Monique A. A. Caljouw

Predictive factors of urinary tract infections among the oldest old in the general population. a population-based prospective follow-up study

BackgroundUrinary tract infections (UTI) are common among the oldest old and may lead to a few days of illness, delirium or even to death. We studied the incidence and predictive factors of UTI among the oldest old in the general population.MethodsThe Leiden 85-plus Study is a population-based prospective follow-up study of 86-year-old subjects in Leiden, The Netherlands. Information on the diagnosis of UTI was obtained annually during four years of follow-up from the medical records and interviews of treating physicians. A total of 157 men and 322 women aged 86 years participated in the study. Possible predictive factors were collected at baseline, including history of UTI between the age of 85 and 86 years, aspects of functioning (cognitive impairment (Mini-Mental State Examination (MMSE) < 19), presence of depressive symptoms (Geriatric Depression Scale (GDS) > 4), disability in activities of daily living (ADL)), and co-morbidities.ResultsThe incidence of UTI from age 86 through 90 years was 11.2 (95% confidence interval (CI) 9.4, 13.1) per 100 person-years at risk. Multivariate analysis showed that history of UTI between the age of 85 and 86 years (hazard ratio (HR) 3.4 (95% CI 2.4, 5.0)), impaired cognitive function (HR 1.9 (95% CI 1.3, 2.9)), disability in daily living (HR 1.7 (95% CI 1.1, 2.5)) and urine incontinence (HR 1.5 (95% CI 1.0, 2.1)) were independent predictors of an increased incidence of UTI from age 86 onwards.ConclusionsWithin the oldest old, a history of UTI between the age of 85 and 86 years, cognitive impairment, ADL disability and urine incontinence are independent predictors of developing UTI. These predictive factors could be used to target preventive measures to the oldest old at high risk of UTI.

Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities

To determine whether cranberry capsules prevent urinary tract infection (UTI) in long‐term care facility (LTCF) residents.

Needs and preferences regarding health care delivery as perceived by patients with systemic sclerosis

This study aims to examine the needs and preferences regarding the delivery of health care services and information provision and their determinants in patients with systemic sclerosis (SSc). A questionnaire was sent to 77 SSc outpatients, comprising 27 items on health care needs within the domains physical, psychological, social support, employment/daily activities, or other health problems and 13 items on information needs. Moreover, the patients’ preferences regarding the provision of health care services and information were listed. Additional assessments included sociodemographic characteristics, physical functioning (SSc Health Assessment Questionnaire), and quality of life (SF-36). Sixty-four patients (83%) returned the questionnaire. Twenty-six patients (41%) reported one or more unmet health care needs, with the highest proportions of patients with unmet needs seen in the physical (28%) and psychological (20%) domain. The highest percentages of patients with information needs were observed for medical subjects (20–28%). A lower mental component summary scale score and younger age were associated with the presence of at least one health care need in the psychological domain. Worse physical functioning, a diagnosis of diffuse SSc and having a partner were associated with higher information need score. A yearly, standardized multidisciplinary assessment program was most frequently mentioned as a preferred, but not yet existing health care model (59%) and the rheumatologist as a preferred source of information supply (75%). Unmet health care and information needs are common among SSc patients. To improve SSc health care, more attention should be paid to health care services for specific physical and psychological problems and medical information supply by the rheumatologist. In addition, the development of new models of care, such as a yearly, standardized multidisciplinary diagnostic program seems warranted.

Cost-effectiveness of cranberry capsules to prevent urinary tract infection in long-term care facilities: economic evaluation with a randomized controlled trial.

To investigate whether the preventive use of cranberry capsules in long‐term care facility (LTCF) residents is cost‐effective depending on urinary tract infection (UTI) risk.

Fear of falling after hip fracture in vulnerable older persons rehabilitating in a skilled nursing facility.

