Frances Horgan

Using Timed Up-and-Go to Identify Frail Members of the Older Population

BACKGROUND Frieds definition of frailty is widely used but its measurement is problematic. Timed up-and-go (TUG) is a simple measure of mobility that may be a useful proxy for frailty. Here, we describe the distribution of frailty and TUG in the older population of Ireland and discuss the extent to which TUG identifies the frail and prefrail populations. METHODS A total of 1,814 participants of The Irish Longitudinal Study on Ageing aged 65 and older completed a comprehensive health assessment. Frailty was defined by having three or more of low gait speed, low grip strength, unintentional weight loss, self-reported exhaustion, and low physical activity. ROC curves were used to identify how well TUG discriminates the frail and prefrail populations and whether TUG improves on gait speed as a single objective measure of frailty. RESULTS Among the Irish population aged 65 and older, 7.7% were frail and 44.0% were prefrail. TUG identifies frail members of the population well (AUC = 0.87) but is less able to discriminate the nonfrail from the prefrail or frail populations (AUC = 0.73). TUG captures the components of frailty that become more common with age but does not discriminate the components that do not, for example, unintended weight loss or exhaustion. There is no advantage in using TUG instead of gait speed with respect to identifying frailty. CONCLUSIONS TUG is a sensitive and specific measure of frailty that offers advantages in its measurement where the full application or interpretation of Frieds criteria is impracticable; however, TUG cannot be used to reliably identify prefrail individuals.

Stroke awareness in the general population: knowledge of stroke risk factors and warning signs in older adults.

BackgroundStroke is a leading cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs and risk factors. This study examined knowledge of stroke warning signs and risk factors among community-dwelling older adults.MethodsRandomly selected community-dwelling older people (aged 65+) in Ireland (n = 2,033; 68% response rate). Participants completed home interviews. Questions assessed knowledge of stroke warning signs and risk factors, and personal risk factors for stroke.ResultsOf the overall sample, 6% had previously experienced a stroke or transient ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half of the overall sample identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland).ConclusionKnowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. As such, many older adults may not recognise early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke.

Stroke rehabilitation: recent advances and future therapies

Despite advances in the acute management of stroke, a large proportion of stroke patients are left with significant impairments. Over the coming decades the prevalence of stroke-related disability is expected to increase worldwide and this will impact greatly on families, healthcare systems and economies. Effective neuro-rehabilitation is a key factor in reducing disability after stroke. In this review, we discuss the effects of stroke, principles of stroke rehabilitative care and predictors of recovery. We also discuss novel therapies in stroke rehabilitation, including non-invasive brain stimulation, robotics and pharmacological augmentation. Many trials are currently underway, which, in time, may impact on future rehabilitative practice.

Stroke and Nursing Home care: a national survey of nursing homes.

BackgroundAlthough stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency.MethodsA cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30) efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment.ResultsAcross all nursing homes (n = 60), 18% (n = 570) of the residents had previously had a stroke. In homes (n = 30), where interviews with residents with stroke (n = 257), only 7% (n = 18) residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239) residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place.ConclusionsThis study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care) for stroke survivors who reside in nursing homes in Ireland.

Long term outcome of stroke: Stroke is a chronic disease with acute events.

Bruins et al and the accompanying editorial on stroke care make a compelling case for reviewing conventional policy approaches to stroke, which often show a dysequilibrium towards the (very important) front end of stroke, and a relative agnosia for (equally important) aftercare.1 Although it is clearly very important that all …

The cost of stroke and transient ischaemic attack in Ireland: a prevalence-based estimate

BACKGROUND stroke is a leading cause of death and disability globally. The economic costs of stroke are high but not often fully quantified. This paper estimates the economic burden of stroke and transient ischaemic attack (TIA) in Ireland in 2007. METHODS a prevalence-based approach using a societal perspective is adopted. Both direct and indirect costs are estimated. RESULTS total stroke costs are estimated to have been €489-€805 million in 2007, comprising €345-€557 million in direct costs and €143-€248 million in indirect costs. Nursing home care and indirect costs together account for the largest proportion of total stroke costs (74-82%). The total cost of TIA was approximately €11.1 million in 2007, with acute hospital care accounting for 90% of the total. CONCLUSIONS the chronic phase of the disease accounts for the largest proportion of the total annual economic burden of stroke. This highlights the need to maximise functional outcomes to lessen the longer term economic and personal impacts of stroke.

