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The aim of this study was to assess the possibility of using scales for measuring cognitive and physical functions for a prognosis of care outcomes in elderly patients. Methodology. The survey was carried out in one of the Vilnius City Hospitals for Nursing and Support Treatment. A total number of 177 respondents were involved in the study. The Mini–Mental State Examination (MMSE), The Barthel Index (BI) and The Morse Fall Scale were used. Results. A statistically significant correlation was revealed between the scores of MMSE and BI (Pearson R = 0.41, p < 0.01); those with severe cognitive impairment were more dependent. A statistically significant correlation (Pearson R = −0.181, p < 0.01) was reported between the scores of MMSE and the Morse Fall Scale – the risk of falling was higher in patients with severe cognitive impairment. Conclusions. The Morse Fall Scale was not suitable for the prognosis of outcomes. The MMSE was suitable for the prognosis of a patient’s discharge. The Barthel Index should be considered as the most suitable tool for the prognosis of care outcomes: the sum-score of the Barthel Index above 25 may suggest that the patient would be discharged home; the sum-score below this level was associated with a higher likelihood of patient death.

As dementia progresses problems in distinguishing and perceiving dates, days of the week, and the time of day becomes more difficult. As a consequence the person with dementia can become more disorientated in time, missing appointments, doing things on the wrong day or at the wrong time, or they may begin to feel insecure with time. We carried out an assessment trial in which 50 persons with dementia tested automatic Night and Day calendars (NDC) at home in Lithuania, Norway, Ireland, the United Kingdom and Finland over one year. The aim of testing the NDC was to help people with dementia with time orientation. Aims of this study were to find out how persons with dementia and their family carers describe time disorientation; what coping mechanisms, if any, they had implement to combat this; what were their expectations of the time-aid; how the time-aid was used; and did they find it useful. Findings from the first three months show that most respondents with dementia used the NDC and found it useful as did their carers. Our conclusion is that it is possible to compensate for problems in time orientation by using an assistive aid. However a thorough assessment of individual and family needs is required, fitting the technology around these needs. Usefulness of the time-aid is also dependent on the motivation of individuals to use the device. [ABSTRACT FROM AUTHOR]

While it is generally agreed that any appraisal of quality of life should as far as possible rely on the individual's own perspective, having people with dementia evaluate their own quality of life remains a much-debated issue. This article reports findings from a longitudinal study (ENABLE) designed to examine the impact of assistive technology on persons with dementia and their family caregivers. The study's methodology sought to empower people with dementia by engaging them in the research process. Both quantitative and qualitative data on quality of life were collected from a sample of 92 persons with dementia before and after assistive technologies were introduced into their homes. This article presents preliminary baseline data on quality of life prior to when the home interventions (technologies) were introduced. Results demonstrate that people with dementia can competently participate in research on dementia and have more positive appraisals of their lives, roles and relationships than might be expected. [ABSTRACT FROM AUTHOR]

This article describes the ethical considerations and the framework that formed the basis for the design of the research methods, as well as the basis for choosing the devices to be tried out, in the ENABLE project. The principles of autonomy, beneficence and justice are defined and applied to an analysis of researchers' experience. Some of the ethical difficulties arising from conducting an intervention study of this type with persons with dementia are outlined. The article needs to be read in conjunction with the other ENABLE articles published in this issue of Dementia. [ABSTRACT FROM AUTHOR]

Assistive aids can support some people with dementia in their daily life. Examples are devices designed to facilitate time orientation, use the telephone, and cooker monitors that switch the gas off in case of over-heating. However, there is a dearth of knowledge about the feasibility of using different assistive aids and how to assess the usefulness of such products to the patient and the carer, as well as their costs and benefits for society. This article describes the development of a protocol for a multinational assessment study of different assistive aids to be used by people with dementia living in their own home. Experiences of using the protocol are also reported in this article. This work is part of the ENABLE project. [ABSTRACT FROM AUTHOR]

