Pertti Aarnio

Mortality and cause of death in hip fracture patients aged 65 or older - a population-based study

BackgroundThe high mortality of hip fracture patients is well documented, but sex- and cause-specific mortality after hip fracture has not been extensively studied. The purpose of the present study was to evaluate mortality and cause of death in patients after hip fracture surgery and to compare their mortality and cause of death to those in the general population.MethodsRecords of 428 consecutive hip fracture patients were collected on a population-basis and data on the general population comprising all Finns 65 years of age or older were collected on a cohort-basis. Cause of death was classified as follows: malignant neoplasms, dementia, circulatory disease, respiratory disease, digestive system disease, and other.ResultsMean follow-up was 3.7 years (range 0-9 years). Overall 1-year postoperative mortality was 27.3% and mortality after hip fracture at the end of the follow-up was 79.0%. During the follow-up, age-adjusted mortality after hip fracture surgery was higher in men than in women with hazard ratio (HR) 1.55 and 95% confidence interval (95% CI) 1.21-2.00. Among hip surgery patients, the most common causes of death were circulatory diseases, followed by dementia and Alzheimers disease. After hip fracture, men were more likely than women to die from respiratory disease, malignant neoplasm, and circulatory disease. During the follow-up, all-cause age- and sex-standardized mortality after hip fracture was 3-fold higher than that of the general population and included every cause-of-death category.ConclusionDuring the study period, the risk of mortality in hip fracture patients was 3-fold higher than that in the general population and included every major cause of death.

Effect of a Risk-Based Multifactorial Fall Prevention Program on the Incidence of Falls

OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program on falls and to identify the subgroups that benefit the most.

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial.

BackgroundThis study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months.MethodsThe study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fishers exact test, the Mann-Whitney U-test and logistic regression.ResultsIn men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group.ConclusionFall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women.

One-time counselling decreases the use of benzodiazepines and related drugs among community-dwelling older persons

BACKGROUND evidence about possibilities to help older persons to withdraw the long-term use of benzodiazepines (BZD) is scarce. Effective and practicable methods are needed. OBJECTIVE the study aimed to assess the persistence of one-time counselling by a geriatrician to reduce psychotropic drugs, especially BZD and related drugs (RD). DESIGN a prospective randomised controlled trial with a 12-month follow-up was conducted. SUBJECTS five hundred ninety-one community-dwelling people aged 65 or older participated in the study. METHODS instructions to withdraw, reduce or change psychotropic drugs were given to the intervention group. A 1-h lecture about these drugs and their adverse effects was given later on. No changes in the drug therapy were suggested for the controls. RESULTS the number of regular users of BZD and RD decreased by 35% (12/34) (odds ratios (OR) = 0.61, 95% confidence interval (95% CI) 0.44-0.86) in the intervention group while it increased by 4% (2/46) (OR = 1.05, 95% CI 0.81-1.36) in the controls (P = 0.012). No significant changes in the users of other types of psychotropics were found. CONCLUSION one-time counselling of psychotropics and other fall-risk-increasing drugs by a geriatrician followed with a 1-h lecture about adverse effects of these drugs had positive effects in decreasing the number of regular users of BZD and RD, and these effects persisted for the total 12-month intervention period.

Teleconsultation as a replacement for referral to an outpatient clinic.

We conducted a randomized case control study of referrals from a primary care centre in Finland. All the consultations and referrals from seven general practitioners (GPs) dealt with by internists and surgeons at Satakunta Central Hospital in Pori and geriatricians at Satalinna Hospital in Harjavalta over five months were included. For patients in the control group, a conventional referral letter was sent to the hospital outpatient clinic. For patients in the intervention group, the GPs had to decide whether they wanted an electronic consultation with the hospital or wanted to refer the patient (i.e. to transfer responsibility for treatment). Communication with the hospital specialist was then via a secure Web-based system. Ninety-three patients consented to participate in the study. None refused, although there were 15 non-attenders. Satisfaction data were collected from questionnaires completed by the patients and doctors. All the patients treated by teleconsultation said that they wanted the same procedure in future and 63% of the control group said they would prefer a teleconsultation next time. The doctors quickly learned to exploit the telemedicine model successfully. The responsibility for treatment was maintained in the health centre in 52% of cases using teleconsultation, without any visit to hospital being required. The GPs and the hospital doctors agreed on the follow-up treatment. Telereferral increased the possibility of the GP maintaining responsibility for the treatment. The reduced number of hospital visits in the telemedicine model should produce significant cost savings.

Effects of Potent Anticholinergics, Sedatives and Antipsychotics on Postoperative Mortality in Elderly Patients with Hip Fracture: A Retrospective, Population-Based Study

AbstractBackground: Concomitant use of several medications for somatic and mental disorders is common in elderly people and increases the risk of falls, with hip fracture being the most serious consequence. Objective: The objective of this study was to describe relationships between use of sedatives, antipsychotics or potent anticholinergics and postoperative mortality in patients with hip fractures. Methods: A retrospective analysis was conducted on population-based data collected during a 2-year period from 1999 to 2000 on 461 hip fracture surgery patients aged ≥65 years in Finland. Information on co-morbidities and intake of sedatives, antipsychotics and potent anticholinergics was obtained from the original patient records. Information on deaths was obtained from the official death statistics in Finland. Results: In men, use of potent anticholinergics was associated with excess age-adjusted mortality at 30 days, 3 months, 6 months and 3 years, but not in women at any timepoint. Use of potent anticholinergic drugs emerged as an independent predictor of excess mortality in men at 3 months and 3 years. Presence of cardiovascular disease and chronic lung disease were independent risk factors for excess mortality at 6 months and 3 years in men. In addition, chronic lung disease independently predicted excess mortality at 30 days. Conclusion: Use of potent anticholinergics should be evaluated critically after diseases.

