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Wiener Klinische Wochenschrift Jun 2024Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and...
Trends over time in the deficit of (instrumental) activities of daily living in the Austrian population aged 65 years and older : Results from the Austrian Health Interview Survey series.
BACKGROUND
Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65 years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS).
METHODS
The ATHIS 2014 and 2019 surveys were used (N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year.
RESULTS
The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men (p < 0.001) and from 19.2% to 25.7% in women (p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men (p < 0.001) and from 38.2% to 50.8% in women (p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93-1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53-1.98). In both sexes, participants aged 80 years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77-5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86-5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41-4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85-4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations.
CONCLUSION
Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had a strong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.
PubMed: 38890264
DOI: 10.1007/s00508-024-02388-4 -
Annals of Intensive Care Jun 2024Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a... (Review)
Review
Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a population of "pre-frail" and "frail" older adults, so as to prevent falls, loss of mobility, and hospitalizations. A different definition of frailty, via the Clinical Frailty Scale, is now actively used in critical care situations to evaluate over 65 year-old patients, whether it be for Intensive Care Unit (ICU) admissions, limitation of life-sustaining treatments or prognostication. Confusion remains when mentioning "frailty" in older adults, as to which tools are used, and what the impact or the bias of using these tools might be. In addition, it is essential to clarify which tools are appropriate in medical emergencies. In this review, we clarify various concepts and differences between frailty, functional autonomy and comorbidities; then focus on the current use of frailty scales in critically ill older adults. Finally, we discuss the benefits and risks of using standardized scales to describe patients, and suggest ways to maintain a complex, three-dimensional, patient evaluation, despite time constraints. Frailty in the ICU is common, involving around 40% of patients over 75. The most commonly used scale is the Clinical Frailty Scale (CFS), a rapid substitute for Comprehensive Geriatric Assessment (CGA). Significant associations exist between the CFS-scale and both short and long-term mortality, as well as long-term outcomes, such as loss of functional ability and being discharged home. The CFS became a mainstream tool newly used for triage during the Covid-19 pandemic, in response to the pressure on healthcare systems. It was found to be significantly associated with in-hospital mortality. The improper use of scales may lead to hastened decision-making, especially when there are strains on healthcare resources or time-constraints. Being aware of theses biases is essential to facilitate older adults' access to equitable decision-making regarding critical care. The aim is to help counteract assessments which may be abridged by time and organisational constraints.
PubMed: 38888743
DOI: 10.1186/s13613-024-01315-0 -
Journal of Pain Research 2024Acute lumbar sprain (ALS) is a common clinical disease characterized by persistent intolerable low back pain and limitation of movement, and quick pain relief and...
PURPOSE
Acute lumbar sprain (ALS) is a common clinical disease characterized by persistent intolerable low back pain and limitation of movement, and quick pain relief and restoration of mobility in a short time are the main needs of patients when they visit the clinic. This study aims to evaluate the immediate efficacy of contralateral acupuncture (CAT) on SI3 combined with active exercise in treating ALS.
METHODS AND ANALYSIS
This study is a randomized controlled trial which will recruit 118 eligible participants aged 18 to 55 years with ALS at the Second Affiliated Hospital of Yunnan University of Chinese Medicine between March 2024 and December 2026. Participants will be randomly assigned to the acupuncture group or the sham-acupuncture group in a 1:1 ratio. The acupuncture group will receive a 10-minute acupuncture treatment combined with active exercise, while the sham-acupuncture group will receive a 10-minute sham acupuncture treatment combined with active exercise. Randomization will use a computer-generated sequence with allocation concealed in opaque envelopes. The primary outcome will be the pain visual analogue scale (VAS) scores after 10 minutes of treatment. Secondary outcomes will include the pain VAS scores at other time points (2, 4, 6, and 8 minutes post-treatment), the lumbar range of motion (ROM) scores at various time points, blinded assessment, the treatment effect expectancy scale, and the rescue analgesia rate. The analysis will follow the intention-to-treat principle. The primary outcome will be analyzed using ANCOVA, and secondary outcomes with repeated measures ANOVA. The rescue analgesia rate will be assessed using either the χ test or Fisher's exact test.
DISCUSSION
This study is the first randomized controlled trial to assess the immediate efficacy of CAT in combination with active exercise for ALS. This study will provide a simple, rapid, and effective treatment for the clinical management of ALS.
