The original Pittsburgh Fatigability Scale (PFS) was developed to assess perceived fatigability in older adults. The objective of this study was to translate the PFS into Dutch and investigate its ...validity and reliability among hospitalized older adults aged ≥70 years.
The PFS was translated into Dutch and pretested for comprehensibility by the Three-Step Test Interview method. The factor structure underlying the final version was evaluated by confirmatory factor analysis (CFA) and exploratory factor analyses (EFA). Internal consistency of the identified subscales was evaluated by Cronbach's alpha. Construct validity was evaluated by hypothesis testing. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC) and Bland Altman plots.
The validation sample included 233 patients. CFA of the original factor structure resulted in poor model fit in our Dutch sample. EFA of PFS physical and mental subscales resulted in a two-factor solution underlying the data with good internal consistency of the identified subscales (Cronbach's alpha: 0.80-0.92). Five out of six hypotheses were confirmed, indicating good construct validity. Retest assessments were performed among 50 patients and showed good reliability for both the physical (ICC: 0.80, 95%CI: 0.68; 0.88) and mental subscale (ICC: 0.81, 95%CI: 0.68; 0.89).
The Dutch PFS is a valid and reliable instrument to assess fatigability in older hospitalized patients.
Objectives
To evaluate current clinical practice for octogenarians with iron‐deficiency anemia (IDA) by assessing referral patterns, diagnostic choices, clinical consequences of omission of ...endoscopy, and risks and benefits of IDA‐related surgery.
Design
Chart review.
Setting
A regional hospital‐based laboratory in the Netherlands between January 2008 and December 2010.
Participants
All individuals aged 80 and older with newly ascertained IDA.
Measurements
IDA was defined as a hemoglobin level of 11.1 g/dL or less and a ferritin level of 25 μg/L or less.
Results
Four hundred seventy‐one participants were newly diagnosed with IDA during the study period (median age 85.4), 276 of whom (59%) did not undergo any diagnostic procedures for IDA. A cause of anemia was identified during the initial examination in 50% of the 205 investigated participants, including nine (4%) upper and 37 (18%) lower gastrointestinal malignancies. Another 24 malignancies were identified during follow‐up, of which 16 were in the gastrointestinal tract, primarily in participants for whom the initial diagnostic examination was limited or omitted. Perioperative mortality was 15% in individuals with colon cancer. Median survival for participants with colon cancer was 2.2 years, and the survival benefit of surgery over supportive care was not apparent until 1.3 years after ascertainment of IDA.
Conclusion
The omission of endoscopy for IDA and the omission of surgery for colon cancer occur frequently in octogenarians and seem appropriate in the presence of significant comorbidity and in cases in which there is limited life expectancy. Further research is needed to determine which baseline factors should guide decision‐making to optimize treatment outcomes and quality of life.
Purpose
Frailty is associated with a higher risk for negative postoperative outcomes. This study aimed to determine the association between the screening tool of the Dutch safety management system, ...Veiligheidsmanagementsysteem (VMS) ‘frail elderly’ and postoperative complications in a gynecological population.
Methods
This cohort study included women aged 70 years or older, who were scheduled for any kind of gynecological surgery. VMS screening data (including risk for delirium, falling, malnutrition, and functional impairment) were extracted from the electronic patient records. VMS score could range between 0 and 4 patients with a VMS score of one or more were considered frail. Data on possible confounding factors and complications within 30 days after surgery, classified with the Clavien–Dindo classification, were collected. Regression analysis was performed.
Results
157 women were included with a median age of 74 years (inter quartile range 71–79). Most patients underwent prolapse surgery (52%) or hysterectomy (31%). Forty-one patients (26%) experienced any postoperative complication. Sixty-two patients (39%) were considered frail preoperatively by the VMS screening tool. Frailty measured with the VMS screening tool was not independently associated with postoperative complications in multivariable analysis (Odds ratio 1.18; 95% CI 0.49–2.82). However, a recent fall in the last 6 months (
n
= 208) was associated with postoperative complications (Odds ratio 3.90; 95% CI 1.57–9.66).
Conclusion
An independent association between frailty, determined by the VMS screening tool ‘Frail elderly’, and postoperative complications in gynecological surgery patients could not be confirmed. A recent fall in the last 6 months seems associated with postoperative complications.
•Psoas hematoma is an uncommon illness, presenting with non-specific symptoms.•The elderly patient often has an atypical presentation of illness.•A psoas hematoma is an easily overlooked diagnosis, ...especially in the elderly patient.
