S. Golgert

The longitudinal urban cohort ageing study (LUCAS): study protocol and participation in the first decade

BackgroundWe present concept, study protocol and selected baseline data of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Germany. LUCAS is a long-running cohort study of community-dwelling seniors complemented by specific studies of geriatric patients or diseases. Aims were to (1) Describe individual ageing trajectories in a metropolitan setting, documenting changes in functional status, the onset of frailty, disability and need of care; (2) Find determinants of healthy ageing; (3) Assess long-term effects of specific health promotion interventions; (4) Produce results for health care planning for fit, pre-frail, frail and disabled elderly persons; (5) Set up a framework for embedded studies to investigate various hypotheses in specific subgroups of elderly.Methods/DesignIn 2000, twenty-one general practitioners (GPs) were recruited in the Hamburg metropolitan area; they generated lists of all their patients 60 years and older. Persons not terminally ill, without daily need of assistance or professional care were eligible. Of these, n = 3,326 (48 %) agreed to participate and completed a small (baseline) and an extensive health questionnaire (wave 1). In 2007/2008, a re-recruitment took place including 2,012 participants: 743 men, 1,269 women (647 deaths, 197 losses, 470 declined further participation). In 2009/2010 n = 1,627 returned the questionnaire (90 deaths, 47 losses, 248 declined further participation) resulting in a good participation rate over ten years with limited and quantified dropouts. Presently, follow-up data from 2007/2008 (wave 2) and 2009/2010 (wave 3) are available. Data wave 4 is due in 2011/2012, and the project will be continued until 2013. Information on survival and need of nursing care was collected continuously and cross-checked against official records. We used Fisher’s exact test and t-tests. The study served repeatedly to evaluate health promotion interventions and concepts.DiscussionLUCAS shows that a cohort study of older persons is feasible and can maintain a good participation rate over ten years, even when extensive self-reported health data are collected repeatedly through self-filled questionnaires. Evidently individual health developments of elderly persons can be tracked quantifying simultaneously behaviour, co-morbidity, functional competence and their changes. In future, we expect to generate results of significance about the five study aims listed above.

Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens—results from the Longitudinal Urban Cohort Ageing Study (LUCAS).

BackgroundThe detection of incipient functional decline in elderly persons is not an easy task. Here, we propose the self-reporting Functional Ability Index (FA index) suitable to screen functional competence in senior citizens in the community setting. Its prognostic validity was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS).MethodsThis index is based equally on both, resources and risks/functional restrictions which precede ADL limitations. Since 2001, the FA index was tested in the LUCAS cohort without any ADL restrictions at baseline (n = 1,679), and followed up by repeated questionnaires in Hamburg, Germany.ResultsApplying the index, 1,022 LUCAS participants were initially classified as Robust (60.9%), 220 as postRobust (13.1%), 172 as preFrail (10.2%) and 265 as Frail (15.8%). This classification correlated with self-reported health, chronic pain and depressive mood (rank correlations 0.42, 0.26, 0.21; all p < .0001). Survival analyses showed significant differences between these classes as determined by the FA index: the initially Robust survived longest, the Frail shortest (p < .0001). Analyses of the time to need of nursing care revealed similar results. Significant differences persisted after adjustment for age, sex and self-reported health.ConclusionsDisability free lifetime and its development over time are important topics in public health. In this context, the FA index presented here provides answers to two questions. First, how to screen the heterogeneous population of community-dwelling senior citizens, i.e. for their functional ability/competence, and second, how far away they are from disability/dependency. Furthermore, the index provides a tool to address the urgent question whether incipient functional decline/incipient frailty can be recognized early to be influenced positively.The FA index predicted change in functional status, future need of nursing care, and mortality in an unselected population of community-dwelling seniors. It implies an operational specification of the classification into Robust, postRobust, preFrail and Frail. Based on a self-administered questionnaire, the FA index allows easy screening of elderly persons for declining functional competence. Thereby, incipient functional decline is recognized, e.g. in GPs’ practices and senior community health centers, to initiate early appropriate preventive action.

In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project

ObjectivesIn-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy.DesignRetrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation.SettingGeriatric clinic at an academic teaching hospital in Hamburg, Germany.Participants4,735 hospitalised patients ≥65 years.MeasurementsSensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated.ResultsThere were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items ‘transfer’ + ‘walking’ score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3.ConclusionsBoth the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients.

Geriatric patients with cognitive impairment.

