively. Multivariate linear regression analyses showed that the apnea–hypopnea index was associated with sex (p =.0001), body mass index (p =.029) and the modified Barthel index (p =.006); the obstructive apnea–hypopnea index was associated with the Mann Assessment of Swallowing Ability (p =.006), sex (p =.004) and body mass index (p =.015) and had a nonlinear relationship with the modified Barthel index (p =.019); and the central apnea–hypopnea index was associated with sex (p =.027) and the modified Barthel index (p =.019). The present study showed that dysphagia severity was associated with obstructive sleep apnea severity and this association was independent of sex, modified Barthel index and body mass index. However, stroke‐induced dysphagia was not associated with central sleep apnea or overall sleep‐disordered breathing. [ABSTRACT FROM AUTHOR]

Background/Objectives: The safety and immunogenicity of the BNT162b2 coronavirus disease 2019 (COVID‐19) vaccine in older adults with different frailty and disability profiles have not been well determined. Our objective was to analyze immunogenicity of the BNT162b2 mRNA COVID‐19 vaccine in older adults across frailty and disability profiles. Design: Multicenter longitudinal cohort study. Setting and participants: A total of 134 residents aged ≥65 years with different frailty and disability profiles in five long‐term care facilities (LTCFs) in Albacete, Spain. Intervention and measurements: Residents were administered two vaccine doses as per the label, and antibody levels were determined 21.9 days (SD 9.3) after both the first and second dose. Functional variables were assessed using activities of daily living (Barthel Index), and frailty status was determined with the FRAIL instrument. Cognitive status and comorbidity were also evaluated. Results: Mean age was 82.9 years (range 65–99), and 71.6% were female. The mean antibody titers in residents with and without previous COVID‐19 infection were 49,878 AU/ml and 15,274 AU/ml, respectively (mean difference 34,604; 95% confidence interval [CI]: 27,699–41,509). No severe adverse reactions were observed, after either vaccine dose. Those with prevaccination COVID‐19 had an increased antibody level after the vaccine (B = 31,337; 95% CI: 22,725–39,950; p < 0.001). Frailty, disability, older age, sex, cognitive impairment, or comorbidities were not associated with different antibody titers. Conclusions: The BNT162b2 mRNA COVID‐19 vaccine in older adults is safe and produces immunogenicity, independently of the frailty and disability profiles. Older adults in LTCFs should receive a COVID‐19 vaccine. [ABSTRACT FROM AUTHOR]

Background: Aphasia is one of the frequent consequences of stroke. The Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) is a commonly used instrument for measuring the quality of life in persons with aphasia following stroke. Aims: The aim of this study was twofold: (1) to examine the reliability and validity of the Persian version of the SAQOL-39, and (2) to examine the agreement between the self- and proxy-report versions of the scale. Methods and procedures: This cross-sectional study included 30 stroke people with aphasia in Tehran, Iran from January to April 2018. The SAQOL-39, 12-Item Short Form Health Survey (SF-12), Visual Analogue Scale (VAS), Barthel index (BI), and Modified Rankin Scale (MRS) were administered to all patients. In addition, the proxy version of SAQOL-39 was completed by the patients'caregivers. Tests of data quality included descriptive statistics of the data, ceiling and floor effects, internal consistency reliability, test-retest reliability, convergent validity, and agreement between self-report and proxy-report versions of the SAQOL-39. Outcomes and results: The mean SAQOL-39 total scores for the self- and proxy-report versions were 3.19 (SD = 0.79) and 3.38 (SD = 0.83) respectively. There were no significant floor and ceiling effects for both self- and proxy-report versions of the SAQOL-39 and its subscales. Both self- and proxy-report versions of the SAQOL-39 demonstrated satisfactory internal consistency (Cronbach's alpha>0.7) and test-retest reliability (intraclass correlation coefficient>0.7). Convergent validity of the SAQOL-39 was supported by its moderate to strong correlation with SF-12 (r = 0.701 for the self-report and r = 0.432 for proxy-report version). The intraclass correlation coefficient and visual inspection of a Bland-Altman plot demonstrated satisfactory agreement between self- and proxy-report versions. Conclusions: The Persian version of the SAQOL-39 demonstrated satisfactory reliability and validity; these results support its use to measure quality of life for Persian stroke people with aphasia. [ABSTRACT FROM AUTHOR]

