Alicja Klich-Rączka

The prevalence of falls and their relation to visual and hearing impairments among a nation-wide cohort of older Poles

Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65 years and older in comparison to younger respondents aged 55-59 years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7 years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p<0.001 in the older group). In the group of older subjects falls occurred most often during walking (66.7% vs. 50.7% in the group of 55-59 years old), p=0.005), while the younger more often fell while practicing sports (5.48% vs. 0.8% in the group 65+, p<0.001) and risky activities (respectively: 13.7% vs. 4.9%, p=0.002). A similar percentage of younger and older fallers reported one (44.0% and 46.1% respectively) or more falls (56.1% and 53.9%; p=0.6). The percentage of recurrent fallers grew with increasing age (Cc=0.177; p<0.001). The prevalence of injurious falls was similar in the younger and older groups (45.4% and 42.8%, p=0.53). In both genders fall-related injuries were more frequent in younger elderly (65-74 years old) and in subjects 90 years old and older. In the non-standardized analysis and after adjustment for age and gender visual and hearing impairments and its degree were associated with falls but both relations lost statistical significance after adjustment for a set of explanatory variables. Despite somewhat lower estimates, falls in older Poles are no less an important factor influencing overall health than in other populations. The higher prevalence of multiple falls should draw attention of the health-care policy makers. Sensory impairment may add to the risk of falls and should be adequately taken care of, however the priority in the future fall prevention initiative should be given to stronger factors, such as age, type of activity, overall health, cognitive function and functional status.

The assessment of cognitive impairment suspected of dementia in Polish elderly people: results of the population-based PolSenior Study.

The growing incidence of dementia in ageing societies is a major concern of health care organizations. Because of its detrimental influence on the mental and functional statuses of elderly people, it leads to increased economic burdens caused by the social and financial needs of patients with dementia and their caregivers. There has been no data concerning the prevalence of dementia in the elderly in the general Polish community so far. The main aim of the study was to assess the prevalence of cognitive impairment suspected of dementia among the Polish elderly and the relationships between cognitive performance and age, gender, place of residence and educational status. The presented data was the result of nationwide, multicentre PolSenior Study conducted from 2007 to 2011 in the Polish elderly population. Cognitive functions were evaluated using Mini-Mental State Examination (MMSE) performed by pre-trained nurses. The result of MMSE lower than 24 points was classified as cognitive impairment suspected of dementia and divided according to its severity into three stages: mild, moderate and severe dementia. The results were analysed in two ways: raw MMSE and MMSE scores after Mungas adjustment (MMSEadj), that is, corrected for age and educational level, and these were compared. To verify the suspicion of dementia an assessment was complemented by an interview of carers for the occurrence and course of memory disorders, treatment of dementia and by functional status assessment. In order to assess the prevalence of suspicion of dementia in the general Polish population, statistical analyses based on weighting were done. The suspicion of dementia on the basis of raw MMSE was made in 20.4% of respondents aged 65years and more, and after Mungas adjustment in 12.1% of older subjects. The prevalence of cognitive impairment grew with increasing age, as well as depending on the educational status of elderly respondents in both types of analyses; raw MMSE and MMSEadj. There was no significant difference in the prevalence of cognitive impairment according to gender in the general population (raw MMSE); however in analyses including MMSEadj results, the suspicion of dementia was made more often among men. Suspicion of dementia based on raw MMSE and MMSEadj results was made significantly more often among men than women at the age of 65-69years, and significantly more often among the oldest women, aged 90years and more. Suspicion of dementia was diagnosed more often in respondents living in rural communities (based on raw MMSE, but not on MMSEadj), which might be related to the differences in their educational status.

