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Nutritional treatment of aged individuals with Alzheimer disease living at home with their spouses: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature124098
Source
Trials. 2012;13:66
Publication Type
Article
Date
2012
Author
Satu K Jyvakorpi
Taija Puranen
Kaisu H Pitkala
Merja H Suominen
Author Affiliation
Society for Memory Disorders Expertise in Finland, Fredriksberginkatu 2, 00240 Helsinki, Finland.
Source
Trials. 2012;13:66
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - complications - diagnosis - physiopathology - psychology - therapy
Body Weight
Caregivers - psychology
Cognition
Counseling
Depression - etiology
Dietary Supplements
Finland
Geriatric Assessment
Hand Strength
Humans
Independent living
Malnutrition - diagnosis - etiology - physiopathology - prevention & control - psychology
Nutrition Assessment
Nutrition Therapy
Nutritional Status
Quality of Life
Research Design
Spouses - psychology
Time Factors
Treatment Outcome
Vitamin D - therapeutic use
Vitamins - therapeutic use
Abstract
Nutritional status often deteriorates in Alzheimer's disease (AD). Less is known about whether nutritional care reverses malnutrition and its harmful consequences in AD. The aim of this study is to examine whether individualized nutritional care has an effect on weight, nutrition, health, physical functioning, and quality of life in older individuals with AD and their spouses living at home.
AD patients and their spouses (aged > 65?years) living at home (n?=?202, 102?AD patients) were recruited using central AD registers in Finland. The couples were randomized into intervention and control groups. A trained nutritionist visited intervention couples 4-8 times at their homes and the couples received tailored nutritional care. When necessary, the couples were given protein and nutrient-enriched complementary drinks. All intervention couples were advised to take vitamin D 20?µg/day. The intervention lasted for one year. The couples of the control group received a written guide on nutrition of older people. Participants in the intervention group were assessed every three months. The primary outcome measure is weight change. Secondary measures are the intake of energy, protein, and other nutrients, nutritional status, cognition, caregiver's burden, depression, health related quality of life and grip strength.
This study provides data on whether tailored nutritional care is beneficial to home-dwelling AD patients and their spouses.
ACTRN 12611000018910.
Notes
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PubMed ID
22624652 View in PubMed
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More attention to pain management in community-dwelling older persons with chronic musculoskeletal pain.

https://arctichealth.org/en/permalink/ahliterature264106
Source
Age Ageing. 2014 Nov;43(6):845-50
Publication Type
Article
Date
Nov-2014
Author
Niina Maria Karttunen
Juha Turunen
Riitta Ahonen
Sirpa Hartikainen
Source
Age Ageing. 2014 Nov;43(6):845-50
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Analgesics - therapeutic use
Attitude of Health Personnel
Chi-Square Distribution
Chronic Pain - diagnosis - physiopathology - therapy
Female
Finland
Geriatric Assessment
Health Knowledge, Attitudes, Practice
Humans
Independent living
Logistic Models
Male
Musculoskeletal Pain - diagnosis - physiopathology - psychology - therapy
Odds Ratio
Pain Management - methods
Pain Measurement
Patient satisfaction
Patients - psychology
Physician's Role
Time Factors
Treatment Outcome
Abstract
persistent pain is a major problem in older people, but little is known about older persons' opinion about the treatment of persistent pain.
the objective of this study was to investigate the factors associated with older participants having chronic musculoskeletal pain and hoping persistently that physician would pay more attention to the pain management.
this 3-year follow-up study was a part of large population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. The population sample (n = 1000) of the GeMS study was randomly selected from older inhabitants (=75 years) of Kuopio city, Finland, and participants were interviewed annually in the municipal health centre or in the participant's current residence by three study nurses. The current substudy included participants with chronic musculoskeletal pain (n = 270). Participants were asked specifically whether they hoped that more attention would be paid to pain management by the physician.
at baseline, 41% of the community-dwelling older participants with chronic musculoskeletal pain hoped the physician would pay more attention to pain management. Of those participants, 49% were still continuing to hope after 1 year and 31% after 2 years. A persistent hope to receive more attention to pain management was associated with poor self-rated health (OR: 2.94; 95% CI: 1.04-8.30), moderate-to-severe pain (OR: 3.46; 95% CI: 1.42-8.44), and the daily use of analgesics (OR: 4.16; 95% CI: 1.08-16.09).
physicians need to take a more active role in the process of recognising, assessing and controlling persistent pain in older people.
