Daily health management and exercise are important for staying healthy and avoiding the need for long-term care. However, it is not easy to maintain regular exercise. Therefore, exercise needs to be ...done efficiently. In recent years, due to the aging population and increasing severity of illness, older patients often experience a significant decline in physical function, even with minimal rest, which often interferes with their daily life after discharge from the hospital. Frailty not only affects ADLs, but also strongly influences prognosis, including the development of atherosclerotic disease and rehospitalization. This perspective is a summary of the 51st Metropolitan Public Lecture held on June 17, 2023, and discusses exercise-based rehabilitation programs that can be delivered at home to prevent physical frailty and avoid hospitalization-related disability.
Background: This study determined the incidence of hospitalization-associated disability (HAD) and its characteristics in older patients with heart failure in Japan.Methods and Results: Ninety-six ...institutions participated in this nationwide multicenter registry study (J-Proof HF). From December 2020 to March 2022, consecutive heart failure patients aged ≥65 years who were prescribed physical rehabilitation during hospitalization were enrolled. Of the 9,403 patients enrolled (median age 83.0 years, 50.9% male), 3,488 (37.1%) had HAD. Compared with the non-HAD group, the HAD group was older and had higher rates of hypertension, chronic kidney disease, and cerebrovascular disease comorbidity. The HAD group also had a significantly lower Barthel Index score and a significantly higher Kihon checklist score before admission. Of the 9,403 patients, 2,158 (23.0%) had a preadmission Barthel Index score of <85 points. Binomial logistic analysis revealed that age and preadmission Kihon checklist score were associated with HAD in patients with a preadmission Barthel Index score of ≥85, compared with New York Heart Association functional classification and preadmission cognitive decline in those with a Barthel Index score <85.Conclusions: This nationwide registry survey found that 37.1% of older patients with HF had HAD and that these patients are indicated for convalescent rehabilitation. Further widespread implementation of rehabilitation for older patients with heart failure is expected in Japan.
Objectives
To describe expectations of, and perceived motivators and barriers to, in‐hospital exercise of hospitalized older adults.
Design
Qualitative study using the framework theory.
Setting
...Public hospital general medical wards.
Participants
Twenty‐eight English‐ or Spanish‐speaking inpatients aged 65 to 103.
Measurements
Semistructured interviews were conducted at the bedside. Questions explored attitudes and expectations regarding in‐hospital exercise. Interviews were tape recorded and transcribed, and content analysis was performed to identify major themes.
Results
For most participants (71%), exercise in the hospital meant walking. Only 29% of participants expected to be exercising in the hospital, although three‐quarters perceived it to be appropriate. Major themes included motivating factors and barriers to in‐hospital exercise. Motivating factors included avoiding the negative effects of prolonged bed rest, promoting a sense of well‐being, promoting functional recovery, and being asked to exercise. Barriers included symptoms related to one's illness, institutional barriers, and fear of injury. Most respondents (85%) felt that if the physician suggested exercise, it would influence their decision to do so, yet few (27%) reported that they had spoken to their physician about exercise.
Conclusion
Hospitalized older adults have positive perceptions about in‐hospital exercise, although they must overcome significant barriers to do so. Medical professionals have a strong influence over the exercise behavior of elderly adults in the hospital yet infrequently address the issue. Incorporating motivating factors and removing barriers may increase the effectiveness of in‐hospital exercise programs.
Abstract
Background
Patients diagnosed with New Daily Persistent Headache and Persistent Post-Traumatic Headache belong to a heterogeneous group of primary and secondary headache disorders, with the ...common clinical feature that these conditions start abruptly, continue unabated, and are refractory to conventional migraine preventive treatments.
Objective
This is a real-world, medium-term audit to explore whether erenumab improves quality of life in a pooled group of 82 abrupt-onset, unremitting and treatment refractory patients, where the diagnosis is new daily persistent headache and persistent post-traumatic headache in the majority of cases.
Methods
Eighty-two patients were treated with erenumab every 28 days over a two to three-year period, beginning in December 2018. These patients were “longstanding chronic” and refractory with a median of eight (IQR 4–12) prior failed migraine preventive treatments and median duration of disease of seven (IQR 3–11) years. The starting dose of erenumab was 70 mg in 79% of cases and 140 mg in the remaining patients (individuals with a BMI of more than 30). All patients were asked to complete three migraine specific Quality of Life questionnaires or Patient Reported Outcome Measures before starting treatment and typically at 3–12 intervals until the end of June 2021 or cessation of treatment. The Patient Reported Outcome Measures included: Headache Impact Test-6, Migraine Associated Disability Assessment test and Migraine-Specific Quality-of-Life Questionnaire. Patients generally only stayed on treatment after 6–12 months if there was deemed to be an improvement of at least 30% and there were no significant side effects. The longest treated cases have quality of life data for 30 months after starting erenumab.
Results
Of the 82 patients, 29 (35%) had improvement in Quality of Life scores, with no significant side effects, and wished to stay on treatment. Fifty-three patients (65%) stopped treatment during the first 6–25 months due to lack of efficacy and/or patient reported side effects (n = 33 and n = 17, respectively) or a combination of both, pregnancy planning (n = 2), and lost to follow up (n = 1).
Conclusion
Significant improvements in Quality of Life scores were recorded by one-third of patients over a period of 11–30 months, with a 35% persistence after a median of 26 months of treatment. This contrasts with our recently published, treatment resistant, chronic migraine cohort where the persistence with erenumab treatment was almost 55% after a median time of 25 months.