Objective: Fatigue and sleep disturbances are important symptoms of anxiety and mood disorders (AMD). Studies about the relationship between these variables usually rely on self-report assessments. Therefore, the aim of our exploratory study was to investigate the independent correlations between subjective and objective fatigue and sleep characteristics in individuals with AMD., Methods: In sum, 233 individuals with AMD attending a stress-related disorders day care unit (78.5 % females, mean age 39.0 years old) participated in a cross-sectional study. Participants completed the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Multidimensional Fatigue Inventory-20, and Pittsburgh Sleep Quality Index self-report questionnaires, as well as an exercise capacity workload test for assessing objective fatigue and polysomnography monitoring for evaluation of sleep structure., Results: In individuals with AMD, exercise capacity workload was associated with lower percent of stage 1 sleep (β = - 0.17, p = 0.006), REM latency (β = -0.13, p = 0.042), and wake after sleep onset (β = -0.12, p = 0.039). General fatigue was associated with a higher percent of body movements (β = 0.12, p = 0.047), as well as mental fatigue was associated with a higher percent of body movements (β = 0.13, p = 0.029), and a higher score on the PSQI (β = 0.21, p = 0.002)., Conclusions: Objective sleep characteristics were associated with objective assessment of fatigue, while subjective sleep quality was associated with subjectively assessed mental fatigue., Competing Interests: Declaration of Competing Interest 1) In the past two years Julius Burkauskas has been serving as a consultant at IQVIA. 2) Vesta Steibliene reports personal fees from Lundbeck, Sanofi-Aventis, Servier, Janssen, and grants from Lithuanian Research Council. 3) Jurate Macijauskiene reports collaboration with Ipsen. 4) Other authors have no potential conflicts of interest to declare., (Copyright © 2023. Published by Elsevier Inc.)

Late-life depression (LLD) is a multifactorial disorder, with susceptibility and vulnerability potentially influenced by gene-environment interaction. The aim of this study was to investigate whether the 5-HTTLPR polymorphism is associated with LLD. The sample of 353 participants aged 65 years and over was randomly selected from the list of Kaunas city inhabitants by Residents' Register Service of Lithuania. Depressive symptoms were ascertained using the EURO-D scale. The List of Threatening Events Questionnaire was used to identify stressful life events that happened over the last 6 months and during lifetime. A 5-HTTLPR and lifetime stressful events interaction was indicated by higher odds of depression in those with s/s genotype who experienced high stress compared to l/l carriers with low or medium stress, while 5-HTTLPR and current stressful events interaction analysis revealed that carriers of either one or two copies of the s allele had increased odds of depressive symptoms associated with stress compared to participants with the l/l genotype not exposed to stressful situations. Although no significant direct association was found between the 5-HTTLPR short allele and depression, our findings demonstrated that lifetime or current stressful life events and their modification by 5-HTTLPR genotype are risk factors for late-life depression., (© 2023. Springer Nature Limited.)

The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) are short self-report questionnaires used to screen and assess depression and anxiety severity in medical and community samples. However, little is known about their psychometric properties in individuals with anxiety and mood disorders (AMD) This study evaluated the psychometric properties of the PHQ-9 and GAD-7 in individuals with AMD. Individuals (n = 244, mean age 39.9 ± 12.3 years) with AMD completed the PHQ-9, GAD-7, as well as other measures of depression, anxiety, and a structured diagnostic interview. The PHQ-9 and GAD-7 demonstrated good internal consistency (Cronbach's alpha 0.87 and 0.84, respectively). The PHQ-9 and GAD-7 showed a weak correlation with clinician-rated scales HAM-D and HAM-A (r = 0.316, p < 0.01, r = 0.307, p < 0.01, respectively). For the PHQ-9, a cut score of ≥11 resulted in 72% sensitivity and 72% specificity at recognizing depression symptoms. For the GAD-7, a cut score ≥7 resulted in 73% sensitivity and 54% specificity at recognizing any anxiety disorders. The confirmatory factor analysis suggested a two-factor structure ("cognitive/affectional", "somatic") for both the PHQ-9 and GAD-7. In conclusion, the PHQ-9 and GAD-7 have adequate formal psychometric properties as severity measures for symptoms of anxiety and depression in individuals with AMD. The PHQ-9 performs well as a screener using a cut score of ≥11. However, the clinical utility of the GAD-7 as a diagnostic tool for recognition of anxiety disorders is limited., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: 1) Naomi A. Fineberg reports in the past 5 years personal fees from Taylor and Francis, Oxford University Press, Global Mental Health Academy and Elsevier; personal fees and non-financial support from Sun; non-financial support from RCPsych, CINP, WPA, the International Forum of Mood and Anxiety Disorders, ECNP and the Indian Association of Biological Psychiatry; grants from the Wellcome, UKRI, Orchard and NIHR; grants and non-financial support from EU COST Action; payment for consultancy from the UK MHRA, all outside of the submitted work. 2) Julija Gecaite-Stonciene works as a consultant at FACITtrans. 3) Vesta Steibliene reports personal fees from Lundbeck, Sanofi-Aventis, Servier, Janssen, and grants from Lithuanian Research Council. 4) In the past two years Julius Burkauskas has been serving as a consultant at Cronos. 5) Other authors have no conflicts of interest to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To investigate the prevalence of burnout, depression, anxiety and stress of Lithuanian midwives., Design: A descriptive, cross-sectional survey design., Methods: The Work Health and Emotional Wellbeing of Midwives (WHELM) survey instrument developed within the Australian maternity context was adapted and used in this research. The survey collects country-specific demographic data and incorporates several validated measures including the Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS-21)., Results: Three hundred and thirty-eight completed surveys were received. Results obtained using a CBI subscale showed that 84.9% experienced personal burnout, 70.1% reported work-related burnout and 41.1% had client-related burnout. The results indicate that the midwives reported moderate to extreme levels of depression (16.3%), anxiety (28.4%) and stress (13.9%) symptoms., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Purpose: We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level., Methods: The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021., Results: There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths., Conclusion: Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness., (© 2022. The Author(s).)

