Matthias Bach

Preventing falls in community-dwelling frail older people using a Home intervention team (HIT): Results from the randomized falls-HIT trial

OBJECTIVES:  To evaluate the effect of an intervention by a multidisciplinary team to reduce falls in older peoples homes.

Prospective value of self-report and performance-based tests of functional status for 18-month outcomes in elderly patients.

To determine predictors of death, nursing home placement and hospital admission, a prospective study was carried out in a university-affiliated geriatric hospital and a general practice. One hundred and thirty-five patients consecutively admitted from home to the geriatric hospital and discharged home again (site 1), and 144 patients, aged 70 years and over, of a general practice (site 2) were recruited for a comprehensive geriatric assessment program. At baseline, none was completely dependent on others, or severely demented. At follow-up after 18 months, 46 subjects (17%) had died, 20 subjects (7%) had been institutionalized, and 79 had been admitted to hospital (28 %) in the interim. Univariate analysis demonstrated a significant association between Barthel Activities of Daily Living (ADL), Lawton-Brody Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Balance and Gait Evaluation, Timed “Up and Go”, Timed Test of Money Counting, Grip-Strength and Williams Board Test, and death as well as nursing home placement. Barthel-ADL were significantly correlated with hospital admission. In a logistic regression analysis, Barthel-ADL were independent predictors for death; Barthel-ADL, Timed “Up and Go”, Timed Test of Money Counting, and Williams Board Test were independent predictors for nursing home placement. No independent predictor was found for hospital admission. It is concluded that self-report and performance-based measures of functional capabilities are useful instruments to identify patients at risk for nursing home placement and death. Factors contributing to hospital admissions are other than those measured by the applied tests.

The Timed Test of Money Counting: A simple method of recognizing geriatric patients at risk for increased health care

The purpose of this prospective study was to measure patients’ ability to open a purse, take out money, and count it, in order to identify persons in need of increased health care. The study population consisted of 183 patients (mean age 78.9; range: 66-95) in two settings: 78 consecutively admitted geriatric hospital patients who could return home, and 105 community-dwelling patients aged 70 years or older. None was completely dependent on others, nor severely demented. Time for task performance was measured. Further assessment included the Mini-mental State Examination (MMSE), Barthel index of ADL, instrumental activities of daily living (IADL), socioeconomic status, grip strength, Williams board test, and medication profile. The Timed Test of Money Counting (TTMC) was reliable (interrater and intrarater), and showed construct and concurrent validity with other measures of physical function. There was a strong correlation (p<0.001) between the time required to count money, and to open and close the panel doors of the Williams board. The other functional measures were also significantly correlated with the TTMC. After 18 months, 26 of the patients had died, and 5 were lost to follow-up. The remainder were divided into those who had stable needs (group I), and those with increasing careneeds or nursing home placement (group II). Time required for money counting was significantly different (p<0.001) between groups (30.9±17.5 seconds for group I, and 122.6±94.4 seconds for group II). Using cut-off times of less than 45 seconds to identify persons with stable needs, and of more than 70 seconds to identify persons with increasing needs, the sensitivity and specificity were 83% and 75%, respectively, with 85% positive and 75% negative predictive accuracy. The TTMC seems helpful in identifying elderly persons in need of increased care. The test is performed quickly, requires no special equipment, and can be easily included in the routine geriatric examination. (Aging Clin. Exp. Res. 7: 179-183, 1995)