BACKGROUND Hospitals are now faced with increasing numbers of cognitively impaired patients aged 80 and older who are at increased risk of treatment complications. This study concerns the outcomes when such patients are treated in a specialized ward for cognitive geriatric medicine. METHODS Observation of a cohort of 2084 patients from 2009 to 2014, supplemented by a sample of 380 patients from the hospital cohort of the Longitudinal Urban Cohort Ageing Study (LUCAS) for the years 2010 and 2011. RESULTS Geriatric inpatients with cognitive impairment tend to be multimorbid. Half of the patients studied (1031 of 2084 patients) were admitted to the hospital on an emergency basis. Complications arising on the ward that necessitated transfer elsewhere arose in 2.6% (51 of 2084 patients). Moreover, analysis of the sample of 380 patients from the LUCAS cohort revealed that the treatments they underwent during hospitalization were associated with an improvement of their functional state: their mean overall score on the Barthel index rose from 39.8 ± 24.3 (median, 35) on admission to 52.7 ± 27.0 (median, 55) on discharge. The percentage of patients being treated with 5 or more drugs fell from 98.2% (373/380) on admission to 79.3% (314/362) on discharge. The percentage receiving potentially inappropriate medications (PIM), as defined by the PRISCUS list, fell from 45% to 13.3%, while the percentage of drug orders and prescriptions involving PIM fell from 7.8 % (327/4181) to 2.0% (53/2600). 70% of the patients were discharged to the same living situation where they had been before admission. CONCLUSION In this study, structured geriatric treatment in a cohort of older acutely ill patients with cognitive impairment was associated with improvement of functions that are relevant to everyday life, as well as with a reduction of polypharmacy. Controlled studies are needed to confirm the observed benefit.

Grauzonen von Gesundheit und Handlungsfähigkeit

ZusammenfassungZieleZiel dieser Arbeit ist die Beschreibung und Unterscheidung von Personen ohne funktionelle Verluste (FIT), mit Frühzeichen (pre-FRAIL) und beschleunigten funktionellen Verlusten (FRAIL) in verschiedenen Zugangsformen (Geriatrische Ambulanz und präventiver Hausbesuch).MethodenBei Zufallsstichproben selbstständig lebender älterer Menschen (mindestens 10%) einer urbanen Langzeitkohorte (n= 1995), die anhand eines Selbstausfüllerfragebogen in die Kohortenteile FIT, pre-FRAIL und FRAIL funktionell klassifiziert worden waren, kamen erweiterte gerontologisch-geriatrische Assessments (EGGA) zum Einsatz.ErgebnisseDie Stichproben FIT (n = 102), pre-FRAIL (n=65) und FRAIL (n = 64) unterscheiden sich teilweise signifikant hinsichtlich Komorbidität, Medikamentenverwendung, Mobilität, Sturzrisiko und Haushaltsführung sowie Nutzung sozialer Unterstützung, aber nicht im Ernährungsstatus. Unterscheidungsmerkmal ist die (körperliche) Erschöpfung.FazitHandlungsfähigkeit bestimmt über die Gesundheit im Alter. Zur Planung präventiver Interventionen ist eine Erfassung von Reserven und Risiken mithilfe eines umfassenden Assessments sinnvoll.AbstractPurposeThe goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits.MethodsAfter screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered.ResultsFit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness).ConclusionCompetence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.PURPOSE The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits. METHODS After screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered. RESULTS Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness). CONCLUSION Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.

When older in-hospital patients fall--insights from the LUCAS in-hospital fall database.

formed within 7 days before their first dose of haloperidol. Sixteen percent had received IV haloperidol despite a baseline QTc of 500 ms or greater (95% confidence interval = 12.2–19.6%). Of the 179 participants with a baseline QTc of 450 to 499 ms, 21% had a repeat ECG performed within 24 hours after their first dose of haloperidol. Only 42% of participants met the primary outcome measure, defined as adherence to all applicable expert recommendations (Figure 1).

[Health and competence: detection and decoding using comprehensive assessments in the Longitudinal Urban Cohort Ageing Study (LUCAS)].