Background: Health-related quality of life (HRQoL) is known to be impaired in individuals with coronary artery disease (CAD), especially in those after a recent acute coronary syndrome (ACS). Heart failure (HF) is a common burden in this population that significantly contributes to worsening HRQoL. To accurately measure the level of HRQoL in individuals with CAD after ACS, disease-specific scales, such as the Minnesota living with heart failure questionnaire (MLHFQ), are recommended. Nevertheless, to date, there has not been a study that would comprehensively evaluate the psychometric properties of the MLHFQ in a large sample of individuals with CAD after ACS. The debate regarding the internal structure of MLHFQ is also still present. Hence, this study aimed to translate the MLHFQ and evaluate its internal structure, reliability/precision, and validity in individuals with CAD following ACS in Lithuania., Methods: In the cross-sectional study, 1,083 participants (70% men, age M = 58, SD = 9) were evaluated for sociodemographic and clinical characteristics. HRQoL was measured using the MLHFQ and the Short Form-36 health survey (SF-36). In addition, exercise capacity (EC) was also evaluated in the study patients, using a standardized computer-driven bicycle ergometer., Results: The internal consistency of the MLHFQ subscales (0.79-0.88) was found to be good. Confirmatory factor analysis (CFA) provided the support for the three-factor model ("physical domain," "social domain," and "emotional domain") of the MLHFQ and showed acceptable fit [comparative fit indices (CFI) = 0.894; goodness-of-fit (GFI) = 0.898; non-normal fit index (NFI) = 0.879, and root mean square error of approximation (RMSEA) = 0.073]. Regarding convergent evidence, significant associations were found between the MLHFQ domains and the SF-36 domains and EC (r's range 0.11-0.58)., Conclusion: The current study completed cultural validation and provided further information on the psychometric characteristics of the MLHFQ in Lithuania, suggesting MLHFQ as a valid and reliable instrument to measure HRQoL. The Lithuanian version of MLHFQ is best described by a three-factor solution, measuring physical, social, and emotional dimensions of HRQoL among individuals with CAD following ACS., Competing Interests: JG-S served as a consultant at FACITtrans. In the past several years JBu worked as a consultant to Cogstate, Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gecaite-Stonciene, Burkauskas, Bunevicius, Steibliene, Macijauskiene, Brozaitiene, Mickuviene and Kazukauskiene.)

Background: Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. Methods: We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives' opinion about patient safety issues. The overall response rate in the survey was 100% ( n  = 233). Results: The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions. Conclusions: On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level - Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.

Background: the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations., Methods: under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators., Results: the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item)., Conclusion: the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states., (© The Author(s) (2019). Published by Oxford University Press on behalf of the British Geriatrics Society.)