OBJECTIVE To identify factors that explain differences in patients with high and low levels of fear of falling after a hip fracture. DESIGN Cross-sectional study in 10 skilled nursing facilities in the Netherlands. PATIENTS A total of 100 patients aged ≥ 65 years admitted to a skilled nursing facility after a hip fracture. METHODS Participants were divided into 2 groups; low and high level of fear of falling, based on median Falls Efficacy Score - International. Data relating to factors that might explain fear of falling were collected, including demographic variables, aspects of functioning, psychological factors, and comorbidities. For every factor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with p < 0.05 were included. RESULTS Walking ability and activities of daily living before fracture, number of complications, activities of daily living after fracture, anxiety and self-efficacy were significantly associated univariately with fear of falling. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83), activities of daily living after fracture (OR 0.89, 95% CI 0.80-0.99), and anxiety (OR 1.22, 95% CI 1.05-1.42) were independently associated with fear of falling. CONCLUSION Impaired walking ability before fracture, impaired activities of daily living after fracture, and increased anxiety help distinguish between older persons with high and low levels of fear of falling after hip fracture. Because the last 2 factors are modifiable, this information enables the development of specific interventions for older persons with a high level of fear of falling.

Clinically diagnosed infections predict disability in activities of daily living among the oldest-old in the general population: the Leiden 85-plus Study

Background: ageing is frequently accompanied by a higher incidence of infections and an increase in disability in activities of daily living (ADL). Objective: this study examines whether clinical infections [urinary tract infections (UTI) and lower respiratory tract infections (LRTI)] predict an increase in ADL disability, stratified for the presence of ADL disability at baseline (age 86 years). Design: the Leiden 85-plus Study. A population-based prospective follow-up study. Setting: general population. Participants: a total of 154 men and 319 women aged 86 years. Methods: information on clinical infections was obtained from the medical records. ADL disability was determined at baseline and annually thereafter during 4 years of follow-up, using the 9 ADL items of the Groningen Activity Restriction Scale. Results: in 86-year-old participants with ADL disability, there were no differences in ADL increase between participants with and without an infection (−0.32 points extra per year; P = 0.230). However, participants without ADL disability at age 86 years (n = 194; 41%) had an accelerated increase in ADL disability of 1.07 point extra per year (P < 0.001). For UTIs, this was 1.25 points per year (P < 0.001) and for LRTIs 0.70 points per year (P = 0.041). In this group, an infection between age 85 and 86 years was associated with a higher risk to develop ADL disability from age 86 onwards [HR: 1.63 (95% CI: 1.04–2.55)]. Conclusions: among the oldest-old in the general population, clinically diagnosed infections are predictive for the development of ADL disability in persons without ADL disability. No such association was found for persons with ADL disability.

Satisfaction in Older Persons and General Practitioners during the Implementation of Integrated Care.

Background Integrated care for older persons with complex care needs is widely advocated. Particularly professionals and policy makers have positive expectations. Care outcome results are ambiguous. Receiver and provider satisfaction is relevant but still poorly understood. Methods During implementation of integrated care in residential homes (The MOVIT project), we compared general satisfaction and satisfaction with specific aspects of General Practitioner (GP) care in older persons and GPs before (cohort I) and after at least 12 months of implementation (cohort II). Results The general satisfaction score for GP care given by older persons does not change (Cohort I (n = 762) mean score 8.0 (IQR:7.0–9.0) vs. Cohort II (n = 505) mean score 8.0 (IQR:7.0–8.0);P = 0.01). Expressions of general satisfaction in GPs do not show consistent change (Cohort I (n = 87) vs Cohort II (n = 66), percentage satisfied about; role as GP, 56% vs 67%;P = 0.194, ability to provide personal care, 60% vs 67%;P = 0.038, quality of care, 54% vs 62%;P = 0.316). Satisfaction in older persons about some specific aspects of care do show change; GP-patient relationship, points 61.6 vs 63.3;P = 0.001, willingness to talk about mistakes, score 3.47 vs 3.73;P = 0.001, information received about drugs, score 2.79 vs 2.46;P = 0.002. GPs also report changes in specific aspects: percentage satisfied about multidisciplinary meetings; occurrence, 21% vs 53%;P = <0.001, GP presence, 12% vs 41%;P = <0.001, and participation, 29% vs.51%;P = 0.046. Conclusion General satisfaction about care received and provided shows no consistent change in older persons and GPs during the implementation of integrated care. Specific changes in satisfaction are found. These show an emphasis on inter-personal aspects in older persons and organizational aspects in GPs.