The LifeShirt system for wireless patient monitoring in the operating room

We examined the functionality and reliability of a wearable physiological monitoring system (LifeShirt) during normal daily activities and in a hospital operating room (OR) environment. The garment collects physiological data such as oxygen saturation, and stores them in a recorder from which it can be read afterwards. Ten normal subjects wore the shirt continuously for 8 h per day. Feedback from the testers was quite positive, although the collected data varied in quality. Ten hospital patients also wore the shirt during endoscopy. The data collected during the hospital stay were qualitatively adequate. Measuring respiratory function caused the biggest problems. The study showed that intelligent garment technology could be used in an OR environment for patient monitoring, albeit not in realtime. It may also be useful in home follow-up.

User satisfaction with teleconsultations for surgery.

We carried out a prospective study of realtime videoconferencing in surgical consultations. Videoconferencing equipment at the Satakunta Central Hospital, Pori, was connected by ISDN at 384 kbit/s to two health centres in the cities of Kankaanpaa and Huittinen (55 and 60 km from Pori, respectively). A document camera was used to transmit images of radiographs and paper documents. Fifty patients who needed a surgical consultation were examined by a doctor in the health centres, and the surgeon interviewed and observed the physical examination by videoconference. The consultation time ranged from 12 to 23 min (mean 15 min). Technically the equipment functioned reliably and the quality of the video-picture was good. According to the consulting surgeon, the decision made in the videoconference was reliable in 48 cases (96%). According to the doctors in the health centres, the consultation was useful in 49 cases (98%) and was considered satisfactory in one. The doctors thought that the teleconsultation was as reliable as an outpatient appointment in 49 cases (98%). The educational benefit of the consultation was excellent or good in 38 cases (76%). The overall satisfaction of patients was very good or good in 45 cases (96%). All patients, except one, avoided travelling to a face-to-face appointment because they received a definite treatment decision during the teleconsultation.

Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment

This non-randomized, controlled trial assessed the effects of ceasing fall-risk-increasing drugs (FRIDs) (psychotropics or opiates or potent anticholinergics) on the risk of falls requiring medical treatment as a sub-analysis of a randomized, controlled multifactorial fall prevention. The population in this 12-month study consisted of 528 community-dwelling subjects aged 65 years or older with a history of at least one fall. The subjects were divided retrospectively into three groups according to the use of any FRID, any psychotropic drug, and benzodiazepine or related drug (BZD/BZDRD). The subjects in the intervention group (IG) ceasing the drug use were compared with the subjects in IG and the control group (CG) not ceasing the use of the corresponding type of drugs during the intervention period. Falls were recorded from medical records. For the year after the 12-month intervention the relative risk ratio (with 95% confidence intervals=CI) for controls in CG compared with the withdrawal group in IG was 8.26 (1.07-63.73) among the users of psychotropics and 8.11 (1.03-63.60) among the users of BZDs/BZDRDs. Withdrawal of psychotropics, especially BZDs/BZDRDs may have played an important role by lowering the risk of falls requiring medical treatment during the year after the 12-month multifactorial intervention.

Effects of risk-based multifactorial fall prevention program on maximal isometric muscle strength in community-dwelling aged: a randomized controlled trial

Background and aims: The aim of this study was to assess the effects of risk-based multifactorial fall prevention program on maximal isometric strength in the community-dwelling aged. Methods: 591 subjects were randomized in two age groups (65–74 and ≥75 yrs), intervention group (IG) (n=293) and control group (CG) (n=298). A 12-month program consisted of individual geriatric assessment, individual guidance on fall prevention, home hazards assessment, physical exercises in groups, lectures, psychosocial activity groups, and home exercises. Strength was measured on an adjustable dynamometer chair. Results: Among women, the extension strength of the left knee increased by 7% in IG and 2% in CG (p=0.006), and that of the right knee by 7% and 4% (p=0.057), respectively. Subgroup analyses in the two age groups revealed a significant difference between groups among men aged 65–74 yrs, in favour of CG subjects, whose flexion strength of the left knee increased by 14% whereas the corresponding increase in IG was only 1% (p=0.042). Among women aged 65–74 yrs, the extension strength of right (increase of 8% in IG, 4% in CG) (p=0.046) and left knees (9% and 3%) (p=0.008) and flexion strength of right (10% and 4%) (p=0.042) and left knees (10% and 4%) (p=0.041) increased more in IG than in CG. Conclusions: The 12-month fall prevention program increased maximal isometric muscle strength among women only, especially those aged 65–74 years. We suggest that more intensive exercise, including the use of extra weights or resistance, is needed to increase muscle strength in men.