Objective: There has been a lack of research examining associations between biomarkers and health-related quality of life (HRQoL) in patients with coronary artery disease and heart failure. In patients with coronary artery disease and heart failure, we aimed to explore potential associations between biomarkers of health such as serum levels of thyroid hormones, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), inflammatory biomarkers and HRQoL., Methods: In sum, 482 patients (75% male; mean age 58±10 years) with coronary artery disease and heart failure were evaluated for socio-demographic and clinical coronary artery disease risk factors. Blood samples were drawn to evaluate thyroid hormones, NT-pro-BNP, high-sensitivity C-reactive protein and interleukin-6 (IL-6). Additional data was collected on HRQoL (the Minnesota Living with Heart Failure Questionnaire), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), Type D personality (DS14 scale)., Results: In multivariable models, lower levels of high-sensitivity C-reactive protein and interleukin-6 were associated with worse results on the Minnesota Living with Heart Failure Questionnaire emotional subscale (β = -0.107, p = 0.003; β = -0.106, p = 0.004). Lower levels of interleukin-6 were associated with worse perceived global health (β = -0.101, p = 0.011)., Conclusion: Even after controlling for socio-demographic and clinical risk factors including mental distress symptoms, lower levels of inflammatory biomarkers were associated with worse HRQoL.

Introduction: Little is known about programmes or interventions for the screening, monitoring and surveillance of frailty at population level., Methods: Three systematic searches and an opportunistic grey literature review from the countries participating in the ADVANTAGE Joint Action were performed., Results: Three studies reported local interventions to screen for frailty, two of them using a two-step screening and assessment method and one including monitoring activities. Another paper reviewed both providers' and participants' experiences of screening activities. Three on-going European projects and population-screening programmes in primary care await evaluation. An electronic Frailty Index for use with patients' primary care records has been recently validated. No study described systematic processes for the surveillance of frailty., Conclusions: There is insufficient evidence for the effectiveness of population-level screening, monitoring and surveillance of frailty. Development and evaluation of community-based two-step programmes including those that incorporate electronic health records, particularly in primary care, are now needed.

Purpose: There is still insufficient data on mental distress factors contributing to exercise capacity (EC) improvement before and after cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). The aim of our study was to evaluate the associations between various mental distress factors and EC before and after exercise-based CR (EBCR)., Methods: Over 12 months, 223 CAD patients (70% men, mean age 58 ± 9 years) were evaluated for socio-demographic, clinical, and mental distress symptoms as measured by the Hospital Anxiety and Depression scale (HADS), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Patients were tested for EC at baseline and after EBCR., Results: In a multivariate linear regression model, EC before EBCR was associated with HADS anxiety subscale (β = -.186, p = .002) and BDI-II somatic/affective subscale (β = -.249, p < .001). EC after EBCR was associated with HADS anxiety and depression subscales (β = -.198, p < .001; β = -.170, p = .002, respectively) and BDI-II (β = -.258, p < .001). The BDI-II somatic/affective subscale was the best predictor of reduced EC before and after EBCR., Conclusions: Mental distress and somatic/affective symptoms of depression are strongly associated with EC both at the beginning and after EBCR. Analysis of possible mediating or moderating factors was beyond the scope of our study. Future studies should focus on comprehensive evaluation of EC risk factors including other mental distress characteristics, subjectively experienced fatigue, and post-operative CAD symptoms.

Background: The role of self-management is often ambiguous, yet, it is an important area in clinical practice for palliative nurses. A clear conceptual understanding, however, of what it represents is lacking., Method: This paper reports an analysis of the concept of self-management support in palliative nursing. Avant and Walker's method was used to guide this concept analysis. A search of electronic databases (1990-2013), use of internet search engines and supplementary hand searching produced an international data set of reviews, empirical research, editorials, protocols and guidelines., Results: Based on the analysis self-management support in palliative nursing has been defined as assessing, planning, and implementing appropriate care to enable the patient to live until they die and supporting the patient to be given the means to master or deal with their illness or their effects of their illness themselves., Conclusions: Clarity with the concept of self-management support and palliative nursing could enable nurses to provide more patient and family centred care to people facing life threatening illnesses.

