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Advance orders to limit therapy in 67 long-term care facilities in Finland.

https://arctichealth.org/en/permalink/ahliterature179892
Source
Resuscitation. 2004 Jun;61(3):333-9
Publication Type
Article
Date
Jun-2004
Author
Marja-Liisa Laakkonen
U Harriet Finne-Soveri
Anja Noro
Reijo S Tilvis
Kaisu H Pitkala
Author Affiliation
Helsinki City Hospital Koskela, P.O. Box 6410, FIN-00099 Helsinki, Finland. marja-liisa.laakkonen@hel.fi
Source
Resuscitation. 2004 Jun;61(3):333-9
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Advance Directives - statistics & numerical data
Aged
Aged, 80 and over
Assisted Living Facilities
Female
Finland
Hospitalization
Hospitals, Chronic Disease
Humans
Living Wills
Long-Term Care
Male
Nursing Homes
Resuscitation Orders
Abstract
To assess the documentation of a do-not-attempt-resuscitation (DNAR) or do-not-hospitalize (DNH) orders in the medical record and to determine factors related to these orders.
Five thousand six hundred and fifty four subjects from three different levels of institutional long-term care (LTC), chronic care hospitals (n = 1989), nursing homes (n = 3310), and assisted living (n = 335) in 67 LTC facilities in 19 municipalities were assessed.
Out of these patients, 751 (13%) had a DNAR order and only 36 (0.6%) had a DNH order. The variation in DNAR orders between individual LTC institutions was enormous, ranging from 0 to 92%. In logistic regression analysis, individual institutions and their local caring cultures had the strongest explanatory value (R(2) = 0.49) for advance orders to limit therapy. Impaired activity in daily living (ADL) function (R(2) = 0.11), impaired cognition (R(2) = 0.07), level of LTC (R(2) = 0.05), and diagnoses (R(2) = 0.04) did not provide adequate explanations. Terminal prognosis was not significantly associated with advance orders.
We found marked differences in the use of DNAR and DNH orders between caring units. Diseases and ADL status were only weakly significant as background factors. Open discussions, general guidelines, and research about the adequacy of DNAR decisions are needed to improve equality and self-empowerment among the elderly residing in institutions.
PubMed ID
15172713 View in PubMed
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Apathy: prevalence, associated factors, and prognostic value among frail, older inpatients.

https://arctichealth.org/en/permalink/ahliterature124530
Source
J Am Med Dir Assoc. 2012 Jul;13(6):541-5
Publication Type
Article
Date
Jul-2012
Author
Eeva H Hölttä
Marja-Liisa Laakkonen
Jouko V Laurila
Timo E Strandberg
Reijo S Tilvis
Kaisu H Pitkälä
Author Affiliation
Helsinki University Central Hospital, Unit of General Practice and City of Helsinki, Health Center, Helsinki, Finland. eeva.holtta@hel.fi
Source
J Am Med Dir Assoc. 2012 Jul;13(6):541-5
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Apathy
Delirium - mortality - psychology
Dementia - mortality - psychology
Female
Finland - epidemiology
Frail Elderly - psychology
Humans
Inpatients - psychology
Male
Prevalence
Prognosis
Proportional Hazards Models
Risk factors
Sex Factors
Statistics, nonparametric
Abstract
The association of apathy with Alzheimer disease and other dementias and caregiver burden has been examined in a number of studies; however, less is known about its relationship with delirium and mortality. We aimed to investigate the prevalence, relationship with delirium and dementia, and prognostic value of apathy in an elderly and frail inpatient population.
The cohort included 425 patients in acute geriatric wards and in 7 nursing homes in Helsinki (1999-2000). Demographic factors, physical functioning, diagnoses, and drugs were assessed with special reference for dementia, delirium, and apathy. Mortality was registered from central registers.
Of the patients, 98 (23.1%) suffered from apathy, and it was more frequent among men (32% versus 21% women, P = .037 ). There was no difference in mean age, number of comorbidities, or in the mean number of medications between those with and without apathy; however, those with apathy had lower mean MMSE points (9.2 versus 14.0 without apathy, P
PubMed ID
22572553 View in PubMed
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Disclosure of dementia diagnosis and the need for advance care planning in individuals with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature154161
Source
J Am Geriatr Soc. 2008 Nov;56(11):2156-7
Publication Type
Article
Date
Nov-2008

Effects of Exercise on Cognition: The Finnish Alzheimer Disease Exercise Trial: A Randomized, Controlled Trial.