PubMed: 38887384
DOI: 10.2147/JPR.S475839 -
The Journal of Rheumatology Jun 2024Difficulty walking is a primary reason that individuals with knee osteoarthritis (OA) seek care. We examined the change in self-reported difficulty walking after...
OBJECTIVE
Difficulty walking is a primary reason that individuals with knee osteoarthritis (OA) seek care. We examined the change in self-reported difficulty walking after participating in the Good Life with osteoArthritis in Denmark (GLA:D®) 8-week education and exercise program and assessed patient factors associated with improvement in difficulty walking.
METHODS
This was a registry-based cohort study of individuals with knee OA who enrolled in GLA:D® in Denmark. Assessments were administered at baseline, at program completion (~3 months), and 12 months. Our pre-specified primary outcome was change in self-reported difficulty walking assessed using the EuroQol 5-dimension 5-level walking item. Exposures included sociodemographic factors, measures of OA illness severity, comorbidities, and psychological factors. In those with baseline moderate/severe difficulty walking, using multivariable regression analysis we assessed the relationship between exposures of interest and improvement to no/slight difficulty walking.
RESULTS
We included 5,262 participants. Of 2,178 (41.4%) individuals with baseline moderate/severe difficulty walking, 51.4% and 58.3% reported no/slight difficulty walking at 3 and 12 months, respectively. Greater self-efficacy, younger age, female sex, lower BMI, less intense knee pain and better function at baseline were associated with greater likelihood of improvement in difficulty walking; severe difficulty walking at baseline and back pain intensity were associated with decreased likelihood of improvement.
CONCLUSION
More than half of those with baseline difficulty walking experienced substantial improvement after completing GLA:D® and this improvement was maintained at 12 months. Several patient factors were associated with the outcome suggesting that some individuals may require additional support and extended treatment.
PubMed: 38879187
DOI: 10.3899/jrheum.2023-1213 -
The American Journal of Medicine Jun 2024Limited data exist on post-severe COVID-19 functional trajectory, particularly considering premorbid status. We characterized 1-year functional recovery...
BACKGROUND
Limited data exist on post-severe COVID-19 functional trajectory, particularly considering premorbid status. We characterized 1-year functional recovery post-hospitalization for COVID-19, highlighting predictors of long-term recovery.
METHODS
We enrolled adult patients with lab-confirmed SARS-CoV-2 infection and hospitalized for COVID-19 sequelae, from five major Ontario, Canada hospitals in a prospective cohort study. Assessments included telephone interviews on admission followed by telephone and in-person assessments at 3-, 6-, 9-, and 12-months post-discharge. The Activity-Measure for Post-Acute Care (AM-PAC) Mobility and Cognition scales were administered at baseline and every 3 months for 1 year. Secondary outcomes included symptoms, spirometry, physical performance, dyspnea, fatigue, distress, anxiety and depression, and quality of life.
RESULTS
254 patients (57.1% male) with a mean age of 60.0 (±13.1) years and an average hospital stay of 14.3 (±19.7) days agreed to participate. At 12 months, 55.3% demonstrated clinically important deficits in mobility and 38.8% had cognitive deficits compared to premorbid levels. Fatigue was reported in 44.2%, followed by difficulty walking long distances in 35.8% and dyspnea in 33.0%. Almost 40% of patients had an FEV1(% Pred) < 80% at 12 months, 60.3% had impairments in physical performance, and 44.5% had problems with anxiety or depression. Predictors of better mobility at 12 months included higher premorbid mobility status, male sex, shorter hospital stay, fewer comorbidities, and higher FEV1 (% pred) at the 3-month follow-up.
CONCLUSIONS
Our study provides compelling evidence of the long-term impact of COVID-19 on functional and cognitive status 1-year post-infection.
PubMed: 38878946
DOI: 10.1016/j.amjmed.2024.06.005 -
International Journal of Rheumatic... Jun 2024To compare the effects of Yoga with traditional exercise on the mobility and functional capacity of individuals with ankylosing spondylitis (AS). (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
AIM
To compare the effects of Yoga with traditional exercise on the mobility and functional capacity of individuals with ankylosing spondylitis (AS).