A psoas hematoma is an uncommon condition in patients on anticoagulant therapy and patients with bleeding disorders. It can present itself with non-specific symptoms, as anemia, pain and hemodynamically instability. The CT angioscan is the diagnostic test of choice.
We report a series of 3 cases of iliopsoas hematoma in older patients. These patients were all on anticoagulant therapy and presented with non-specific symptoms as pain in back or groin, anemia and weakness of the leg. These symptoms could be well explained by other, concurrent diseases. Moreover in one case it was not possible to obtain a reliable history due to cognitive impairment of the patient. In our cases the diagnosis of a psoas hematoma was made after performing many diagnostics or found fortuitously. All three patients recovered well after (temporarily) ceasing of anticoagulant therapy.
The diagnosis of a psoas hematoma is difficult, especially in elderly patients as illustrated in these cases. The symptoms of a psoas hematoma are often aspecific and can also be explained by other, comorbid diseases. Moreover, elderly patients often have an unusual presentation of illness and the presence of cognitive impairment compromises the reliability of a patients history. It is important to be aware of this diagnosis and perform a CT-scan when a psoas hematoma is possible.
A psoas hematoma is easily overlooked in older patients due to an unusual presentation of illness, comorbidity and cognitive impairment.
The preoperative phase is a potential window of opportunity. Although frail elderly patients are known to be more prone to postoperative complications, they are often not considered capable of ...accomplishing a full prehabilitation program. The aim of this study was to assess the feasibility of Fit4SurgeryTV, an at-home prehabilitation program specifically designed for frail older patients with colorectal cancer.
The Fit4SurgeryTV program consisted of a daily elderly adapted computer-supported strength training workout and two protein-rich meals. Frail patients 70 yrs or older with colorectal cancer were included. The program was considered feasible if 80% of the patients would be able to complete 70% of the program.
Fourteen patients (median age, 79 yrs; 5 males) participated. At baseline, 86% patients were physically impaired and 64% were at risk for malnourishment. The median duration of the program was 26 days. The program was feasible as patients followed the exercises for 6 (86%) of 7 days and prepared the recipes 5 (71%) of 7 d/wk. Patients specifically appreciated at-home exercises.
This study showed that at-home prehabilitation in frail older patients with colorectal cancer is feasible. As a result, patients might be fitter for surgery and might recover faster. The perioperative period could serve as a pivotal time point in reverting complications of immobility.
Key Summary Points
Aim
To explore goals of older hospitalized patients with multimorbidity and compare their goals to those of older hospitalized patients without multimorbidity.
Findings
No ...differences were found in goals mentioned by patients with and without multimorbidity. Forty-one percent of both patients with and without multimorbidity mentioned goals that were disease-unrelated.
Message
The large proportion of patients mentioning disease-unrelated goals emphasizes the importance of goal elicitation by healthcare professionals within hospital care to provide optimally integrated care.
Purpose
Patient-centered healthcare, with aligning treatment to a patients’ goal, is recognized by experts as essential to improve healthcare for older patients with multimorbidity. Little literature exists on goals of these specific patients. Therefore, we aimed to explore goals of older hospitalized patients with multimorbidity and compare their goals to those of older hospitalized patients without multimorbidity.
Methods
Older hospitalized patients (aged ≥ 70 years) were included in a prospective mixed-methods cohort study at the University Medical Centre Groningen, the Netherlands. Goals were assessed by a standardized interview, whereafter they were categorized and analyzed descriptively.
Results
Four hundred and ninety-three older hospitalized patients (median age 75 (IQR 72–80), 64% male) were included, of which 223 patients presented with multimorbidity (45%). Goals mentioned most often were ‘controlling disease’ and ‘alleviating complaints’. No differences were found in goals mentioned by patients with and without multimorbidity. Forty-one percent of both patients with and without multimorbidity mentioned goals that were disease-unrelated.
Conclusion
No major differences were found in goals of older hospitalized patients with and without multimorbidity. However, the large proportion of patients mentioning disease-unrelated goals emphasizes the importance of goal elicitation by healthcare professionals within hospital care to provide optimally integrated care.
This study aimed to reveal information that can be used for composing a prehabilitation program tailored to elderly gynecological oncological patients and is applicable to healthcare professionals. ...We investigated possible content and indications for prehabilitation, and what potential barriers might exist.
Because of the primary exploratory study aim, inductive thematic template analysis on semi-structured interviews with gynecologic oncological patients aged ≥60 years and healthcare professionals were used.