https://arctichealth.org/en/permalink/ahliterature275911
Source
J Am Geriatr Soc. 2016 Apr;64(4):731-8
Publication Type
Article
Date
Apr-2016
Author
Hannareeta Öhman
Niina Savikko
Timo E Strandberg
Hannu Kautiainen
Minna M Raivio
Marja-Liisa Laakkonen
Reijo Tilvis
Kaisu H Pitkälä
Source
J Am Geriatr Soc. 2016 Apr;64(4):731-8
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Alzheimer Disease - rehabilitation
Caregivers
Cognition - physiology
Day Care, Medical
Exercise Therapy - methods
Female
Finland - epidemiology
Humans
Male
Prospective Studies
Treatment Outcome
Abstract
To examine whether a regular, long-term exercise program performed by individuals with Alzheimer's disease (AD) at home or as group-based exercise at an adult daycare center has beneficial effects on cognition; to examine secondary outcomes of a trial that has been published earlier.
Randomized, controlled trial.
Community.
Community-dwelling dyads (N = 210) of individuals with AD and their spousal caregivers randomized into three groups.
Two types of intervention comprising customized home-based exercise (HE) and group-based exercise (GE), each twice a week for 1 year, were compared with a control group (CG) receiving usual community care.
Cognitive function was measured using the Clock Drawing Test (CDT), Verbal Fluency (VF), Clinical Dementia Rating (CDR), and Mini-Mental State Examination (MMSE) at baseline and 3, 6, and 12 months of follow-up.
Executive function, measured using CDT, improved in the HE group, and changes in the score were significantly better than those of the CG at 12 months (adjusted for age, sex, and CDR, P = .03). All groups deteriorated in VF and MMSE score during the intervention, and no significant differences between the groups were detected at 12-month follow-up when analyses were adjusted for age, sex, and CDR.
Regular, long-term, customized HE improved the executive function of community-dwelling older people with memory disorders, but the effects were mild and were not observed in other domains of cognition.
PubMed ID
27037872 View in PubMed
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Effects of Self-Management Groups for People with Dementia and Their Spouses--Randomized Controlled Trial.

https://arctichealth.org/en/permalink/ahliterature275909
Source
J Am Geriatr Soc. 2016 Apr;64(4):752-60
Publication Type
Article
Date
Apr-2016
Author
Marja-Liisa Laakkonen
Hannu Kautiainen
Eeva Hölttä
Niina Savikko
Reijo S Tilvis
Timo E Strandberg
Kaisu H Pitkälä
Source
J Am Geriatr Soc. 2016 Apr;64(4):752-60
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Aged
Comorbidity
Dementia - nursing - rehabilitation
Female
Finland
Humans
Male
Neuropsychological Tests
Quality of Life
Self-Help Groups - economics
Spouses
Surveys and Questionnaires
Treatment Outcome
Abstract
To investigate the effect of self-management group rehabilitation for persons with dementia (PwD) and their spouses on their health-related quality of life (HRQoL), the cognition of the PwD, and the costs of health and social services.
A randomized controlled trial.
Primary care and memory clinics in the Helsinki metropolitan area, Finland.
PwD (N = 136) and their spouses (N = 136).
Couples were randomized to usual care or eight-session self-management groups for PwD and concurrently for their spouses. Sessions aim to enhance self-efficacy and problem-solving skills and to provide peer support.
The primary outcome measures were the HRQoL of PwD (measured using a generic, comprehensive (15-dimensional), self-administered instrument (15D)) and spouses (measured using the RAND-36) and the spousal Sense of Competence Questionnaire (SCQ). Secondary outcome measures were PwD cognition (Verbal Fluency (VF), Clock Drawing Test (CDT)) and costs of health and social services during 24 months.