METHODS
The participants of the study were recruited at the rheumatology department, adhering to the study's inclusion and exclusion criteria. Participants were randomized into two groups (Group A - Yoga, and Group B - exercise).The candidates participated in an 8-week intervention consisting of 3 weekly sessions of either Yoga or Exercise intervention. Outcomes were collected at pre-treatment, at 8 weeks, and at 12 weeks.
RESULTS
The within-group comparison showed an improvement in all outcome measures with p < .05 between post-treatment and the follow-up. In the yoga group, there was an improvement in the measures of BASMI (p = .001), BASFI (p = .005), PSQI (p = .021), CE (p = .053) and NPRS (p = .001). Similarly, in the exercise group, there was an improvement in BASMI (p = .002), BASFI (p = .003), PSQI (p = .010), CE (p = .004) and NPRS (p = .001). In the between group comparison at post-treatment, there were no statistically significant differences in BASMI (yoga = 3.0 ± 1.50, exercise = 2.3 ± 1.38), PSQI (yoga = 5.3 ± 1.50, exercise = 4.9 ± 1.17) and NPRS (yoga = 1.3 ± 2.22, exercise = 0.4 ± 0.50) CE (yoga = 4.0 ± 1.18, exercise = 3.4 ± 0.96), BASFI (yoga = 1.8 ± 2.14, exercise = 2.1 ± 1.87).
CONCLUSION
The results demonstrated a statistically significant improvement in within-group scores of mobility, functional capacity, sleep quality and pain in AS patients of both intervention programs but there were no significant differences between the groups.
Topics: Humans; Yoga; Spondylitis, Ankylosing; Male; Female; Adult; Treatment Outcome; Exercise Therapy; Time Factors; Middle Aged; Functional Status; Recovery of Function; Mobility Limitation
PubMed: 38873950
DOI: 10.1111/1756-185X.15223 -
Etomidate-induced hypokalemia in electronic cigarette users: two case reports and literature review.Frontiers in Endocrinology 2024Hypokalemia is a common clinical condition that can lead to muscle weakness, difficulty breathing, malignant arrhythmias, and even death. This report describes two cases... (Review)
Review
Hypokalemia is a common clinical condition that can lead to muscle weakness, difficulty breathing, malignant arrhythmias, and even death. This report describes two cases of severe hypokalemia resulting from the use of electronic cigarettes containing etomidate, both accompanied by varying degrees of adrenal hyperplasia. In both cases, the patients were admitted to the hospital with lower limb weakness and difficulty walking. Relevant examinations revealed low blood potassium, low cortisol, high adrenocorticotropic hormone, low renin, and low aldosterone levels in the patients, with Case 2 also having significant hypertension. In both cases, adrenal CT scans showed thickening of the adrenal glands. After the delivery of potassium supplementation in both cases, blood potassium levels gradually returned to normal and muscle strength gradually improved. The case reports are followed by a review of the literature on etomidate and its related mechanisms of action with discussion of its association with hypokalemia.
Topics: Adult; Humans; Male; Electronic Nicotine Delivery Systems; Etomidate; Hypokalemia
PubMed: 38872965
DOI: 10.3389/fendo.2024.1321610 -
Advanced Science (Weinheim,... Jun 2024White light-emitting diodes (WLEDs) with high color-rendering index (CRI, >90) are important for backlight displays and solid-state lighting applications. Although the...
White light-emitting diodes (WLEDs) with high color-rendering index (CRI, >90) are important for backlight displays and solid-state lighting applications. Although the well-developed colloidal quantum dots (QDs) based on heavy metals such as cadmium and lead are promising candidates for WLEDs, the low CRI still remains a significant limitation. In addition, the severe toxicity of heavy metals greatly limits their widespread use. Herein, the study demonstrates low-cost and environmentally friendly carbon quantum dots (CQDs)-based WLEDs that exhibit a high CRI of 94.33, surpassing that of conventional cadmium/lead-containing QD-based WLEDs. This achievement is attained through the employment of a binary host-induced exciplex strategy. The high hole/electron mobility and suitable energy levels of the donor and acceptor give rise to a broadband orange-yellow emission stemming from the exciplex. As the host, the binary exciplex is capable of contributing blue and orange-yellow emission components while efficiently mitigating the aggregation-induced quenching of CQDs. Meanwhile, CQDs effectively address the deep-red emission gap, enabling the realization of CQDs-based WLEDs with high CRI. These WLEDs also exhibit a remarkably low turn-on voltage of 2.8 V, a maximum luminance exceeding 2000 cd m , a correlated color temperature of 4976 K, and Commission Internationale de l'Eclairage coordinates of (0.34, 0.32).
