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Anticholinergic drug use and its association with self-reported symptoms among older persons with and without diabetes.

https://arctichealth.org/en/permalink/ahliterature298928
Source
J Clin Pharm Ther. 2019 Apr; 44(2):229-235
Publication Type
Journal Article
Date
Apr-2019
Author
Niina-Mari Inkeri
Merja Karjalainen
Maija Haanpää
Hannu Kautiainen
Juha Saltevo
Pekka Mäntyselkä
Miia Tiihonen
Author Affiliation
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Source
J Clin Pharm Ther. 2019 Apr; 44(2):229-235
Date
Apr-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cholinergic Antagonists - adverse effects - therapeutic use
Cohort Studies
Cross-Sectional Studies
Diabetes Mellitus - epidemiology
Female
Finland
Humans
Independent living
Male
Practice Patterns, Physicians' - statistics & numerical data
Primary Health Care
Self Report
Surveys and Questionnaires
Abstract
Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self-reported symptoms in older community-dwelling persons with and without diabetes.
The basic population was comprised of Finnish community-dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD-10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross-sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire.
The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self-reported symptoms.
There is no difference in anticholinergic drug use in older community-dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.
PubMed ID
30315583 View in PubMed
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Attending an activity center: positive experiences of a group of home-dwelling persons with early-stage dementia.

https://arctichealth.org/en/permalink/ahliterature264606
Source
Clin Interv Aging. 2014;9:1923-31
Publication Type
Article
Date
2014
Author
Ulrika Söderhamn
Live Aasgaard
Bjørg Landmark
Source
Clin Interv Aging. 2014;9:1923-31
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Dementia - therapy
Exercise
Female
Humans
Independent Living - psychology
Interpersonal Relations
Male
Middle Aged
Norway
Patient satisfaction
Qualitative Research
Social Participation
Abstract
In Norway, there is a focus on home-dwelling people with dementia receiving the opportunity to participate in organized meaningful activities. The aim of this study was to elucidate the experiences of home-dwelling persons with early-stage dementia who attend an activity center and participate in adapted physical and social activities delivered by nurses and volunteers.
The study adopted a qualitative approach, with individual interviews conducted among eight people diagnosed with early-stage dementia. The interview texts were analyzed using manifest and latent content analysis.
Four categories, ie, "appreciated activities", "praised nurses and volunteers", "being more active", and "being included in a fellowship", as well as the overall theme "participation in appreciated activities and a sense of feeling included in a fellowship may have a positive influence on health and well-being" emerged in the analysis. The informants appreciated the adapted physical and social activities and expressed their enjoyment and gratitude. They found the physical activities useful, and they felt themselves to be included in a fellowship through cheerful nurses and volunteers. The nurses were able to create a good atmosphere and spread joy in the center together with the volunteers. The informants felt themselves valued as the persons they were. These findings indicated that such activities may have had a positive influence on the informants' health and well-being.
In order to succeed with this kind of activity center, it is decisive that the nurses are able to tailor meaningful activities and create an environment where the persons with dementia can feel that they are respected and valued. The municipality health care service should implement such activity centers with specialist nurses in dementia care together with volunteers.
Notes
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PubMed ID
25419121 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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Effects of Cognitive Training on Cognition and Quality of Life of Older Persons with Dementia.

https://arctichealth.org/en/permalink/ahliterature302899
Source
J Am Geriatr Soc. 2018 04; 66(4):664-670
Publication Type
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Date
04-2018
Author
Eeva-Liisa Kallio
Hannareeta Öhman
Marja Hietanen
Helena Soini
Timo E Strandberg
Hannu Kautiainen
Kaisu H Pitkälä
Author Affiliation
Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland.
Source
J Am Geriatr Soc. 2018 04; 66(4):664-670
Date
04-2018
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Keywords
Aged, 80 and over
Cognition - physiology
Cognitive Behavioral Therapy - methods
Dementia - therapy
Female
Finland
Humans
Independent living
Male
Neuropsychological Tests - statistics & numerical data
Quality of Life - psychology
Single-Blind Method
Abstract
To evaluate the effect of cognitive training on cognition and health-related quality of life (HRQoL) in community-dwelling persons with dementia.
Single-blind randomized controlled trial with 3- and 9-month follow-up.
Adult day care centers in Helsinki, Finland.
Older individuals with mild to moderate dementia living at home and attending adult day care twice a week (N = 147; mean age 83, 72% female, 63% at mild stage of dementia).
A systematic 12-week training program focused on subskills of executive function: attention, working memory, cognitive flexibility, and planning. The intervention group (n = 76) underwent cognitive training twice a week for 45 minutes, and the control group (n = 71) attended day care as usual.
Primary outcomes were the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) for global cognition and the 15-dimensional instrument (15D) for HRQoL. The outcomes were measured at baseline and 3 and 9 months.
Both groups deteriorated in global cognition and HRQoL during follow-up, and there were no differences between the two groups in change on the ADAS-Cog (P = .43) or 15D (P = .61) over time (adjusted for age and sex). At 3 months, changes were 0.8 (95% confidence interval (CI) = -0.2-1.8) for the intervention group and 1.7 (95% CI = 0.6-2.7) for the control group on the ADAS-Cog and -0.040 (95% CI = -0.058 to -0.021) for the intervention group and -0.037 (95% CI = -0.056 to -0.018) for the control group on the 15D.
Systematic cognitive training had no effect on global cognition or HRQoL in community-living persons with mild to moderate dementia.
Notes
CommentIn: J Am Geriatr Soc. 2018 Apr;66(4):645-647 PMID 29345742
PubMed ID
29345724 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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Glycemic control and health-related quality of life among older home-dwelling primary care patients with diabetes.