PubMed ID
24814961 View in PubMed
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Progressive strength training in older patients after hip fracture: a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature137788
Source
Age Ageing. 2011 Mar;40(2):221-7
Publication Type
Article
Date
Mar-2011
Author
Hilde Sylliaas
Therese Brovold
Torgeir Bruun Wyller
Astrid Bergland
Author Affiliation
Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Oslo, Norway. hilde.sylliaas@medisin.uio.no
Source
Age Ageing. 2011 Mar;40(2):221-7
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Age Factors
Aged
Aged, 80 and over
Aging
Chi-Square Distribution
Exercise Test
Female
Fracture Fixation
Hip Fractures - physiopathology - rehabilitation - surgery
Humans
Independent living
Male
Muscle strength
Norway
Postural Balance
Questionnaires
Recovery of Function
Resistance Training
Single-Blind Method
Time Factors
Treatment Outcome
Walking
Abstract
the aim of this study was to assess the effect of a 3-month strength-training programme on functional performance and self-rated health in a group of home-dwelling older hip fracture patients.
randomised, controlled; single-blind parallel-group trial.
intervention at outpatient's clinic.
one hundred and fifty patients with surgical fixation for a hip fracture.
strength training was integrated into all stages of the programme. The programme comprised four exercises, half of them in a standing position, performed at 80% of maximum. Measurements were taken after the 3-month intervention. The primary outcome measurement was the Berg Balance Scale (BBS). Secondary outcomes were results of the sit-to-stand test, Timed Up-and-Go test, maximal gait speed, 6-min walk test, Nottingham Extended Activities of Daily Living scale and the SF-12 health status questionnaire.
at baseline, there were no significant between-group differences. At follow-up, the intervention group showed highly significant improvements both in the primary endpoint (BBS, mean difference 4.7 points) and in secondary endpoints of tapping strength, mobility and instrumental activities of daily living.
home-dwelling hip fracture patients can benefit from an extended supervised strength-training programme in a rehabilitation setting. These patients are capable of high-intensity strength training, which should optimise gains in physical function, strength and balance. Resistance exercise training seems to influence functional performance adaptation.
PubMed ID
21247887 View in PubMed
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Progressive resistance training for community-dwelling women aged 90 or older; a single-subject experimental design.

https://arctichealth.org/en/permalink/ahliterature261956
Source
Disabil Rehabil. 2014;36(15):1240-8
Publication Type
Article
Date
2014
Author
Gro Idland
Hilde Sylliaas
Anne Marit Mengshoel
Renate Pettersen
Astrid Bergland
Source
Disabil Rehabil. 2014;36(15):1240-8
Date
2014
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged, 80 and over
Feasibility Studies
Female
Humans
Independent living
Mobility Limitation
Muscle Strength - physiology
Norway
Postural Balance - physiology
Program Evaluation
Resistance Training - methods - organization & administration
Treatment Outcome
Walking - physiology
Abstract
To examine the effect and feasibility of a 12-week programme of progressive resistance exercise on a group of nonagenarian (=90 years) community-dwelling women.
An A-B single-subject experimental design was applied. Visual analyses were used for estimating the effect of the intervention. Outcome measurements were: Timed Up and Go (TUG), comfortable walking speed and 30-s chair stands. The programme comprised four exercises, following the principle of overload, aiming at improving strength in the main muscle groups. Feasibility of the progressive resistance intervention was assessed by recording the recruitment of participants, adherence to the intervention and adverse events.
Twenty-seven women were invited; eight women aged 90 and above agreed to participate and six completed the study. They suffered from one to 10 chronic medical conditions. All improved their performance in the TUG test. Five of the six participants achieved a higher walking speed (11-59%) and four of them improved on the 30-s chair-stand test with five to 10 stands. No major adverse events were reported.
Progressive resistance training was a safe and efficient method to enhance mobility and increase lower body strength in this heterogeneous group of nonagenarian community-dwelling women.
Progressive resistance (PRT) training was found to be a safe and efficient method to enhance mobility and increase lower body strength in a group of community-dwelling women 90+. Participants with the poorest initial functional performance had great benefits, and the improvements appeared already after a few weeks of PRT. PRT might be useful in the rehabilitation field and could be implemented in facilities such as day care and senior centres frequented by very old persons with mobility limitations.
PubMed ID
24093596 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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One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial.