Background: The high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal.Methods: Data on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants' ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status.Results: The overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning.Conclusions: One in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status. [ABSTRACT FROM AUTHOR]

Background: In hospitalized patients recovering from the SARS-coronavirus-2 disease 19 (COVID-19), high prevalence of muscle weakness and physical performance impairment has been observed. Objectives: The aim of this study was to evaluate the effectiveness of pulmonary rehabilitation in these subjects in a real-life setting. Methods: Retrospective data analysis of patients recovering from COVID-19, including those requiring assisted ventilation or oxygen therapy, consecutively admitted to an in-patient pulmonary rehabilitation program between April 1 and August 15, 2020. Short Physical Performance Battery (SPPB: primary outcome), Barthel Index (BI), and six-min walking distance were assessed as outcome measures. Results: Data of 140 patients were analyzed. After rehabilitation, patients showed improvements in SPPB {from: (median [IQR]) 0.5 (0–7) to 7 (4–10), p < 0.001} and BI (from 55 [30–90] to 95 [65–100], p < 0.001), as well as in other assessed outcome measures. The proportion of patients unable at admission to stand, rise from a chair and walk was significantly reduced (p < 0.00). Conclusions: Pulmonary rehabilitation is possible and effective in patients recovering from COVID-19. Our findings may be useful to guide clinicians taking care of patients surviving COVID-19 infection. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and to identify the associated factors of malnutrition among elderly Chinese with physical functional dependency.Design: Face-to-face interviews using standardised questionnaires were conducted to collect demographic information, health-related issues and psychosocial status. Physical function was measured by the Barthel Index (BI), and nutrition status was assessed by the Mini Nutritional Assessment-Short Form. Multivariate binary logistic regression was used to assess associated factors of malnutrition.Setting: China.Participants: A total of 2323 participants (aged ≥ 60 years) with physical functional dependency in five provinces in China were enrolled using a multistage cluster sampling scheme.Results: The prevalence of malnutrition was 17·9 % (95 % CI 16·3, 19·4). Multivariable binary logistic regression revealed the independent risk factors of poor nutrition status were being female, older age, lower educational status, poor hearing, poor physical functional status, lack of hobbies, low religious participation, poor social support, lack of social participation and changes in social participation. The study found that the most significant independent risk factor for malnutrition was complete physical functional dependence (OR 4·46, 95 % CI 2·92, 6·82).Conclusions: The findings of the study confirm that malnutrition and the risk of malnutrition are prevalent in Chinese older adults with physical functional dependency. In addition to demographic and physical health-related factors, psychosocial factors, which are often overlooked, are independently associated with nutrition status in Chinese older adults with physical functional dependency. A holistic approach should be adopted to screen for malnutrition and develop health promotion interventions in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease has provoked much discussion since its first appearance. Despite it being widely studied all over the world, little is known about the impact of the disease on functional ability related to performing activities of daily living (ADL) in patients post COVID-19 infection. Objectives: To understand the impact of COVID-19 on ADL performance of adult patients and to describe the common scales used to assess performance of ADL on patients post-COVID-19. Methods: A systematic review was conducted. We included studies that applied a physical capacity test in COVID-19 patients, post-infection. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence. Results: A total of 1,228 studies were included, after removing duplicates, 1,005 abstracts were screened and of those 983 were excluded. A final number of nine studies which met the eligibility criteria were included. The findings revealed worsening of physical function and ADL performance in all patients post COVID-19 infection. Conclusion: All included studies found a reduction of ADL beyond the test or scale used, revealing a vital worsening of functional ability in ADL performance and consequently loss of independence in COVID-19 patients after the acute phase of infection. Functional ability status previous to COVID-19 is crucial for predicting the severity of the disease and mortality. Barthel Index and ADL score were the most used assessment tools across subjects with different intrinsic capacity and context levels. [ABSTRACT FROM AUTHOR]