Background: This is the first ever study on the planning of the supply and demand for radiographers in Lithuania. The aim of this study was to analyze the supply and demand for radiographers in the labor market with respect to their number, structure, and services, and to provide a prognosis for the period of 2012-2030., Materials and Methods: Supply was calculated using two scenarios with differing duration of studies, annual student drop-out rates, rates of failure to start working, the annual number of new entrants into the labor market, and emigration rates. Annual mortality rates, the number of first-year students, and retirement rates were evaluated equally in both scenarios. Two projections of the demand for radiographers, based on the population's differing (by age and gender), need for outpatient radiology services, computed tomography, and magnetic resonance scans. Subsequently, the supply and demand scenarios were compared., Results: Evaluation of the perspective supply and demand scenarios - which are the most probable - revealed a gap forming during the analyzed period, the predicted specialist shortage will reach 0.13 full-time equivalents per 10,000 population, and in 2030-0.37 full-time equivalents per 10,000 population., Conclusions: Considering the changes in education of radiographers, the socio-demographic characteristics of the staff, and the increasing need for radiographers' services, the supply of radiographers during the next two decades will be insufficient. To meet the forecasted demand for radiographers in the perspective scenario, the number of students choosing this specialty from 2013 on should increase by up to 30%., (Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Many of the strategic planning studies worldwide have made recommendations to the policy makers on the steps to be taken in eliminating the perceived shortages of physician workforce or in improving their distribution and retention. Policy makers have also considered various policy interventions to ensure adequate numbers of physicians. This study reviewed the research evidence and health policy decisions taken from 2000 to 2010 in Lithuania and evaluated the chronological links over time between scientific recommendations and policy decisions. From the analysis it would seem that Lithuania's success in retaining physicians between 2000 and 2010 was influenced by the timely implementation of particular research recommendations, such as increased salaries and increased enrolment to physician training programmes. In addition were the health policy interventions such as health sector reform, change in the legal status of medical residents and establishment of professional re-entry programmes. Based on this evidence it is recommended that policy makers in Lithuania as well as in other countries should consider comprehensive and systematic health policy approaches that combine and address various aspects of physician training, retention, geographic mal-distribution and emigration. Implementation of such an inclusive policy however is impossible without the integration of research into strategic decision making in workforce planning and effective health policy interventions., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Rapid political and economic changes have exerted a great influence on the health of the Lithuanian population, particularly on the most vulnerable layers such as older adults. The aim of this study was to assess mortality from major causes of death of older adults in the context of the socioeconomic transition and health reform in Lithuania., Methods: Information was gathered on deaths of older adults (aged 65 years and older) from 1991 to 2010 by examining death certificates held by the Lithuanian Department of Statistics. Overall mortality and mortality from cardiovascular diseases (CVD) and cancer were analyzed. Joinpoint analysis was used to identify the best-fitting points wherever a statistically significant change in mortality occurred., Results: Because of considerable variations in overall mortality throughout the two decades, average annual changes were not statistically significant for males; however, a decline of 0.81% was observed for females (p < 0.05). Mortality from CVD decreased and cancer mortality increased statistically significantly both for males and females. The most critical points for overall mortality occurred in 1993, when an increasing trend reversed to a decreasing one. The major decline was observed in mortality from CVD in males and females. After the period of growing mortality (2000-2007 for males and 2003-2006 for females), the trend reversed to the declining one, which was mainly determined by the positive changes in CVD and cancer mortality, particularly among females., Conclusion: A shift from a health care system based on inpatient services towards a system including preventive strategies and being opened to the modern medical achievements seems to have played an important role in the health improvement of the older adults. However, organization of geriatric care and development of the social system for active ageing is still challenging. A major priority is to persuade all of the different sectors to commit to the establishment and implementation of the national policy for health and social care among the older population., (Copyright © 2012 S. Karger AG, Basel.)

Purpose: Hip fractures constitute a serious and common health problem from both individual and public health perspectives. Unified data collection and comparison between countries is recognised as an effective tool for care improvements. However, the variation in patients' demography, treatment methods and other local cultural aspects in different countries should be considered. The aim of our study was to compare femoral neck fracture patients treated in Kaunas and Lund, concerning functional outcome and quality of life., Methods: We investigated 99 patients treated by arthroplasty in Kaunas Clinics and 117 patients in Lund University Hospital. Patients were investigated according to the National Swedish Hip Fracture Register model and were followed up for a period of four months after the injury. The patient's place of residence, mobility, complaints of pain and additional hospital stay were recorded. The EQ-5D questionnaire was used to evaluate quality of life., Results: Patients in Kaunas were significantly younger, had lower ASA grade and were more mobile before trauma and at four moths follow-up. However, when comparing quality of life at four months follow-up between the institutions, Lund patients reported significantly better self care, felt less pain and discomfort, and had less symptoms of anxiety and depression., Conclusions: The difference observed in quality of life rating between institutions might be related to local cultures of the countries and should be considered when comparing the data.

