orders do not recognize even people with OSA severe enough to require CPAP treatment, or if the apnea is known, it is not documented as part of the discharge and care plan paperwork. Alternatively, the vast majority of people with an OSA diagnosis were not using CPAP; potential reasons for this are noted above. These findings may also be related to inadequate integration of care teams across care settings, poor health information exchange, and other issues associated with perceptions about CPAP use.Given the emerging recognition of the importance of effective identification and management of sleep disorders in older people, 10 attention should be called to the likely failure to diagnose, document, and treat sleep apnea in HH and hospice recipients, because treatment can make a difference in the health and quality of life of these individuals.
The Spanish SF-LLDFI is a valid instrument for detecting disability and functional limitation.
Objectives:To determine the association between functional assessment instruments and frailty.Design:Concurrent cohort study. Setting:Albacete Health Area (Spain). Participants:993 subjects aged ≥ 70years, participating in the FRADEA Study. Measurements:The following functional instruments were applied:Barthel index, Lawton index and Short Form-Late Life Function and Disability Instrument (SF-LLFDI) asdisability questionnaires; Holden ́s Functional Ambulation Classification (FAC) as ambulation scale, and sevenperformance tests: gait speed (m/s), Timed up and go (TUG) (sec), unipodal balance time (sec), 5-chair-sit-to-stand test (sec), Short Physical Performance Battery (SPPB), hand grip strength (kg) and elbow flexion strength(kg). Frailty was assessed by Fried ́s criteria. The association between functional instruments and frailty wasassessed, ROC curves were constructed and the area under the curves (AUC) calculated. The best cut-point wasidentified for each instrument and their sensitivity (S) and specificity (SP) are described. Results:16.9%participants were frail. The AUC, best cut-point, S and SP for each instrument were respectively: Barthel (0.916;≤ 85; 0.90, 0.82), Lawton (0.917; ≤ 3; 0.86, 0.93), SF-LLFDI (0.948; ≤ 90; 0.87, 0.91), FAC (0.885; ≤ 4; 0.81,0.83), gait speed (0.938; ≤ 0.62; 0.90, 0.90), TUG (0.984; ≥ 17.8; 0.93, 0.98), unipodal balance time (0.753; ≤ 5;0.73, 0.71), 5-chair-sit-to-stand test (0.880; ≥ 15; 0.78, 0.76), SPPB (0.956; ≤ 6; 0.88, 0.88), hand grip strength(0.807; ≤ 26; 0.75, 0.75) and elbow flexion strength (0.924; ≤ 15; 0.89, 0.87). Conclusion:The best performancetests to identify frail subjects are the Timed Up and Go test, gait speed and the SPPB, and the best questionnaireis the SF-LLFDI.
Objetivo Analizar si la presencia de anemia incrementa el riesgo de mortalidad a largo plazo asociado al estado de fragilidad y discapacidad en adultos mayores. Diseño Subestudio de la cohorte concurrente de base poblacional FRADEA (Fragilidad y Dependencia en Albacete), con 10 años de seguimiento (2007-2017), en mayores de 69 años. Emplazamiento Albacete capital, España. Participantes De los 993 participantes incluidos en la primera oleada se seleccionaron 790 sujetos con datos válidos de función (fragilidad y discapacidad), anemia y estado vital a los 10 años. Mediciones principales La anemia se definió según los criterios de la Organización Mundial de la Salud (hemoglobina < 13 g/dl en hombres y < 12 g/dl en mujeres). Se creó la variable «clasificación funcional» incluyendo fragilidad y discapacidad, e identificando cuatro niveles progresivos: robusto, prefrágil, frágil y con discapacidad en actividades básicas de la vida diaria, empleando el fenotipo de fragilidad e índice de Barthel, respectivamente. Se construyó una nueva variable de ocho categorías combinando las cuatro funcionales con la presencia o ausencia de anemia. La asociación con mortalidad se determinó mediante Kaplan-Meier y análisis de riesgos proporcionales de Cox ajustado por edad, sexo, comorbilidad, polifarmacia, institucionalización y creatinina. Resultados Edad media 79 años, siendo el 59,6% mujeres. Un total de 393 participantes (49,7%) fallecieron durante el periodo de seguimiento. La mediana de supervivencia fue de 98,4 meses (rango intercuartil 61). El riesgo de mortalidad aumentó desde los niveles con mejor clasificación funcional hasta aquellos con peor, y para cada subgrupo fue mayor en los participantes con anemia. Prefrágiles sin anemia hazard ratio (HR): 1,59, IC 95%: 1,07-2,36, y con anemia HR: 2,37, IC 95%: 1,38-4,05. Frágiles sin anemia HR: 3,18, IC 95%: 1,68-6,02, y con anemia HR: 4,42, IC 95%: 1,99-9,84. Discapacitados sin anemia HR: 3,81, IC 95%: 2,45-5,84, y con anemia HR: 5,48, IC 95%: 3,43-8,76. Conclusión La anemia incrementa el riesgo de mortalidad asociado a la fragilidad y discapacidad en adultos mayores.
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