0000000001293466
AUTHOR
Raimo Sulkava
Effects of comprehensive geriatric intervention on physical performance among people aged 75 years and over.
Background and aims: We studied the effects of comprehensive geriatric assessment and multifactorial intervention on physical performance among older people. Methods: In a 3-year geriatric development project with an experimental design, 668 participants aged 75–98 were assigned to intervention (n=348) or control (n=320) groups. The intervention group received comprehensive geriatric assessment with an individually targeted intervention for 2 years. The outcome measures—performance in the Timed Up-and-Go (TUG), 10-meter walking and Berg Balance Scale tests 2 were gathered annually during the intervention and the 1-year follow-up after it. Results: With linear mixed models, over the 2-year i…
Effects of comprehensive geriatric assessment and targeted intervention on mobility in persons aged 75 years and over: a randomized controlled trial
Objective: To assess the effect of a comprehensive geriatric assessment and individually tailored intervention on mobility in older people. In addition, the effectiveness of the geriatric intervention was evaluated among a subgroup of persons with musculoskeletal pain. Design: Three-year geriatric development project with randomized assignment to intervention and control group. Setting: Research centre, community and assisted living facilities. Participants: Seven hundred and eighty-one Finnish persons aged 75–98 years were assigned to an intervention ( n = 404) or control ( n = 377) group. Intervention: A comprehensive geriatric assessment with a multifactorial intervention lasting two ye…
Analgesic use among community-dwelling people aged 75 years and older : a population-based interview study
Abstract Background: Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics. Objectives: The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged ≥75 years, and to investigate factors associated with daily and as-needed analgesic use. Methods: A random sample of people aged ≥75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each parti…
Contribution of musculoskeletal pain to postural balance in community-dwelling people aged 75 years and older.
Background. Balance is among the most important prerequisites for safe and independent mobility. Whether musculoskeletal pain is related to standing balance impairment has received limited attention. The aim of this study was to examine the association of musculoskeletal pain with the control of balance in older people. Methods. A total of 605 participants aged 75 years and older (mean age 80.4, 71 % women) were interviewed about presence and severity of musculoskeletal pain. Balance was measured by a force platform, and impaired balance was defined as a high sway velocity moment or inability to maintain semitandem standing. Results. Musculoskeletal pain was reported by 48% of the participa…
Musculoskeletal pain and use of analgesics in relation to mobility limitation among community-dwelling persons aged 75 years and older
Pain and factors related to it constitute serious health problems in the older population. This populationbased cross-sectional study aimed to investigate whether musculoskeletal pain is associated with mobility limitation and whether the relationship between pain and mobility limitation varies according to the use of analgesics among community-dwelling older people. A total of 622 community-dwelling participants aged 75 years and older (mean age 80.4, 74% women) were interviewed about presence and severity of musculoskeletal pain. Self-reported analgesic drug utilization was verified against medical records. Mobility limitation was assessed by the Timed Up & Go test (TUG) time of >13.5 s o…
Impact of missing data mechanism on the estimate of change: a case study on cognitive function and polypharmacy among older persons
Piia Lavikainen,1,2 Esko Leskinen,3 Sirpa Hartikainen,1,2 Jyrki Möttönen,4 Raimo Sulkava,5 Maarit J Korhonen6 1Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; 2School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; 3Department of Mathematics and Statistics, University of Jyväskylä, Jyväskylä, Finland; 4Department of Social Research, University of Helsinki, Helsinki, Finland; 5Department of Geriatrics, Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; 6Department of Pharmacology, D…
Effects of comprehensive geriatric assessment-based individually targeted interventions on mobility of pre-frail and frail community-dwelling older people
Aim To assess the effects of comprehensive geriatric assessment (CGA)-based individually targeted interventions on the ability to walk 400 m in pre-frail or frail and non-frail community-dwelling older people. Methods A subgroups analysis of a population-based comparative study, the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) was carried out in the city of Kuopio, Finland, from 2004 to 2007. This study was based on data from 2005 to 2007. The present analysis included 605 community-dwelling older adults aged ≥76 years (mean age 80.9, 70% women), 314 in the intervention and 291 in the control group. Frailty status was assessed in 2005. Mobility was assessed b…
Physical activity at age of 20-64 years and mobility and muscle strength in old age: a community-based study.