Reduced functionality in everyday activities of patients with self-reported heart failure hospitalization — Population-based study results

AIM To assess daily functioning and geriatric conditions of older subjects suffering from heart failure (HF) as compared to the general population. METHODS AND RESULTS The data were collected as part of the nationwide PolSenior project (2007-2011). Of 4979 individuals (age range 65-104 years), data on self-reported HF hospitalization were available for 4795 subjects (96%). Geriatric assessment (GA) included functional status (ADL, Activities of Daily Living and IADL, Instrumental ADL scales), cognitive function, mood disorders, sensory organ impairment, falls and comorbidity. Mean age ± SD of the study population was 73.8 ± 6.5 years; 62% were female. The proportion of subjects with HF hospitalizations increased from 8% in subjects aged 65-69 years up to 13% in the age group of 85-89 years, and decreased in nonagenarians (11%). Subjects with the HF hospitalization were older, used more drugs, and were characterized by a higher prevalence of comorbid conditions, mood disorders, hearing impairment and functional limitations. In logistic regression, HF hospitalization increased the age-sex adjusted risk of disability by 40%, both in ADL and IADL. After adjustment to other clinical and geriatric conditions, HF hospitalization remained an independent predictor of disability in both ADL (OR=1.36, 95%CI: 1.00-1.84) and IADL (OR=1.40, 95%CI: 1.01-1.93). CONCLUSIONS Older people who reported HF admissions had a higher number of comorbidities and geriatric conditions: mood disorders, hearing impairment and functional limitations. Besides, in our study, HF hospitalization independently and significantly increased the risk of limitations in IADL and ADL. Therefore, further studies are needed to evaluate the benefits of GA in patients with HF.

Clustering of geriatric deficits emerges to be an essential feature of ageing - results of a cross-sectional study in Poland

The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI:4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI: 4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.

Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project

Background: Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community‐dwelling older patients with a history of AF. Methods: The data were collected as part of the nationwide PolSenior project (2007–2012). Out of 4979 individuals (age range 65–104years), data on self‐reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15‐item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression. Results: Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self‐reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P<0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR=1.69; 95%CI: 1.43–2.00), stronger than heart failure, diabetes or coronary heart disease. Conclusions: In community‐dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke). HIGHLIGHTSDepression is independently associated with AF in population aged ≥65years.The results come from a study involving >4000 participants.The relationship with AF is stronger than with other cardiac diseases.

Analiza kosztów miesięcznej terapii chorób przewlekłych, zaleconej po okresie hospitalizacji, prowadzonej w warunkach opieki ambulatoryjnej u pacjentów w wieku 80 lat i powyżej

The analysis of the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge Background: It is thought that at least one medication is taken by up to 60% of elderly people. What is more, in US elderly people living in the community take on average four medications, while home-care residents take averagely seven drugs a day. The above-mentioned facts, in the light of current demographic changes of the structure of population, indicate the growing cost of ambulatory drug therapy of the elderly. Aim of the study: To analyze the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge. Moreover, the relation between the number of pills and drugs taken in general, concomitant illnesses and costs of therapy were assessed. Materials and methods: The retrospective analysis of medical documentation of 116 patients aged 80 and over was performed. The costs of therapy were calculated accordingly to the prices published in The Drug Index. Co-morbid illnesses were classified accordingly to the International Classification of Diseases (ICD-10). Analysis in the age subgroups was performed. Results: Mean age was 85.2 ± 4.2y-rs, group consisted of 62 women and 27 men; 27 patients were excluded from further analysis. Mean number of prescribed drugs was 7.6 ± 2.9 (min.–max.: 1–16), mean number of prescribed pills was 8.8 ± 4.3 (min.–max.: 0–23). Patients in the examined group suffered from 5.8 ± 2.0 chronic diseases averagely. Mean cost of one month of ambulatory drug therapy was 135.9 ± 95.7 PLN (min.–max.: 1,96–625,9 PLN). Significant relations between the costs of ambulatory drug therapy and the number of chronic diseases (r = 0.51, p < 0.0001) as well as the number of pills (r = 0.68, p < 0.001) and drugs (r = 0.74, p < 0.001) were observed. The differences in the subgroups were observed. Conclusions: The high co-morbidity observed in the elderly results in the need for taking a great number of drugs and consequently causes high costs of ambulatory drug therapy. When planning ambulatory treatment, it is important to analyze the patients’ and their families’ financial situation, and when necessary provide economical support.