At 3 months, the spouse physical component of the RAND-36 improved (mean change 1.0, 95% confidence interval (CI) = -0.5 to 2.4) for those undergoing the intervention and worsened for controls (mean change -2.0, 95% CI = -3.5 to -0.4) (P = .006 adjusted for age, sex, baseline value of the physical component of the RAND-36). There were no differences between the groups on the mental component of the RAND-36, the SCQ, or the 15D. At 9 months, PwD change in VF was -0.38 (95% CI = -1.03 to 0.27) in intervention group and -1.60 (95% CI = -2.26 to -0.94) for controls (P = .011 adjusted for age, sex, baseline MMSE score). CDT changes were similar to VF changes. Differences in incremental costs between the groups was -436 € per person per year (95% CI = -4,986 to 4,115) for PwD (P = .35 adjusted for age, CDR) and -896 € per person per year (95% CI = -3,657 to 1,864) for spouses (P = .51 adjusted for PwD age, CDR).
The intervention had beneficial effects on the HRQoL of spouses and the cognitive function of PwD without increasing total costs.
anzctr.org.au Identifier: ACTRN12611001173987.
PubMed ID
27060101 View in PubMed
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Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature114708
Source
JAMA Intern Med. 2013 May 27;173(10):894-901
Publication Type
Article
Date
May-27-2013
Author
Kaisu H Pitkälä
Minna M Pöysti
Marja-Liisa Laakkonen
Reijo S Tilvis
Niina Savikko
Hannu Kautiainen
Timo E Strandberg
Author Affiliation
Unit of Primary Health Care, Helsinki University Central Hospital, Finland. kaisu.pitkala@helsinki.fi
Source
JAMA Intern Med. 2013 May 27;173(10):894-901
Date
May-27-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Alzheimer Disease - economics - therapy
Caregivers
Day Care - economics - organization & administration
Exercise Therapy - economics - methods - organization & administration
Female
Finland - epidemiology
Follow-Up Studies
House Calls - economics
Humans
Independent living
Male
Physical Therapists
Prospective Studies
Quality of Life
Treatment Outcome
Abstract
Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD).
To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services.
A randomized controlled trial.
A total of 210 home-dwelling patients with AD living with their spousal caregiver.
The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care.
The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services.
All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P = .003) and 12 (P = .015) months. The FIM changes at 12 months were -7.1 (95% CI, -3.7 to -10.5), -10.3 (95% CI, -6.7 to -13.9), and -14.4 (95% CI, -10.9 to -18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25,112 (95% CI, $17,642 to $32,581) (P = .13 for comparison with the CG), $22,066 in the GE group ($15,931 to $28,199; P = .03 vs CG), and $34,121 ($24,559 to $43,681) in the CG.
An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects.
anzctr.org.au Identifier: ACTRN12608000037303.
Notes
Comment In: Ann Intern Med. 2013 Aug 20;159(4):JC1024026274
Comment In: MMW Fortschr Med. 2013 Nov 7;155(19):3224475662
Comment In: JAMA Intern Med. 2013 May 27;173(10):901-223588877
PubMed ID
23589097 View in PubMed
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Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial. Study protocol.

https://arctichealth.org/en/permalink/ahliterature140239
Source
Trials. 2010;11:92
Publication Type
Article
Date
2010
Author
Kaisu H Pitkala
Minna M Raivio
Marja-Liisa Laakkonen
Reijo S Tilvis
Hannu Kautiainen
Timo E Strandberg
Author Affiliation
Unit of General Practice, Helsinki University Central Hospital, University of Helsinki, PO Box 20, 00014 University of Helsinki, Finland. kaisu.pitkala@kolumbus.fi
Source
Trials. 2010;11:92
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - economics - physiopathology - psychology - rehabilitation
Caregivers
Clinical Protocols
Cognition
Cost of Illness
Cost-Benefit Analysis
Day Care - economics
Depression - etiology
Disability Evaluation
Exercise Therapy - economics
Finland
Frail Elderly
Health Care Costs
Humans
Independent living
Mobility Limitation
Neuropsychological Tests
Postural Balance
Quality of Life
Research Design
Time Factors
Treatment Outcome
Walking
Abstract
Besides cognitive decline, Alzheimer's disease (AD) leads to physical disability, need for help and permanent institutional care. The trials investigating effects of exercise rehabilitation on physical functioning of home-dwelling older dementia patients are still scarce. The aim of this study is to investigate the effectiveness of intensive exercise rehabilitation lasting for one year on mobility and physical functioning of home-dwelling patients with AD.