Implications of stroke for caregiver outcomes: findings from the ASPIRE-S study

Background Informal caregivers are vital to the long-term care and rehabilitation of stroke survivors worldwide. However, caregiving has been associated with negative psychological outcomes such as anxiety and depression, which leads to concerns about caregiver as well as stroke survivor well-being. Furthermore, caregivers may not receive the support and service provision they require from the hospitals and community. Aims This study examines caregiver psychological well-being and satisfaction with service provision in the context of stroke. Methods Caregiver data were collected as part of the ASPIRE-S study, a prospective study of secondary prevention and rehabilitation which assessed stroke patients and their carers at six-months post stroke. Carer assessment included measurement of demographics, satisfaction with care (UK Healthcare Commission National Patient Survey of Stroke Care), psychological distress (Hospital Anxiety and Depression Scale), and vulnerability (Vulnerable Elders Scale). Logistic regression analyses and chi-squared tests were performed using STATA version 12. Results Analyses from 162 carers showed substantial levels of dissatisfaction (37·9%) with community and hospital services, as well as notable levels of anxiety (31·3%) and depressive symptoms (18·8%) among caregivers. Caregiver anxiety was predicted by stroke survivor anxiety (OR = 3·47, 95% CI 1·35–8·93), depression (OR = 5·17, 95% CI 1·83–14·58), and stroke survivor cognitive impairment (OR 2·35, 95% CI 1·00–5·31). Caregiver depression was predicted by stroke survivor anxiety (OR = 4·41, 95% CI 1·53–12·72) and stroke survivor depression (OR = 6·91, 95% CI 2·26–21·17). Conclusion Findings indicate that caregiver and stroke survivor well-being are interdependent. Thus, early interventions, including increased training and support programs that include caregivers, are likely to reduce the risk of negative emotional outcomes.

Footwear Antennas for Body Area Telemetry

Antennas designed to link footwear sensors within body centric networks are introduced with two small UWB antennas, one directional and another quasi-omnidirectional. The radiating characteristics are evaluated for three positions on a sample sports shoe using a detailed simulation model and measurements with a homogenous foot phantom. Antenna performance is assessed for resilience to close proximity loading by the footwear materials and the phantom foot.

Community-based post-stroke service provision and challenges: a national survey of managers and inter-disciplinary healthcare staff in Ireland

BackgroundThe extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement.MethodsThe study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7) and disciplinary allied health professional and public health nurse managers (N = 25) were interviewed (94% response rate).ResultsResults indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients.ConclusionsThis study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for strategic planning; increased funding of healthcare staff; increased team resources and teamwork; and removal of service provision barriers based on age. There were notably many challenges beyond funding. Similar evaluations in other healthcare systems would serve to provide comparative lessons to serve to tackle this underserved aspect of care for patients with stroke and their families.

Clinical assessment of rehabilitation potential of the older patient: a pilot study

Clinical assessment of ‘rehabilitation potential’ is an everyday occurrence in hospitals, where scarcity of dedicated rehabilitation facilities require clinicians to decide who is most likely to benefit from extended rehabilitation. We examined the reliability of this judgement by different interdisciplinary team members in 27 consecutive admissions to a geriatric rehabilitation ward. The reliability of a clinical judgement was in general quite poor (kappa = 0.21). A more reliable means of determining patient ‘rehabilitation potential’ is needed.