Abstract: Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged 75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. ‘Difficulty in walking’ and ‘unexplained weight loss’ appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.
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Objective: To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods: A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion: Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
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I was somewhat surprized with the fog in Groningen upon my arrival. This is notthe fog that covers the beautiful landscapes of the northern Netherlands in theevening and in the early morning. No… It is the fog that obscures the real aspectsof the earthquake problem in the region and is crystallised in the phrase “Groningen earthquakes are different”, which I have encountered numerous times whenever I raised a question of the type “But why..?”. A sentence taken out of the quiver as the absolute technical argument which mysteriously overshadows the whole earthquake discussion.Q: Why do we not use Eurocode 8 for seismic design, instead of NPR?A: Because the Groningen earthquakes are different!Q: Why do we not monitor our structures like the rest of the world does?A: Because the Groningen earthquakes are different!Q: Why does NPR, the Dutch seismic guidelines, dictate some unusual rules?A: Because the Groningen earthquakes are different!Q: Why are the hazard levels incredibly high, even higher than most Europeanseismic countries?A: Because the Groningen earthquakes are different!and so it keeps going…This statement is very common, but on the contrary, I have not seen a single piece of research that proves it or even discusses it. In essence, it would be a difficult task to prove that the Groningen earthquakes are different. In any case it barricades a healthy technical discussion because most of the times the arguments converge to one single statement, independent of the content of the discussion. This is the reason why our first research activities were dedicated to study if the Groningen earthquakes are really different. Up until today, we have not found any major differences between the Groningen induced seismicity events and natural seismic events with similar conditions (magnitude, distance, depth, soil etc…) that would affect the structures significantly in a different way.Since my arrival in Groningen, I have been amazed to learn how differently theearthquake issue has been treated in this part of the world. There will always bedifferences among different cultures, that is understandable. I have been exposed to several earthquake engineers from different countries, and I can expect a natural variation in opinions, approaches and definitions. But the feeling in Groningen is different. I soon realized that, due to several factors, a parallel path, which I call “an augmented reality” below, was created. What I mean by an augmented reality is a view of the real-world, whose elements are augmented and modified. In our example, I refer to the engineering concepts used for solving the earthquake problem, but in an augmented and modified way. This augmented reality is covered in the fog I described above. The whole thing is made so complicated that one is often tempted to rewind the tape to the hot August days of 2012, right after the Huizinge Earthquake, and replay it to today but this time by making the correct steps. We would wake up to a different Groningen today. I was instructed to keep the text as well as the inauguration speech as simple aspossible, and preferably, as non-technical as it goes. I thus listed the most common myths and fallacies I have faced since I arrived in Groningen. In this book and in the presentation, I may seem to take a critical view. This is because I try to tell a different part of the story, without repeating things that have already been said several times before. I think this is the very reason why my research group would like to make an effort in helping to solve the problem by providing different views. This book is one of such efforts.The quote given at the beginning of this book reads “How quick are we to learn: that is, to imitate what others have done or thought before. And how slow are we to understand: that is, to see the deeper connections.” is from Frits Zernike, the Nobel winning professor from the University of Groningen, who gave his name to the campus I work at. Applying this quotation to our problem would mean that we should learn from the seismic countries by imitating them, by using the existing state-of-the-art earthquake engineering knowledge, and by forgetting the dogma of “the Groningen earthquakes are different” at least for a while. We should then pass to the next level of looking deeperinto the Groningen earthquake problem for a better understanding, and alsodiscover the potential differences.
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