16 patients and 20 healthcare professionals were interviewed. Three themes important for prehabilitation were found: (1) "Motivation," (2) "Practical issues and facilitators," and (3) "Patient-related factors." A short time interval between diagnosis and surgery was reported as a potential barrier for prehabilitation. Given components for a tailor-made prehabilitation program are: (1) The first contact with a nurse who screens the patients, gives tailor-made advice on prehabilitation and keeps patients motivated and supports them mentally; (2) If patients are referred to a more extensive/supervised program, this should preferably be arranged close to a patients' home.
Based on our findings, an outline of a patient-tailored prehabilitation program was developed. The main important themes for prehabilitation were "Motivation," "Practical issues and facilitators," and "Patient-related factors."
IMPLICATIONS FOR REHABILITATION
Patients and healthcare professionals are positive about prehabilitation.
Main themes for designing a prehabilitation program are "Motivation," "Practical issues and facilitators," and "Patient-related factors."
Nursing staff can play a key role in prehabilitation.
It is important to screen patients for specific impairments to obtain a tailor-made prehabilitation program.
For some patients, general advice on prehabilitation might be sufficient, while others may need more supervision.
The time interval between diagnosis and surgery is often short and is perceived as a potentially significant barrier for an effective prehabilitation program.
Abstract
Background
as the coronavirus disease of 2019 (COVID-19) pandemic progressed diagnostics and treatment changed.
Objective
to investigate differences in characteristics, disease presentation ...and outcomes of older hospitalised COVID-19 patients between the first and second pandemic wave in The Netherlands.
Methods
this was a multicentre retrospective cohort study in 16 hospitals in The Netherlands including patients aged ≥ 70 years, hospitalised for COVID-19 in Spring 2020 (first wave) and Autumn 2020 (second wave). Data included Charlson comorbidity index (CCI), disease severity and Clinical Frailty Scale (CFS). Main outcome was in-hospital mortality.
Results
a total of 1,376 patients in the first wave (median age 78 years, 60% male) and 946 patients in the second wave (median age 79 years, 61% male) were included. There was no relevant difference in presence of comorbidity (median CCI 2) or frailty (median CFS 4). Patients in the second wave were admitted earlier in the disease course (median 6 versus 7 symptomatic days; P < 0.001). In-hospital mortality was lower in the second wave (38.1% first wave versus 27.0% second wave; P < 0.001). Mortality risk was 40% lower in the second wave compared with the first wave (95% confidence interval: 28–51%) after adjustment for differences in patient characteristics, comorbidity, symptomatic days until admission, disease severity and frailty.
Conclusions
compared with older patients hospitalised in the first COVID-19 wave, patients in the second wave had lower in-hospital mortality, independent of risk factors for mortality.
The better prognosis likely reflects earlier diagnosis, the effect of improvement in treatment and is relevant for future guidelines and treatment decisions.
ObjectiveAtrial fibrillation (AF) is a condition that occurs in the presence of comorbidities. With the accumulation of comorbidities (multimorbidity), some combinations may more often occur together ...than others. Information on the impact of clustering of these on incident AF is sparse. We aimed to investigate clustering of cardiovascular and renal comorbidities and study the association between comorbidity clusters and incident AF.MethodsWe used the community-based Prevention of Renal and Vascular ENd-stage Disease (PREVEND) cohort in which 8592 individuals participated. Latent class analysis was performed to assess clustering of 10 cardiovascular and renal comorbidities.ResultsWe excluded individuals with prior AF or missing ECG data, leaving 8265 individuals for analysis (mean age 48.9±12.6 years, 50.2% women). During 9.2±2.1 years of follow-up, 251 individuals (3.0%) developed AF. A model with three clusters was the optimal model, with one cluster being young (44.5±10.8 years) and healthy, carrying a low (1.0%) risk of incident AF; one cluster being older (63.0±8.4 years) and multimorbid, carrying a high (16.2%) risk of incident AF and a third middle-aged (57.0±11.3 years), obese and hypertensive cluster carrying an intermediate risk (5.9%) of incident AF. While the prevalence of the comorbidities differed between classes, no clear combination(s) of comorbidities was observed within the classes.ConclusionsWe identified three clusters of comorbidities in individuals in the community-based PREVEND cohort. The three clusters contained different amount of comorbidities carrying different risks of incident AF. However, there were no differences between the clusters regarding specific combination(s) of comorbidities.
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