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Niklas Ekerstad,1,2 Synneve Dahlin Ivanoff,3 Sten Landahl,4 Göran Östberg,5 Maria Johansson,5 David Andersson,6 Magnus Husberg,2 Jenny Alwin,2 Björn W Karlson7 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg, 2Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, 3Center of Aging and Health (AGECAP), Section of Health and Rehabilitation, 4Department of Geriatrics, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, 5Division of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla-Vänersborg, 6Department of Management and Engineering, Division of Economics, 7Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Background: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services.Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services.Results: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052–0.164; P

Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost. Keywords: frailty, elderly, acute care, intervention, comprehensive geriatric assessment

Summary In a population study of 70-year-old people in Goteborg, Sweden, a representative sample of 449 men and 524 women was followed for nine years. The prevalence of coronary heart disease (CHD) at age 70 was about 30% in both sexes and did not change up to age 79. Myocardial infarction appeared twice as often in men as in women at age 70 but angina pectoris and ST-T changes on ECG showed no sex difference. Myocardial infarction and probable ischaemia on ECG increased significantly between ages 70 and 79 in both sexes. Half of the men with angina pectoris had a history of myocardial infarction and/or probable ischaemia on ECG criteria compared with 23% of the women. The mortality rate was twice as high in men as in women irrespective of CHD. When CHD was present at age 70 the nine-year mortality was doubled. CHD was shown to be a strong independent risk factor for death also in this age group.

A representative systematic selection of 30% of all 70-year-olds (1148 persons) in Göteborg were invited to a population study. The participation rate was 85%. Sixteen per cent of the men and 25% of the women reported dryness in the mouth (sex. diff. P < 0.01). There was a significant correlation between the number of drugs consumed by the subjects and subjective dryness (in both sexes P < 0.001). Intake of drugs from the groups of anticholionergics, antihistamines, sedatives, hypnotics or phenothiazines respectively seemed to have the highest predicative value for dryness in the mouth (men P < 0.05 and women P < 0.01). There was also a positive correlation between subjective dryness and number of definable diseases in both sexes (P < 0.01). In a Consecutive sample (fifty-eight men and fifty-three women) a study of salivary flow, direct pH and buffer effect were performed. The mean value of unstimulated salivary secretion was in men 0.25 and in women 0.18ml/min. Corresponding figures for stimulated secretion was 1.65 and 1.04 ml/min (sex. diff. P < 0.01). A significantly lower unstimulated secretion was noted in women with subjective dryness (P < 0.01). A negative significant correlation were found between dental invalidity, according to Eichner's classification, and stimulated secretion when drug treatment had been considered (men P < 0.05 and women P < 0.01). Only weak relations were noted between salivary secretions and drug treatment. Only intake of drugs with diuretic effect were negatively correlated to stimulated secretion (P < 0.01). Diseases of the circulatory system were correlated to subjective dryness (P < 0.01). [ABSTRACT FROM AUTHOR]