P299: Structured scoring of supporting nursing tasks in post-acute care to enhance early supported discharge in geriatric rehabilitation. The BACK-HOME study

Introduction: The aim of this study was to evaluate if the use of a structured scoring of supporting nursing tasks in the evening and night, leads to earlier discharge home in geriatric rehabilitation patients. Methods: A preand post-implementation cohort design was followed. One cohort (n = 200) was assessed before and the other (n = 283) after the implementation of the scorecard. The implementation consisted of weekly filling out a validated structured scorecard for identifying the supporting nursing tasks, discussing them in the multidisciplinary team-meeting, in order to establish if discharge home was possible with help in less than 3 nursing tasks within 2 weeks. Results: Both cohorts were comparable in age, gender and reasons for admission (mean age 80 years (SD:10); 69% females). Reason for admission were stroke (23%), joint replacement (13%), traumatic injuries (32%), and other (32%). Participants from the post-implementation cohort were discharged home earlier, within 48 days (SD:26) compared with 56 days (SD:31) in the preimplementation cohort; P =0.044. 28% of the participants that were able to be discharged home according to the supporting nursing tasks, were discharged within 2 weeks. Reasons for discharge delay were: no realized home adjustments (47%), diminished cognition participant (29%) and impaired general condition participant or informal caregiver (65%). Conclusion: The use of a scorecard for discharge planning may lead to earlier discharge home. After being indicated for discharge, this is often not realised within 2 weeks. An early inventarisation of the possibilities and barriers in the home situation is needed to avoid discharge delay.

Perceived doctor-patient relationship and satisfaction with general practitioner care in older persons in residential homes

Abstract Objective: Understanding patient satisfaction from the perspective of older adults is important to improve quality of their care. Since patient and care variables which can be influenced are of specific interest, this study examines the relation between patient satisfaction and the perceived doctor-patient relationship in older persons and their general practitioners (GPs). Design: Cross-sectional survey. Subjects and setting: Older persons (n = 653, median age 87 years; 69.4% female) living in 41 residential homes. Main outcome measures: Patient satisfaction (report mark) and perceived doctor-patient relationship (Leiden Perioperative care Patient Satisfaction questionnaire); relationships were examined by comparing medians and use of regression models. Results: The median satisfaction score was 8 (interquartile range 7.5–9; range 0–10) and doctor-patient relationship 65 (interquartile range 63–65; range 13–65). Higher satisfaction scores were related to higher scores on doctor-patient relationship (Jonckheere Terpstra test, p for trend <.001) independent of gender, age, duration of stay in the residential home, functional and clinical characteristics. Adjusted for these characteristics, per additional point for doctor-patient relationship, satisfaction increased with 0.103 points (β = 0.103, 95% CI 0.092–0.114; p < .001). In those with a ‘low’ doctor-patient relationship rating, the percentage awarding ‘sufficient or good’ to their GP for ‘understanding about the personal situation’ was 12%, ‘receiving attention as an individual’ 22%, treating the patient kindly 78%, and being polite 94%. Conclusion: In older persons, perceived doctor-patient relationship and patient satisfaction are related, irrespective of patient characteristics. GPs may improve patient satisfaction by focusing more on the affective aspects of the doctor-patient relationship. Key Points Examination of the perceived doctor-patient relationship as a variable might better accommodate patients’ expectations and improve satisfaction with the provided primary care.

Effect of ultraviolet light on mood, depressive disorders and well-being

Human and animal studies have shown that exposure to ultraviolet light can incite a chain of endocrine, immunologic, and neurohumoral reactions that might affect mood. This review focuses on the evidence from clinical trials and observational studies on the effect of ultraviolet light on mood, depressive disorders, and well‐being.