https://arctichealth.org/en/permalink/ahliterature286064
Source
Scand J Public Health. 2016 Dec;44(8):791-798
Publication Type
Article
Date
Dec-2016
Author
Liv Faksvåg Hektoen
Ingvild Saltvedt
Olav Sletvold
Jorunn L Helbostad
Hilde Lurås
Vidar Halsteinli
Source
Scand J Public Health. 2016 Dec;44(8):791-798
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Female
Health Care Costs - statistics & numerical data
Hip Fractures - economics - therapy
Humans
Independent living
Male
Norway
Treatment Outcome
Abstract
The aim of this study was to estimate the one-year health and care costs related to hip fracture for home-dwelling patients aged 70 years and older in Norway, paying specific attention to the status of the patients at the time of fracture and cost differences due to various patient pathways after fracture.
Data on health and care service provision were extracted from hospital and municipal records and from national registries; data on unit costs were collected from the municipalities, hospital administrations and previously published studies. Four different patient pathways were identified and the total costs for subgroups of patients according to age, sex, fracture type and instrumental activity of daily living at fracture incidence were calculated. Descriptive statistics were used to identify cost estimates.
The mean total one-year costs per patient were EUR 68,376 and the costs for patients alive one year after hip fracture were EUR 71,719. The patients' age and pre-fracture functional status contributed most to the total cost.
On average, care costs accounted for more than 50% of the total cost; even for patients with good functional status before hip fracture, care costs accounted for 40% of the total cost compared with hospital costs of 38%. To reduce the financial costs of hip fractures in the care sector, the results point to the importance of preventive programmes to reduce the risk of hip fracture, but also to the importance of comprehensive geriatric care in the initial phase after a hip fracture.
PubMed ID
28929932 View in PubMed
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Combined resistance and balance-jumping exercise reduces older women's injurious falls and fractures: 5-year follow-up study.

https://arctichealth.org/en/permalink/ahliterature273603
Source
Age Ageing. 2015 Sep;44(5):784-9
Publication Type
Article
Date
Sep-2015
Author
Saija Karinkanta
Pekka Kannus
Kirsti Uusi-Rasi
Ari Heinonen
Harri Sievänen
Source
Age Ageing. 2015 Sep;44(5):784-9
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control
Age Factors
Aged
Aging
Female
Finland - epidemiology
Follow-Up Studies
Fractures, Bone - diagnosis - epidemiology - physiopathology - prevention & control
Geriatric Assessment
Humans
Incidence
Independent living
Kaplan-Meier Estimate
Muscle strength
Odds Ratio
Postural Balance
Proportional Hazards Models
Prospective Studies
Registries
Resistance Training
Risk factors
Time Factors
Treatment Outcome
Women's health
Abstract
previously, a randomised controlled exercise intervention study (RCT) showed that combined resistance and balance-jumping training (COMB) improved physical functioning and bone strength. The purpose of this follow-up study was to assess whether this exercise intervention had long-lasting effects in reducing injurious falls and fractures.
five-year health-care register-based follow-up study after a 1-year, four-arm RCT.
community-dwelling older women in Finland.
one hundred and forty-five of the original 149 RCT participants; women aged 70-78 years at the beginning.
participants' health-care visits were collected from computerised patient register. An injurious fall was defined as an event in which the subject contacted the health-care professionals or was taken to a hospital, due to a fall. The rate of injured fallers was assessed by Cox proportional hazards model (hazard ratio, HR), and the rate of injurious falls and fractures by Poisson regression (risk ratio, RR).
eighty-one injurious falls including 26 fractures occurred during the follow-up. The rate of injured fallers was 62% lower in COMB group compared with the controls (HR 0.38, 95% CI 0.17 to 0.85). In addition, COMB group had 51% less injurious falls (RR 0.49, 95% CI 0.25 to 0.98) and 74% less fractures (RR 0.26, 95% CI 0.07 to 0.97).
home-dwelling older women who participated in a 12-month intensive multi-component exercise training showed a reduced incidence for injurious falls during 5-year post-intervention period. Reduction in fractures was also evident. These long-term effects need to be confirmed in future studies.
PubMed ID
25990940 View in PubMed
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Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: a randomised comparison of 538 patients.

https://arctichealth.org/en/permalink/ahliterature273948
Source
Clin Rehabil. 2015 Sep;29(9):892-906
Publication Type
Article
Date
Sep-2015
Author
Antti Lahtinen
Juhana Leppilahti
Samppa Harmainen
Jaakko Sipilä
Riitta Antikainen
Maija-Liisa Seppänen
Reeta Willig
Hannu Vähänikkilä
Jukka Ristiniemi
Pekka Rissanen
Pekka Jalovaara
Source
Clin Rehabil. 2015 Sep;29(9):892-906
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Female
Finland
Hip Fractures - mortality - rehabilitation - surgery
Humans
Independent living
Male
Physical Therapy Modalities
Prospective Studies
Recovery of Function - physiology
Treatment Outcome
Walking - physiology
Abstract
To examine effects of physical and geriatric rehabilitation on institutionalisation and mortality after hip fracture.