Abstract
Background
Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether ...appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with the development of hospital-associated ADL disability in older adults in the Health ABC Study.
Methods
Individuals hospitalized during the first 5 years of follow-up (n = 1 724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual-energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of prehospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability.
Results
Each standard deviation decrement in prehospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared with not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with the development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death.
Conclusions
Prehospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.
Objective
To evaluate the effectiveness of inpatient medical ward exercise on physical and health outcomes in adults compared with usual care.
Data sources
Medline, CINAHL and EMBASE were searched ...from inception to 20 April 2023.
Review methods
Randomised-controlled trials in English that reported physical and health outcomes of adults who received an exercise intervention on an acute medical ward were included. Two reviewers independently extracted data. Methodological quality was assessed using the PEDro and TESTEX scales. The GRADE rating assessed the quality of evidence to evaluate the certainty of effect. Meta-analyses were performed where possible.
Results
Thirteen studies were included, with 1273 unique participants (mean SD age, 75.5 11 years), which compared exercise intervention with usual care. Low quality evidence demonstrated a significant improvement in aerobic capacity (MD, 1.39 m 95% CI, 0.23, 2.55, p = 0.02) and maximum isometric strength (MD, 2.3 kg 95% CI, 2.2, 2.4, p < 0.001) for the exercise intervention compared with usual care. Low quality evidence demonstrated no difference for in-hospital falls count (OR, 1.93 95% CI, 0.61, 6.12 p = 0.27) or mortality (OR, 0.77 95% CI, 0.48, 1.23, p = 0.27). Moderate quality evidence demonstrated no difference for length of stay (MD, −0.10 days 95% CI, −0.31, 0.11 p = 0.36).
Conclusion
Exercise prescribed during an acute medical ward stay improves aerobic capacity and maximum isometric strength but may not reduce length of stay, in-hospital falls or mortality.
BACKGROUNDThe impact of body mass index (BMI) on hospital mortality in patients with acute heart failure has been well documented in Asian populations. However, the relationship between BMI, ...hospital-associated disability (HAD), and hospitalization costs in patients with heart failure is poorly understood. This study aimed to explore the impact of BMI on HAD and hospitalization costs for acute heart failure in Japan. METHODSFrom April 2012 to March 2020, the Japanese Registry of All Cardiac and Vascular Disease Diagnosis Procedure Combination (JROAD-DPC) database was used to identify patients with acute heart failure. All patients were categorized into five groups according to the World Health Organization Asian BMI criteria. The hospitalization costs and HAD were evaluated. RESULTSAmong the 238,160 eligible patients, 15.7% were underweight, 42.2% were normal, 16.7% were overweight, 19.3% were obese I, and 6.0% were obese II, according to BMI. The prevalence of HAD was 7.43% in the total cohort, and the risk of HAD increased with a lower BMI. Restricted cubic spline analysis showed a U-shaped relationship between BMI and hospitalization costs for all ages. Furthermore, developing HAD was associated with greater costs compared with non-HAD, regardless of BMI category. CONCLUSIONSWe found that the lower the BMI, the higher the incidence of HAD. A U-shaped association was confirmed between BMI and hospitalization costs, indicating that hospitalization costs increased for both lower and higher BMI regardless of age. BMI could be an important and informative risk stratification tool for functional outcomes and economic burdens.
Objective A biopsychosocial model was used to treat pain-associated disability in children and adolescents. We assessed the clinical outcomes of children and adolescents (8–21 years of age) with ...pain-associated disability who were treated in an interdisciplinary inpatient rehabilitation program which included physical, occupational, and recreational therapy, medicine, nursing, pediatric psychology, neuropsychology, psychiatry, social work, and education. Psychological treatment emphasized cognitive-behavioral intervention for pain and anxiety management, and behavioral shaping to increase functioning. Methods We conducted a retrospective chart review of 41consecutive patients. School attendance, sleep, and medication usage were assessed at admission and discharge; functional disability and physical mobility were assessed at admission, discharge, and 3-month follow-up. Results As a group, significant improvements were observed in school status, sleep, functional ability, physical mobility, and medication usage. Conclusion Findings support the efficacy of an inpatient interdisciplinary behavioral rehabilitation approach to the treatment of pain-associated disability in pediatric patients.
•Hospitalization of elderly patients can lead to serious adverse effects on their functional capability.•We study the outcome of hospitalization of elderly patients as a supervised learning task.•We ...use a rich set of features characterizing the medical and social situation of elderly patient and show that the need for help and supervision are the most important features predicting whether these patients will return home.•Our random forest model outperforms current models used to predict hospital associated disability.•Our findings can help to improve hospitalization and rehabilitation of elderly patients.
Hospitalization of elderly patients can lead to serious adverse effects on their functional capability. Identifying the underlying factors leading to such adverse effects is an active area of medical research. The purpose of the current paper is to show the potential of artificial intelligence in the form of machine learning to complement the existing medical research. This is accomplished by studying the outcome of hospitalization of elderly patients as a supervised learning task. A rich set of features characterizing the medical and social situation of elderly patients is leveraged and using confusion matrices, association rule mining, and two different classes of supervised learning algorithms, it is shown that the need for help and supervision are the most important features predicting whether these patients will return home after hospitalization. Such findings can help to improve hospitalization and rehabilitation of elderly patients.
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