Background. Physical activity in midlife has been related to lower mortality and better health in old age. The present study evaluated whether physical activity at age of 20–64 years was associated with mobility and muscle strength in old age. Methods. A random sample of 1,000 persons was extracted from all the ≥75-year-old people living in Kuopio, Finland, and 679 community-dwelling participants were included in the present analyses. Data on health status, ability to walk outside or 400 m, and physical activity level were obtained through structured interviews. Participants’ walking speed, grip strength, and knee extension strength were measured by physiotherapists. Relationship between ph…
A randomized controlled trial of rehabilitation after hospitalization in frail older women: effects on strength, balance and mobility
When frail older people become acutely ill, they are at increased risk of further functional deterioration and rehabilitation is needed to restore functioning. The effects of an out-patient multicomponent training program including strength training after hospitalization were studied in a randomized controlled trial. Sixty-eight women (mean age 83.0 +/- 3.9 years) who were hospitalized due to an acute illness and were mobility impaired at admission were randomized into training (N = 34) and home exercise (N = 34) groups. Maximal voluntary isometric strength of knee extension and hip abduction, dynamic balance, and maximal walking speed were measured before and after the 10-week training per…
Self-reported sleep duration and cognitive functioning in the general population
This study investigated the relationship between self-reported sleep factors (sleep duration, insomnia, use of sleeping medicine, probable sleep apnoea and feelings of fatigue and tiredness) with cognitive functioning in 5177 people aged 30 years or older from a cross-sectional representative sample of the adult population in Finland (The Finnish Health 2000 Survey). Previous studies have indicated a U-shaped association between increased health risks and sleep duration; we hypothesized a U-shaped association between sleep duration and cognitive functioning. Objective cognitive functioning was assessed with tasks derived from the Consortium to Establish a Registry for Alzheimer's Disease te…
Effect of cognitive impairment on basic activities of daily living in hip fracture patients: a 1-year follow-up.
Background and aims: To compare changes in basic self-care activities in various cognitive groups of hip fracture patients by the Katz Index of Independence in activities of daily living (ADL). Methods: 117 community-dwelling elderly subjects with acute hip fracture (age 67–92 years), referred to the geriatric unit of Jyvaskyla Central Hospital for rehabilitation, participated in the study. Basic self-care activities were evaluated by the Katz ADL Index and cognition by the Mini-Mental State Examination (MMSE). Results: Prior to hip fracture, the patients in the lowest MMSE group had a significantly lower Katz Index than the other three groups (p<0.001). Disability increased in a statistica…
Cost analysis of an exercise program for older women with respect to social welfare and healthcare costs: a pilot study
The aim of this study was to analyze social welfare and healthcare costs and fall-related healthcare costs after a group-based exercise program. The 10-week exercise program, which started after discharge from the hospital, was designed to improve physical fitness, mood, and functional abilities in frail elderly women. Sixty-eight acutely hospitalized and mobility-impaired women (mean age 83.0, SD 3.9 years) were randomized into either group-based (intervention) or home exercise (control) groups. Information on costs was collected during 1 year after hospital discharge. There were no differences between the intervention and control groups in the mean individual healthcare costs: 4381 euros …
Psychomotor slowness is associated with self-reported sleep duration among the general population
Short and long self‐reported sleep durations have been found to be associated with several seemingly disparate health risks and impaired functional abilities, including cognitive functioning. The role of long sleep is especially poorly understood in this context. Psychomotor slowness, shown to have analogous associations with cognitive performance and health risks as self‐reported long sleep duration, has not been studied together with sleep duration in epidemiological settings. We hypothesized that self‐reported habitual sleep duration, especially long sleep, is associated with slow psychomotor reaction time, and that this association is independent of vigilance‐related factors. The hypoth…
Effects of a group-based exercise program on the mood state of frail older women after discharge from hospital
Background Older people with somatic illnesses are at increased risk of depression. It is not known whether exercise alleviates depressive symptoms in frail, very old people recuperating from an acute illness. Objective To determine the effects of a group-based exercise training program on mood. Methods Sixty-eight women (mean age 83.0, SD 3.9 years) who were hospitalized due to an acute illness, and were mobility impaired at admission, were randomized into group-based 10-week strength training intervention (N=34) and home exercise control (N=34) groups. Twenty-four women in the training and 28 in the control group completed the follow-up. Measures of mood state with the Zung Self-Rating De…
Randomized, Double-Blind, Clinically Controlled Trial of Intranasal Calcitonin Treatment in Patients with Hip Fracture
The objective of this study was to evaluate the short-term outcome of intranasal calcitonin treatment of elderly hip fracture patients on pain, bone loss, functional recovery, and length of hospital stay. In addition, we wanted to compare the effect of calcitonin with placebo on fusion of hip fractures treated with internal fixation using a screw or a nail. In a randomized, double-blind, clinically controlled trial, 260 independently living patients (aged 65 years or older) with acute hip fracture were randomly assigned to intranasal calcitonin 200 IU daily for 3 months or matching placebo nasal spray. Analyses were completed on an intention-to-treat basis. Three months after the operation,…
Relationship between functional vision and balance and mobility performance in community-dwelling older adults
Background and Aims: Vision is an important prerequisite for balance control and mobility. The role of objectively measured visual functions has been previously studied but less is known about associations of functional vision. That refers to selfperceived vision-based ability to perform daily activities. The aim was to investigate the relationship between functional vision and balance and mobility performance in a community-based sample of older adults. Methods: This study is part of a Geriatric Multidisciplinary Strategy for the Good Care of the Elderly project (GeMS). Participants (576) aged 76 to 100 years (mean age 81 years, 70% women) were interviewed using a seven-item functional vis…