Light changes in mental function after operation occur in patients of all ages, but more frequent they are observed in older patients. The incidence of early postoperative cognitive dysfunction varies depending on surgical procedure and may be as high as 20-90% in aged patients, and occurs most often in patients undergoing cardiovascular surgery. Early postoperative cognitive dysfunction is a predictor of late postoperative cognitive dysfunction. Delirium develops in at least 50% of older surgical patients and even more frequently after cardiac surgeries (72%). Postoperative delirium, like delirium manifesting with co-existing disease, and late postoperative cognitive dysfunction are strong predictors of functional and cognitive decline in one-year period after discharge and are associated with higher morbidity and mortality, longer hospital stay, and a higher rate of institutionalization. The reasons of postoperative cognitive dysfunction and delirium are not well understood. An assessment of cognitive function should be completed as a routine in older patients, and effective prevention requires the identification of risk factors for delirium: advanced age, preexisting dementia and depression, visual and hearing impairment, Parkinson disease, emergency operation, anticholinergic drugs, and others. After operation, elderly patients must be carefully monitored for probable postoperative delirium. It is important to deepen health care professionals' knowledge of postoperative cognitive complications in older surgical patients.

Unlabelled: The aim of this study was to assess cognitive functions of the elderly in an acute care department and long-term care institutions., Material and Methods: A total of 151 hospitalized patients and 111 residents in long-term care facilities participated in the study; in total, 262 respondents. The general items of the inter RAI Questionnaires (Acute Care and Long-Term Care Facilities) were used to evaluate and compare cognitive functions. Hospitalized patients were examined on admission (during 24 hours) evaluating the patient's status before hospitalization (three days before admission to hospital) and 24 hours before planned discharge. The residents in long-term care institutions were examined once., Results: The assessment of skills for daily decision-making showed that more patients made decisions independently at discharge (68.6%) comparing with admission day (53.0%). Impaired decision-making was more common on admission than at discharge, while the residents in long-term care institutions were more dependent than the hospitalized elderly. Procedural memory problems were more frequent among the residents in long-term care institutions (67.6%) than among the hospitalized elderly both on admission (34.7%) and discharge (21.9%) (P<0.001). The patients were able to express themselves clearly and understood others well at discharge more frequently (81.0% and 82.5%, respectively) than on admission (72.7% and 75.3%, respectively), while only 14.4% of the residents in long-term care institutions were able to express themselves clearly and understood others well (P<0.001)., Conclusions: The residents in long-term care institutions had worse cognitive functions than the hospitalized patients. Cognitive functions of the hospitalized elderly were significantly more impaired on admission as compared to discharge, possibly due to impaired somatic and functional status on admission.

Although Lithuanian population is aging and the number of older persons is increasing, the expectancy of autonomous life is one of the shortest in Europe. An increasing number of the elderly results not only in aging society, but in increasing morbidity as well. Reality of life is encouraging health care systems to take into account the needs of older patients and to seek for comprehensive assessment, which is not limited by physical assessment only but includes evaluation of functional state, cognition, socioeconomic status, home environment, identification of geriatric syndromes and vulnerability factors, and assessment of frailty. The term "frailty" is used to describe the status of the elderly person who can usually perform the main practical and social daily tasks, but due to loss of various functions, changes, or disorders cannot restore quickly the strength. Concomitant diseases, disorders, disability, and frailty were considered as synonyms, but the researchers have recently agreed that these terms are not the same. The social part of supportive environment is composed of people (family, friends, professional caregivers) who provide help. The physical part includes technologies that make living easier and more autonomous. Gerontechnologies in vulnerable and frail elderly people can compensate impaired orientation and memory, widen the possibility to communicate, exchange information, and move. With the help of gerontechnologies, safe home environment and monitoring of health state can be ensured. In the article, algorithm for maintenance of autonomy in older persons made by the authors is presented.

