Purpose Pre-stroke frailty in older adults is associated with adverse outcomes after stroke in community-based and hospitalbased populations. The aim of our study was to investigate the prevalence of pre-stroke frailty among older stroke survivors receiving medical specialistic rehabilitation and its association with outcomes and recovery. Methods Pre-stroke frailty was measured by the Groningen Frailty Indicator (GFI, score ≥ 4 indicates frailty) in patients≥65 years receiving stroke medical specialistic rehabilitation. Baseline, follow-up and change (i.e. recovery) scores of the Barthel index (BI), Stroke Impact Scale (SIS) ‘mobility’, ‘communication’, and ‘memory and thinking’, Hospital Anxiety and Depression Scale (HADS) and the EuroQoL-5 dimensions (EQ-5D) were compared between frail and non-frail patients with a multivariable regression model adjusting for confounders. Results Of 322 included patients (34.2% females, median age 70 years), 43 (13.4%) patients reported pre-stroke frailty. There were no diferences in BI or in destination of discharge between pre-stroke frail and non-frail stroke survivors receiving inpatient rehabilitation. However, pre-stroke frailty was associated with worse follow-up scores for all other measures. Recovery in pre-stroke frail patients was less favorable compared to non-frail patients for SIS mobility, HADS subscales and EQ-5D index and visual analogue scale. Conclusion Pre-stroke frailty was present in a minority of older stroke survivors receiving medical specialistic rehabilitation. BI and destination of discharge did not difer. Nevertheless, pre-stroke frailty was associated with worse functioning at follow-up for most measures of health status and with smaller improvements in mobility, mood and quality of life.
Thirty to sixty per cent of older patients experience functional decline after hospitalisation, associated with an increase in dependence, readmission, nursing home placement and mortality. First step in prevention is the identification of patients at risk. The objective of this study is to develop and validate a prediction model to assess the risk of functional decline in older hospitalised patients.
Background There is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs and preferences regarding emergency care in frail older patients based on their experiences with received care during Emergency Department admission. Method A qualitative study design was used, and semi-structured interviews were conducted after discharge with twelve frail older patients admitted to emergency departments in the Netherlands. Data collection and analysis were performed iteratively, and data were thematically analysed. Results The analysis enfolded the following themes; feeling disrupted, expecting to be cared for, suppressing their needs and wanting to be seen. These themes indicated a need for situational awareness by healthcare professionals when taking care of the participants and were influenced by the participants' life experiences. Conclusion Frail older patients feel disrupted when admitted to the emergency department. Because of this, they expect to be cared for, lessen their own needs and want to be seen as human beings. The impact of the admission is influenced by the extent to which healthcare professionals show situational awareness.
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De samenwerking tussen de onderzoeksgroep FRIA van de Vrije Universiteit Brussel, afdeling oudergeneeskunde van het UMCG Groningen en de onderzoeksgroep (lectoraat) Healthy Ageing, Allied health Care and Nursing van de Hanzehogeschool Groningen is gericht op onderzoek naar bewegingsstoornissen bij veroudering. In het bijzonder wordt gekeken naar paratonic, een bewegingsstoornis bij dementie.The International Joint Research group ‘Move in Age’ concluded in a systematic review that paratonia still is a barely understood and devastating phenomenon in dementia and revealed the urgency of gaining more insight in the pathophysiology. Paratonia, a distinctive change in muscle tone, starts in early stages of dementia and develops further with progress of the disease. Resulting in severe discomfort for patients, but also affecting caregivers since daily care becomes increasingly difficult. It is hypothesized that changes in motor control due to dementia influences peripheral neurological control and biomechanical muscle structures (by crosslinking and inflammation caused by advanced glycation end-products (AGEs).This IJRG started in 2018 and aims to develop a long-term comprehensive research program on movement-related impairments at higher age. The three partners have a strong track record on research in the area of movement-related impairments in older persons; however, each focusing on a specific aspect. In fact, the Frailty in Ageing research group (FRIA) of the Vrije Universiteit Brussel (VUB) is running focused research program on the triad sarcopenia-dynapenia-inflammation with mainly a bio-gerontological and bio-psycho-medical approach; the department of General Practice and Elderly Care Medicine of the University Medical Center Groningen (UMCG) has anongoing research line on the medical aspects of mobility impairments in frail elderly persons and in elderly dementia patients; and finally Research Group Healthy Ageing, Allied Health Care and Nursing of the Hanze University of Applied Sciences Groningen (HUAS) developed a research program on physical, psycho-cognitive and social dimensions of frailty including the functional impact of mobility impairments. In the first 3-5 years, the focus will be on the movement-related impairments that occur in patients with dementia and in specific on paranoia. The programme will be extended towards movement-related impairments in the context of other geriatric syndromes.