Prospective randomised study.
Physically oriented (187 patients), geriatrically oriented (171 patients), and health centre hospital rehabilitation (180 patients, control group).
A total of 538 consecutively, independently living patients with non-pathological hip fracture.
Patients were evaluated on admission, at 4 and 12 months for social status, residential status, walking ability, use of walking aids, pain in the hip, activities of daily living (ADL) and mortality.
Mortality was significantly lower at 4 and 12 months in physical rehabilitation (3.2%, 8.6%) than in geriatric rehabilitation group (9.6%, 18.7%, P=0.026, P=0.005, respectively) or control group (10.6%, 19.4%, P=0.006, P=0.004, respectively). At 4 months more patients in physical (84.4%) and geriatric rehabilitation group (78.0%) were able to live at home or sheltered housing than in control group (71.9%, P=0.0012 and P
PubMed ID
25452632 View in PubMed
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Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study).

https://arctichealth.org/en/permalink/ahliterature301757
Source
BMC Geriatr. 2018 10 01; 18(1):232
Publication Type
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Date
10-01-2018
Author
Paula Soukkio
Sara Suikkanen
Sanna Kääriä
Hannu Kautiainen
Sarianna Sipilä
Katriina Kukkonen-Harjula
Markku Hupli
Author Affiliation
Rehabilitation, South Karelia Social and Health Care District, Valto Käkelän katu 3, FI-53130, Lappeenranta, Finland. paula.soukkio@eksote.fi.
Source
BMC Geriatr. 2018 10 01; 18(1):232
Date
10-01-2018
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Keywords
Accidental Falls - prevention & control
Aged
Aged, 80 and over
Female
Finland - epidemiology
Frail Elderly - psychology
Hip Fractures - epidemiology - psychology - rehabilitation
Home Care Services - trends
Humans
Independent Living - psychology - trends
Male
Nutrition Assessment
Physical Therapy Modalities - psychology - trends
Quality of Life - psychology
Surveys and Questionnaires
Time Factors
Treatment Outcome
Abstract
Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture.
This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age?=?65) and 300 persons with a recent hip fracture (age?=?60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried's frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant's home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant's home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months.
Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services.
ClinicalTrials.gov Identifier: NCT02305433 , Registered Nov 28, 2014.
PubMed ID
30285645 View in PubMed
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Reablement in community-dwelling older adults: a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature273144
Source
BMC Geriatr. 2015;15:145
Publication Type
Article
Date
2015
Author
Hanne Tuntland
Mona Kristin Aaslund
Birgitte Espehaug
Oddvar Førland
Ingvild Kjeken
Source
BMC Geriatr. 2015;15:145
Date
2015
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Aged
Aged, 80 and over
Female
Home Care Services - organization & administration
Humans
Independent Living - psychology
Male
Norway
Patient satisfaction
Program Evaluation
Quality of Life
Recovery of Function
Rural Population
Treatment Outcome
Abstract
There has been an increasing interest in reablement in Norway recently and many municipalities have implemented this form of rehabilitation despite a lack of robust evidence of its effectiveness. The aim of this study was to investigate the effectiveness of reablement in home-dwelling older adults compared with usual care in relation to daily activities, physical functioning, and health-related quality of life.
This is a parallel-group randomised controlled trial conducted in a rural municipality in Norway. Sixty-one home-dwelling older adults with functional decline were randomised to an intervention group (n = 31) or a control group (n = 30). The intervention group received ten weeks of multicomponent home-based rehabilitation. The Canadian Occupational Performance Measure (COPM) was used to measure self-perceived activity performance and satisfaction with performance. In addition, physical capacity and health-related quality of life were measured. The participants were assessed at baseline and at 3- and 9-month follow-ups.
There were significant improvements in mean scores favouring reablement in COPM performance at 3 months with a score of 1.5 points (p = 0.02), at 9 months 1.4 points (p = 0.03) and overall treatment 1.5 points (p = 0.01), and for COPM satisfaction at 9 months 1.4 points (p = 0.03) and overall treatment 1.2 points (p = 0.04). No significant group differences were found concerning COPM satisfaction at 3 months, physical capacity or health-related quality of life.
A 10-week reablement program resulted in better activity performance and satisfaction with performance on a long-term basis, but not the other outcomes measured.
The trial was registered in ClinicalTrials.gov November 20, 2012, identifier NCT02043262 .
Notes
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PubMed ID
26537789 View in PubMed
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16 records – page 1 of 2.