During years 2008-2010, patients with AD (n = 210) living with their spousal caregiver in community are recruited using central AD registers in Finland, and they are offered exercise rehabilitation lasting for one year. The patients are randomized into three arms: 1) tailored home-based exercise twice weekly 2) group-based exercise twice weekly in rehabilitation center 3) control group with usual care and information of exercise and nutrition. Main outcome measures will be Guralnik's mobility and balance tests and FIM-test to assess physical functioning. Secondary measures will be cognition, neuropsychiatric symptoms according to the Neuropsychiatric Inventory, caregivers' burden, depression and health-related quality of life (RAND-36). Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up.
To our knowledge this is the first large scale trial exploring whether home-dwelling patients with AD will benefit from intense and long-lasting exercise rehabilitation in respect to their mobility and physical functioning. It will also provide data on cost-effectiveness of the intervention.
ACTRN12608000037303.
Notes
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PubMed ID
20925948 View in PubMed
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How do officially organized services meet the needs of elderly caregivers and their spouses with Alzheimer's disease?

https://arctichealth.org/en/permalink/ahliterature160625
Source
Am J Alzheimers Dis Other Demen. 2007 Oct-Nov;22(5):360-8
Publication Type
Article
Author
Minna Raivio
Ulla Eloniemi-Sulkava
Marja-Liisa Laakkonen
Marja Saarenheimo
Minna Pietilä
Reijo Tilvis
Kaisu Pitkälä
Author Affiliation
Memory Research and Treatment Centers Finland, Medical Center Hemo Oy, Lahti, Social Insurance Institution of Finland. minna.raivio@phnet.Fi
Source
Am J Alzheimers Dis Other Demen. 2007 Oct-Nov;22(5):360-8
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - therapy
Caregivers - statistics & numerical data
Demography
Finland
Health Surveys
Humans
Income
Mental Disorders - epidemiology
Middle Aged
Needs Assessment - standards
Questionnaires
Spouses
Abstract
The caregiving situation among caregivers and their spouses with Alzheimer's disease, the support and services received, the unmet needs, and the caregivers' satisfaction with the services are examined. The study included a survey of a random sample of 1943 caregivers of persons with Alzheimer's disease in Finland. Mean age of the caregivers was 78.2 years, and 35% had poor subjective health. Disabilities and behavioral symptoms were common among the spouses with Alzheimer's disease. The services most often offered were financial support (36%), technical devices (33%), physiotherapy (32%), and respite care in nursing homes (31%). Most often needed services were physiotherapy for the spouse with dementia (56%), financial support (50%), house-cleaning (41%), and home respite (40%). Only 39% of the caregivers were satisfied with the services, and 69% felt they did not have any influence on what services were offered. It was concluded that official services poorly meet the needs of these caregivers.
PubMed ID
17959871 View in PubMed
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Older people's reasoning for resuscitation preferences and their role in the decision-making process.

https://arctichealth.org/en/permalink/ahliterature174999
Source
Resuscitation. 2005 May;65(2):165-71
Publication Type
Article
Date
May-2005
Author
Marja-Liisa Laakkonen
Kaisu H Pitkala
Timo E Strandberg
Saila Berglind
Reijo S Tilvis
Author Affiliation
Helsinki City Hospital Koskela, P.O. Box 6410, FIN-00099 Helsinki, Finland. marja-liisa.laakkonen@kolumbus.fi
Source
Resuscitation. 2005 May;65(2):165-71
Date
May-2005
Language
English
Publication Type
Article
Keywords
Aged - psychology
Aged, 80 and over
Attitude to Death
Decision Making
Female
Finland
Health Care Surveys
Health Knowledge, Attitudes, Practice
Health status
Humans
Male
Patient Participation - psychology
Patient satisfaction
Qualitative Research
Religion
Resuscitation - psychology
Abstract
To investigate older patients' reasoning for their cardiopulmonary resuscitation (CPR) preferences and the related decision-making process (DMP).
In a descriptive study 220 elderly home-dwelling cardiovascular patients were interviewed and asked to justify their CPR preferences according to the given statements. Questions related to DMP were asked and their physical function, cognition, mood, and quality of life were assessed.