https://arctichealth.org/en/permalink/ahliterature293508
Source
Prim Care Diabetes. 2017 Dec; 11(6):577-582
Publication Type
Journal Article
Date
Dec-2017
Author
Anna-Kaisa Aro
Merja Karjalainen
Miia Tiihonen
Hannu Kautiainen
Juha Saltevo
Maija Haanpää
Pekka Mäntyselkä
Author Affiliation
Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Finland; Rantakylä Health Center, Siunsote, Finland. Electronic address: koistine@student.uef.fi.
Source
Prim Care Diabetes. 2017 Dec; 11(6):577-582
Date
Dec-2017
Language
English
Publication Type
Journal Article
Keywords
Activities of Daily Living
Age Factors
Aged
Aged, 80 and over
Aging
Biomarkers - blood
Blood Glucose - metabolism
Cognition
Cross-Sectional Studies
Diabetes Mellitus - blood - diagnosis - psychology - therapy
Female
Finland
Geriatric Assessment
Glycated Hemoglobin A - metabolism
Humans
Independent living
Male
Mental health
Mental Status and Dementia Tests
Mobility Limitation
Predictive value of tests
Primary Health Care
Quality of Life
Risk factors
Self Care - methods
Time Factors
Treatment Outcome
Abstract
To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients.
Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 172 of them attended and provided complete data. The participants were divided into three groups based on the HbA1c: good (HbA1c57mmol/mol (N=29)) glycemic control. HRQoL was measured with the EuroQol EQ-5D questionnaire. Functional and cognitive capacity and mental well-being were assessed with the Lawton Instrumental Activities of Daily Living (IADL) scale, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15).
EQ-5D scores for good, intermediate and poor glycemic control were 0.78; 0.74 and 0.70, p=0.037. Sub-items of mobility (p=0.002) and self-care were the most affected (p=0.031). Corresponding trend was found for IADL, p=0.008. A significant correlation was found between MMSE scores and HbA1c.
Older primary care home-dwelling patients with diabetes and poorer glycemic control have lower functional capacity and HRQoL, especially in regard to mobility and self-care.
PubMed ID
28754430 View in PubMed
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Persons with Dementia and Their Caregivers Using GPS.

https://arctichealth.org/en/permalink/ahliterature281980
Source
Stud Health Technol Inform. 2015;217:212-21
Publication Type
Article
Date
2015
Author
Tone Øderud
Bjørg Landmark
Sissel Eriksen
Anne Berit Fossberg
Sigrid Aketun
May Omland
Karl-Gerhard Hem
Elisabeth Østensen
Dag Ausen
Source
Stud Health Technol Inform. 2015;217:212-21
Date
2015
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Caregivers
Data Collection - methods
Dementia
Female
Geographic Information Systems - utilization
Humans
Independent living
Male
Norway
Personal Autonomy
Abstract
The aim of the study is to generate knowledge on the use of Global Positioning Systems (GPS) to support autonomy and independence for persons with dementia. By studying a larger cohort of persons with dementia (n=208) and their caregivers, this study provides essential knowledge for planning and implementing GPS technology as a part of public health care services. Commercially available GPS technology was provided to the cohort of 208 persons with dementia from nineteen different Norwegian municipalities. The participants used GPS when performing outdoor activities as part of their daily life during a period of time between 2012 and 2014. Their family caregivers were instructed on how to use the GPS technology for locating the participants. The study documents that using GPS for locating persons with dementia provide increased safety for the person with dementia, their family caregivers and their professional caregivers. Furthermore the results confirm that by using GPS, persons with dementia may maintain their autonomy, enjoy their freedom and continue their outdoor activities despite the progression of the disease. Preconditions for successful implementation are that health professionals are trained to assess the participant's needs, that ethical dilemmas are considered, that caregivers have adequate knowledge about using the technology and that procedures and routines for administrating the GPS and locating persons with dementia are established. Early intervention and close collaboration between persons with dementia, family caregivers and professional caregivers are important for successful implementation of GPS in public health care.
PubMed ID
26294475 View in PubMed
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8 records – page 1 of 1.