Unlabelled: The aim of this study was to identify and evaluate the prevalence of urinary incontinence and risk factors that influenced it among inpatients treated in the departments of internal medicine., Material and Methods: A total of 151 inpatients were questioned using a standardized geriatric questionnaire (InterRAI-Acute Care). Inpatients aged 65 years and more and who gave written informed consent were enrolled into the study. The mean age of the inpatients was 78+/-0.6 years. There were 58.9% of women and 41.06% of men., Results: Urinary incontinence was significantly influenced by the age of the inpatients. Inpatients with urinary incontinence were 3 years older on the average as compared to those without urinary continence (P<0.025). Women were more frequently affected than men (74.2% vs. 48.4%). A significant association between urinary and fecal incontinence and memory problems, movement disorders, delirium, dependence in daily activities, falls was established. The odds of having double incontinence were increased by dementia (OR=20.9; 95%, CI 2.3-186) and residual effects of a stroke (OR=3.5; 95%, CI 1.2-9.6). The prevalence of urinary incontinence decreased from 63.6% before hospitalization to 39.7% after hospitalization. According to standard medical documentation, urinary incontinence was diagnosed in 3.3% of cases, while using the interRAI-AC questionnaire, it was documented in 63.6% of cases., Conclusions: The prevalence of urinary incontinence increases in the elderly; therefore, it has to be investigated and treated. Memory problems, delirium, dependence in daily activities, movement disorders, and falls are directly related to the risk of urinary, fecal, and double incontinence among elderly inpatients. Double incontinence was significantly influenced by dementia (20.9 times) and residual effects of a stroke (3.5 times). Underdiagnosis of urinary and fecal incontinence in inpatients burdens the possibility of providing aid for elderly patients with this disorder.

Unlabelled: Arterial hypertension (AH) is one of the most important risk factors for development of ischemic heart disease; thus, control of AH and effective treatment are of great importance. Since arterial hypertension is commonly referred as asymptomatic condition, the question whether hypertensive condition is associated with the change of well-being and health-related quality of life is still debatable., The Aim of the Study: To evaluate the impact of duration and treatment of AH on health-related quality of life., Material and Methods: The contingent of the study consisted of patients who arrived for a cardiologist's consultation at the Clinic of Cardiology, Hospital of Kaunas University of Medicine. The patients were randomly selected for the study. The inclusion criteria were as follows: diagnosed arterial hypertension, diabetes mellitus, and the metabolic syndrome. Diagnosed ischemic heart disease (chronic and acute coronary syndromes and their complications) and severe concomitant diseases were exclusion criteria. A total of 101 patients (19 males and 82 females) met the inclusion criteria and consented to participate in the study. Their mean age was 58.03+/-5.63 years. The patients' quality of life was evaluated using the Medical Outcomes Study short form 36-item questionnaire (SF-36 questionnaire), which comprises 36 questions grouped into eight domains. The questionnaire was filled in by the subjects independently. Other methods applied to the study were inquiry (for the evaluation of risk factors, lifestyle, and medical history), analysis of medical documents (cholesterol levels and glycemia in blood), and objective examination (height, weight, waist circumference, and arterial blood pressure)., Results: The subjects with AH showed lower values compared to normotensive patients in the following domains: physical functioning (P=0.014), role limitations due to physical health (P=0.012), energy/vitality (P=0.016), and general health evaluation (P=0.023). We have not determined the differences in quality of life of the patients whose AH was regulated if compared to those patients without AH. The patients whose treatment of AH was not effective reported lower quality of life in the following SF-36 domains: physical functioning (P=0.003), role limitations due to physical health (P=0.003), general evaluation of health (P=0.017), energy/vitality (P=0.008), and emotional status (P=0.015), if compared to the patients without AH., Conclusions: Patients with AH reported lower quality of life in the following domains: physical functioning, role limitations due to physical health, energy/vitality, and general evaluation of health. Compared to patients without AH, the quality of life of the patients who had the effective treatment did not differ, whereas patients with ineffective treatment had the lower quality of life. Functioning is more statistically significantly limited due to physical health in patients with AH.