PubMed: 38872266
DOI: 10.1002/advs.202404485 -
Surgical Endoscopy Jun 2024Sarcopenia has been reported to be associated with short-term outcomes after gastric endoscopic submucosal dissection (ESD). The "strength, assistance with walking,...
BACKGROUND
Sarcopenia has been reported to be associated with short-term outcomes after gastric endoscopic submucosal dissection (ESD). The "strength, assistance with walking, rising from a chair, climbing stairs, and falls" (SARC-F) questionnaire has been widely used as a screening tool for sarcopenia; however, SARC-F combined with body mass index and age (SARC-F+EBM) has recently been reported to be more useful than SARC-F alone. This study aimed to investigate the association between sarcopenia, measured using SARC-F+EBM, and short-term outcomes after gastric ESD.
METHODS
Patients who underwent gastric ESD at our institution between May 2020 and June 2023 were included, and their medical records were reviewed retrospectively. A SARC-F+EBM score ≥ 12 indicated sarcopenia. We evaluated the incidence of adverse events and the length of hospital stay in the sarcopenia and non-sarcopenia groups.
RESULTS
Overall, 263 patients (64 and 199 in the sarcopenia and non-sarcopenia groups, respectively) were investigated. The incidence of adverse events with a Common Terminology Criteria for Adverse Events grade ≥ 3 was not significantly different between the sarcopenia and non-sarcopenia groups (6.2% vs. 8.5%, p = 0.791). The proportion of patients with an extended hospital stay (≥ 10 days) was significantly higher in the sarcopenia group than that in the non-sarcopenia group (12.5% [8/64] vs. 3.5% [7/199], p = 0.012). Multivariate analysis showed that sarcopenia and lesions that present technical difficulty in ESD were independent risk factors for extended hospital stays (≥ 10 days). Of the eight cases having extended hospital stays in the sarcopenia group, four were due to the management after gastric ESD, three were due to family circumstances, and one was due to decreased activities of daily living.
CONCLUSIONS
Sarcopenia is not a predictor of adverse events associated with gastric ESD. However, patients with sarcopenia may be hospitalized for longer owing to non-ESD-related factors.
PubMed: 38864884
DOI: 10.1007/s00464-024-10903-x -
Scientific Reports Jun 2024As age increases, a decline in lower extremity strength leads to reduced mobility and increased fall risks. This decline outpaces the age-related reduction in muscle...
As age increases, a decline in lower extremity strength leads to reduced mobility and increased fall risks. This decline outpaces the age-related reduction in muscle mass, resulting in mobility limitations. Older adults with varying degrees of mobility-disability use different stepping strategies. However, the link between functional lower extremity strength and stepping strategy is unknown. Therefore, understanding how age-related reductions in functional lower extremity strength influence stepping strategy is vital to unraveling mobility limitations. Twenty participants (17F, 72 ± 6 years) were recruited and tested at a local community event. Participants were outfitted with inertial measurement units (IMU) and walked across a pressurized walkway under single and dual motor task conditions (walking with and without carrying a tray with water) at their usual and fast speeds. Participants were dichotomized into normal (11) or low functional strength groups (9) based on age-specific normative cutoffs using the instrumented 5-repetition Sit-to-Stand test duration. Our study reveals that older adults with normal strength prefer adjusting their step time during walking tasks, while those with reduced strength do not exhibit a preferred stepping strategy. This study provides valuable insights into the influence of functional lower extremity strength on stepping strategy in community-dwelling older adults during simple and complex walking tasks. These findings could aid in diagnosing gait deviations and developing appropriate treatment or management plans for mobility disability in older adults.
Topics: Humans; Aged; Male; Female; Walking; Lower Extremity; Muscle Strength; Independent Living; Gait; Aged, 80 and over; Mobility Limitation
PubMed: 38862689
DOI: 10.1038/s41598-024-64293-0