ZusammenfassungZieleZiel dieser Arbeit ist die Beschreibung und Unterscheidung von Personen ohne funktionelle Verluste (FIT), mit Frühzeichen (pre-FRAIL) und beschleunigten funktionellen Verlusten (FRAIL) in verschiedenen Zugangsformen (Geriatrische Ambulanz und präventiver Hausbesuch).MethodenBei Zufallsstichproben selbstständig lebender älterer Menschen (mindestens 10%) einer urbanen Langzeitkohorte (n= 1995), die anhand eines Selbstausfüllerfragebogen in die Kohortenteile FIT, pre-FRAIL und FRAIL funktionell klassifiziert worden waren, kamen erweiterte gerontologisch-geriatrische Assessments (EGGA) zum Einsatz.ErgebnisseDie Stichproben FIT (n = 102), pre-FRAIL (n=65) und FRAIL (n = 64) unterscheiden sich teilweise signifikant hinsichtlich Komorbidität, Medikamentenverwendung, Mobilität, Sturzrisiko und Haushaltsführung sowie Nutzung sozialer Unterstützung, aber nicht im Ernährungsstatus. Unterscheidungsmerkmal ist die (körperliche) Erschöpfung.FazitHandlungsfähigkeit bestimmt über die Gesundheit im Alter. Zur Planung präventiver Interventionen ist eine Erfassung von Reserven und Risiken mithilfe eines umfassenden Assessments sinnvoll.AbstractPurposeThe goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits.MethodsAfter screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered.ResultsFit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness).ConclusionCompetence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.PURPOSE The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits. METHODS After screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered. RESULTS Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness). CONCLUSION Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.

P214: Multi-component health PROmotion and primary preventive intervention programmes and LONG-term evaluation in HEALTHy community-dwelling senior citizens (PROLONG-HEALTH)

Dapp U1, Anders J1, Minder CE2, Golgert S1, Neumann L1, Pröfener F3, Wegscheider K4, Stender KP5, v Renteln-Kruse W1 1: Albertinen-Haus Hamburg, Forschungsabteilung, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg, Sellhopsweg 18-22, D-22459 Hamburg 2: Horten-Zentrum, Universitäts-Spital Zürich, Rämistrasse 100, CH-8091 Zürich 3: Hamburgische Pflegegesellschaft, Burchardstraße 19, D-20095 Hamburg 4: Institut für Medizinische Biometrie und Epidemiologie (IMBE), Universität Hamburg, Martinistr. 52, D-20246 Hamburg 5: Behörde für Gesundheit und Verbraucherschutz (BGV) der Freien und Hansestadt Hamburg, Billstraße 80a, D-20539 Hamburg

Grauzonen von Gesundheit und Handlungsfähigkeit@@@Health and competence: Erfassung und Aufschlüsselung durch erweiterte Assessments in der Longitudinalen Urbanen Cohorten-Alters-Studie (LUCAS)@@@Detection and decoding using comprehensive assessments in the Longitudinal Urban Cohort Ageing Study (LUCAS)

ZusammenfassungZieleZiel dieser Arbeit ist die Beschreibung und Unterscheidung von Personen ohne funktionelle Verluste (FIT), mit Frühzeichen (pre-FRAIL) und beschleunigten funktionellen Verlusten (FRAIL) in verschiedenen Zugangsformen (Geriatrische Ambulanz und präventiver Hausbesuch).MethodenBei Zufallsstichproben selbstständig lebender älterer Menschen (mindestens 10%) einer urbanen Langzeitkohorte (n= 1995), die anhand eines Selbstausfüllerfragebogen in die Kohortenteile FIT, pre-FRAIL und FRAIL funktionell klassifiziert worden waren, kamen erweiterte gerontologisch-geriatrische Assessments (EGGA) zum Einsatz.ErgebnisseDie Stichproben FIT (n = 102), pre-FRAIL (n=65) und FRAIL (n = 64) unterscheiden sich teilweise signifikant hinsichtlich Komorbidität, Medikamentenverwendung, Mobilität, Sturzrisiko und Haushaltsführung sowie Nutzung sozialer Unterstützung, aber nicht im Ernährungsstatus. Unterscheidungsmerkmal ist die (körperliche) Erschöpfung.FazitHandlungsfähigkeit bestimmt über die Gesundheit im Alter. Zur Planung präventiver Interventionen ist eine Erfassung von Reserven und Risiken mithilfe eines umfassenden Assessments sinnvoll.AbstractPurposeThe goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits.MethodsAfter screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered.ResultsFit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness).ConclusionCompetence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.PURPOSE The goal of this work was to characterise and distinguish persons without (fit), with earliest signs (pre-frail) or accelerated functional decline (frail) during self-referral (geriatric centre) or preventive home visits. METHODS After screening independently living older people in an urban longitudinal cohort (n = 1,995) using a self-administered questionnaire, they were functionally classified as fit, pre-frail or frail. In 10% randomly selected samples of these cohort parts a comprehensive extended gerontological-geriatric assessment (EGGA) was administered. RESULTS Fit, pre-frail and frail samples are significantly different regarding comorbidity, medication, mobility, fall risk, instrumental activities of daily living and use of social support but not nutrition. The best indicator to discriminate fit versus frail was exhaustion (mobility tiredness). CONCLUSION Competence is essential regarding health in old age. Identification of resources and risks by comprehensive assessment is useful before planning interventions to prevent frailty or its progression.