Unlabelled: The aim of this study was to assess nutritional status of aged surgical patients, to determine the prevalence of malnutrition and factors associated with it., Material and Methods: A total of 156 patients aged 45 years and more, treated at the Departments of Surgery and Urology of Kaunas 2nd Clinical Hospital, were enrolled in the study. Elderly group (aged 65 years and more) consisted of 99 patients, and middle-aged group (45 to 64 years old) of 57 patients. The following anthropometric measurements were performed: weight, height, mid-arm circumference; hemoglobin, serum albumin level, and total lymphocyte count were determined. Standard assessment scales included Instrumental Activities of Daily Living, Geriatric Depression Scale, and Mini Mental State Exam. Statistical analysis was performed with the help of SPSS 12.0., Results: Malnutrition was diagnosed in 53.5% of older patients and in 15.8% of middle-aged patients (P<0.05). Obesity was diagnosed in 32.3% of elderly patients and in 40.4% of middle-aged patients (P<0.05). Among men, obese patients made up 20%, among women - 54.4% (P<0.05). Malnutrition was more prevalent among elderly patients who underwent urgent operations than in patients who underwent planned operations (69.6% and 34.1%, respectively; P<0.05) and among elderly patients with impaired cognitive functions than among those without impaired cognitive functions (in 100% of patients with medium impaired cognitive function, in 59.3% of patients with mild impaired cognitive function, and in 44.4% of patients with unimpaired cognitive function, P<0.05). Malnourished elderly patients had lower functional level than the remaining (IADL score of 3.97 and 4.75 for men, 5.38 and 6.89 for women, respectively; P<0.05). The prevalence of malnutrition did not differ significantly in the groups of older patients with depression, probable depression and not depressed patients - 75.0%, 57.7%, and 46.7%, respectively (P>0.05)., Conclusions: Malnutrition was diagnosed more frequently in elderly surgical patients than in middle-aged patients. Obesity was more common in women than in men. The prevalence of obesity was not associated with age. Malnutrition in elderly surgical patients was associated with poor functional status, impaired cognitive function, and urgent operation.

The aim of this paper is to present the Lithuanian experience in creating a geriatric care system with the hope that it can be of some use to other countries undergoing similar transitions and changes. The Lithuanian population is old with 20% of the population being 60 years and older, and 15% being 65 years and older, with the trend toward a rapidly aging society. In 1990, Soviet rule in Lithuania ceased and the country regained its independence. With its recent acceptance into the European Union, the nation has set goals to meet the recommended requirements for the care of the elderly. The changes began with specialist training in gerontology and geriatrics, and were an essential first step to bridge the gap between the real and the future needs. Later, the Geriatric Care System Development Program was approved by the Ministry of Health. Despite its difficult past, Lithuania is confronting the challenges of health and social care of the aging population. It is embracing the opportunities to initiate policies and related measures to meet these challenges, and is potentially setting an example of good practice as a new European community., (Copyright 2006 S. Karger AG, Basel.)

Lithuania, like many European countries, is facing the problem of ageing population. The ageing society is accompanied by an increase in the prevalence of the disorders that are characteristic for old age. This article presents an overview of the current situation with respect to care of patients with dementia in Lithuania. Calculations based on epidemiological studies in other countries reveal that at least 31,000 persons may be suffering from dementia in Lithuania, with 6407 new cases occurring each year. Management of persons with dementia is mainly conducted by psychiatrists and neurologists with a few geriatricians. Mental health centers with interdisciplinary teams assure medical treatment, primary diagnosis of dementia, family consultations, managing of social and psychological problems and visits to homes when needed. Institutional services and home help services for persons with dementia are scarce and underdeveloped. Our future priorities in developing care for people with dementia are to improve the timely diagnosis and comprehensive management of dementia with the establishment of a continuity of high quality social services with special emphasis on home help and the support of family members.

Objective: To examine the prevalence of anxiety symptoms in hospitalized geriatric patients., Design: Controlled cross-sectional study., Subjects: Ninety-eight geriatric in-patients and 68 healthy home-dwelling controls of similar age recruited from senior citizen centres., Outcome Measure: Anxiety measured as a current emotional state by Spielberger's State-Trait Anxiety Inventory (STAI)., Results: The geriatric patients scored significantly higher than the controls. Applying Spielberger's recommended cut-off of 39/40 on the STAI sumscore, 41% of the female and 47% of the male geriatric patients might be suspected of suffering from significant anxiety symptoms. Patients with chronic obstructive pulmonary disease tended to score higher; otherwise no relationship was found between the STAI sumscore and type of chronic somatic disease, nor between the STAI sumscore and number of drugs in regular use., Conclusions: STAI proved feasible for use in the elderly. The scoring on the STAI is high in geriatric in-patients. Further studies are needed to clarify to what extent this relates to a high prevalence of anxiety disorders., (Copyright 2001 John Wiley & Sons, Ltd.)