Resuscitation preferences were associated with several patient characteristics, such as age, mood and quality of life. Patients preferring CPR (114/220, 52%) estimated their prognosis of CPR to be better than those preferring to forgo CPR. They justified their view: "Life is precious and worth living for me" (92%), "Maintaining life is a value of its own" (92%), "I feel needed by my family and my closest" (81%). Participants preferring to forgo CPR (106/220, 48%) justified: "I have already gained old age and led a full life" (88%), "People cannot decide these things" (72%). Only 9% of patients had discussed, and 38% would like to discuss preferences for life-sustaining treatments (LSTs) with their physician. However, 80% of respondents felt that the patients should take some part in the DMP; either alone (9%), together with a physician (23%), or together with a physician and a close relative (48%).
Older people justify their resuscitation preferences highlighting their experiences of meaningful life or fulfillment of their life, interpersonal relationships with their loved ones and presumed outcome of CPR. Less than a half of the patients wished to discuss CPR and LSTs preferences in their current situation with their physician, but nevertheless wanted to participate in the DMP of end-of-life treatment. Physicians should assess patients' own preferences in-depth.
PubMed ID
15866396 View in PubMed
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Reducing inappropriate, anticholinergic and psychotropic drugs among older residents in assisted living facilities: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature123333
Source
Trials. 2012;13:85
Publication Type
Article
Date
2012
Author
Kaisu H Pitkala
Anna-Liisa Juola
Helena Soini
Marja-Liisa Laakkonen
Hannu Kautiainen
Mariko Teramura-Gronblad
Harriet Finne-Soveri
Mikko Bjorkman
Author Affiliation
Unit of General Practice, Helsinki University Central Hospital and Department of General Practice, University of Helsinki, Tukholmankatu 8 B, 00014, University of Helsinki, Finland. kaisu.pitkala@helsinki.fi
Source
Trials. 2012;13:85
Date
2012
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Assisted Living Facilities - economics
Cholinergic Antagonists - adverse effects - economics - therapeutic use
Clinical Protocols
Cognition - drug effects
Cost-Benefit Analysis
Drug Interactions
Finland
Geriatric Assessment
Health Care Costs
Health Services - economics - utilization
Homes for the Aged - economics
Humans
Inappropriate Prescribing - economics - prevention & control
Inservice Training - economics
Neuropsychological Tests
Nursing Staff - economics - education
Polypharmacy
Psychotropic Drugs - adverse effects - economics - therapeutic use
Quality of Life
Research Design
Abstract
Use of inappropriate drugs is common among institutionalized older people. Rigorous trials investigating the effect of the education of staff in institutionalized settings on the harm related to older people's drug treatment are still scarce. The aim of this trial is to investigate whether training professionals in assisted living facilities reduces the use of inappropriate drugs among residents and has an effect on residents' quality of life and use of health services.
During years 2011 and 2012, a sample of residents in assisted living facilities in Helsinki (approximately?212) will be recruited, having offered to participate in a trial aiming to reduce their harmful drugs. Their wards will be randomized into two arms: one, those in which staff will be trained in two half-day sessions, including case studies to identify inappropriate, anticholinergic and psychotropic drugs among their residents, and two, a control group with usual care procedures and delayed training. The intervention wards will have an appointed nurse who will be responsible for taking care of the medication of the residents on her ward, and taking any problems to the consulting doctor, who will be responsible for the overall care of the patient. The trial will last for twelve months, the assessment time points will be zero, six and twelve months. The primary outcomes will be the proportion of persons using inappropriate, anticholinergic, or more than two psychotropic drugs, and the change in the mean number of inappropriate, anticholinergic and psychotropic drugs among residents. Secondary endpoints will be, for example, the change in the mean number of drugs, the proportion of residents having significant drug-drug interactions, residents' health-related quality of life (HRQOL) according to the 15D instrument, cognition according to verbal fluency and clock-drawing tests and the use and cost of health services, especially hospitalizations.
To our knowledge, this is the first large-scale randomized trial exploring whether relatively light intervention, that is, staff training, will have an effect on reducing harmful drugs and improving QOL among institutionalized older people.
ACTRN12611001078943.
Notes
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PubMed ID
22709731 View in PubMed
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11 records – page 1 of 2.