It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment-short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11-14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI -0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI -47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure.
BACKGROUND: Over 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the protocol for the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, which aims to unravel the potential mechanisms behind HAD from admission to three months post-discharge.METHODS/DESIGN: The Hospital-ADL study is a multicenter, observational, prospective cohort study aiming to recruit 400 patients aged ≥70 years that are acutely hospitalized at departments of Internal Medicine, Cardiology or Geriatrics, involving six hospitals in the Netherlands. Eligible are patients hospitalized for at least 48 h, without major cognitive impairment (Mini Mental State Examination score ≥15), who have a life expectancy of more than three months, and without disablement in all six ADLs. The study will assess possible cognitive, behavioral, psychosocial, physical, and biological factors of HAD. Data will be collected through: 1] medical and demographical data; 2] personal interviews, which includes assessment of cognitive impairment, behavioral and psychosocial functioning, physical functioning, and health care utilization; 3] physical performance tests, which includes gait speed, hand grip strength, balance, bioelectrical impedance analysis (BIA), and an activity tracker (Fitbit Flex), and; 4] analyses of blood samples to assess inflammatory and metabolic markers. The primary endpoint is additional disabilities in ADLs three months post-hospital discharge compared to ADL function two weeks prior to hospital admission. Secondary outcomes are health care utilization, health-related quality of life (HRQoL), physical performance tests, and mortality. There will be at least five data collection points; within 48 h after admission (H1), at discharge (H3), and at one (P1; home visit), two (P2; by telephone) and three months (P3; home visit) post-discharge. If the patient is admitted for more than five days, additional measurements will be planned during hospitalization on Monday, Wednesday, and Friday (H2).DISCUSSION: The Hospital-ADL study will provide information on cognitive, behavioral, psychosocial, physical, and biological factors associated with HAD and will be collected during and following hospitalization. These data may inform new interventions to prevent or restore hospitalization-associated disability.
OBJECTIVES: The aim of the present study was to disentangle the impact of age and that of cancer diagnosis and treatment on functional status (FS) decline in older patients with cancer.MATERIALS AND METHODS: Patients with breast and colorectal cancer aged 50-69years and aged ≥70years who had undergone surgery, and older patients without cancer aged ≥70years were included. FS was assessed at baseline and after 12months follow-up, using the Katz index for activities of daily living (ADL) and the Lawton scale for instrumental activities of daily living (IADL). FS decline was defined as ≥1 point decrease on the ADL or IADL scale from baseline to 12months follow-up.RESULTS: In total, 179 older patients with cancer (≥ 70years), 341 younger patients with cancer (50-69years) and 317 older patients without cancer (≥ 70years) were included. FS decline was found in 43.6%, 24.6% and 28.1% of the groups, respectively. FS decline was significantly worse in older compared to younger patients with cancer receiving no chemotherapy (44.5% versus 17.6%, p<0.001), but not for those who did receive chemotherapy (39.4% versus 30.8%, p=0.33). Among the patients with cancer, FS decline was significantly associated with older age (OR 2.63), female sex (OR 3.72), colorectal cancer (OR 2.81), polypharmacy (OR 2.10) and, inversely, with baseline ADL dependency (OR 0.44).CONCLUSION: Cancer treatment, and older age are important predictors of FS decline. The relation of baseline ADL dependency and chemotherapy with FS decline suggest that the fittest of the older patients with cancer were selected for chemotherapy.
Het belang van robots in het onderwijs groeit. Robots dragen bij aan leerondersteuning, werkdrukvermindering en bereiden kinderen voor op een samenleving waarin robots een steeds grotere rol spelen. Toch lijkt grootschalige adoptie uit te blijven. Na een kortdurende periode van enthousiasme, verdwijnt de robot vaak in de kast. Terwijl de potentie juist zit in het blijven leren met robots. De motivatie van kinderen hangt samen met de relatie die ze met de robot kunnen opbouwen. Door deze relatievorming beter te begrijpen en te stimuleren, kan de motivatie worden behouden en toenemen. Onderzoek biedt echter weinig richtlijnen voor hoe robots in de praktijk relaties kunnen stimuleren. Er is behoefte aan een overzicht van relatievormingsfactoren die praktisch, technisch en financieel mogelijk zijn. Ook is behoefte aan instrumenten waarmee de relatievorming (en daarmee meerwaarde) eenvoudig in de praktijk gemeten en langdurig gemonitord kan worden. Deze twee behoeftes uit de praktijk zijn vertaald naar twee concrete onderzoeksvragen die beantwoord worden binnen een interdisciplinair consortium bestaande uit robotbouwers/leveranciers, onderwijs- en jeugdspecialisten, en robot/AI/digitale media onderzoekers. De onderzoekers inventariseren de potentiële relatievormingsfactoren en meetinstrumenten om deze vervolgens in en met de praktijk te evalueren op praktische toepasbaarheid. De geselecteerde methoden worden vervolgens vertaald in een opportunity map met de potentiële relatievormingsfactoren voor de industrie, en een website met relatievormingsmeetinstrumenten voor de industrie, het onderwijs en onderzoek. De praktijkpartners kunnen met deze kennis de robots aanpassen en evalueren op het vermogen relaties te vormen, met als doel de meerwaarde van robots zichtbaar te maken en adoptie onder scholen te vergroten. Het streven is om met het nieuw gevormde consortium ook een vervolgaanvraag in te dienen waarin de relatievormingsfactoren toegepast worden in verschillende contexten, de meetinstrumenten gevalideerd worden, en relatievorming longitudinaal getoetst wordt.
