Journal of the American Medical Directors Association
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Comparative Study Observational Study
Osteoporosis prevalence and characteristics of treated and untreated nursing home residents with osteoporosis.
Our primary objective was to describe the prevalence of osteoporosis (OP) diagnosis in nursing home residents (NHRs). Secondary objectives included assessment of pharmacologic therapies and risk of fracture in NHRs with OP, as well as differentiating clinical characteristics of treated versus untreated male and female NHR with OP. Finally, we sought to evaluate persistence and compliance rates in NHRs treated with OP and determine the prevalence of severe renal impairment in NHRs with OP treated with a bisphosphonate. ⋯ The recognized prevalence of OP in NHRs using MDS records was low, but consistent with previous reports. Among those with a documented diagnosis of OP, approximately 89% of NHRs with OP were at high risk of fracture and only one-third were treated with active pharmacologic therapy. For those treated, persistence and compliance was suboptimal, but higher with oral therapies. More than half of NHRs with OP treated with bisphosphonates had Clcr of less than 35 mL/min, suggesting alternative forms of therapy should be considered. For all of these reasons, the opportunity exists to improve the care and medication use of residents with OP who are at high risk of fracture.
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Randomized Controlled Trial Multicenter Study Comparative Study
A double-blind randomized placebo-controlled withdrawal trial comparing memantine and antipsychotics for the long-term treatment of function and neuropsychiatric symptoms in people with Alzheimer's disease (MAIN-AD).
Neuropsychiatric symptoms in Alzheimer disease (AD) cause significant distress and present a complex clinical challenge for treatment. Pharmacological treatment options are limited to antipsychotics, which carry extensive safety issues. There is emerging evidence to support the potential benefits of memantine, currently licensed for moderate to severe AD, in the prophylaxis of neuropsychiatric symptoms. ⋯ This study indicates no benefits for memantine in the long-term treatment and prophylaxis of clinically significant neuropsychiatric symptoms. The results did indicate some benefits for antipsychotic medications in reducing the relapse of neuropsychiatric symptoms, but this must be balanced against increased mortality risk.
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Multicenter Study Comparative Study
The characteristics of diabetic residents in European nursing homes: results from the SHELTER study.
The objectives of this study were to describe the prevalence of diabetes mellitus (DM) in European nursing homes (NHs), and the health and functional characteristics of diabetic residents (DMR) aged 60 years and older. ⋯ Prevalence of DM in European NH residents is comparable to US national NH surveys, and to UK and German NH data based on glucose-level testing. DMRs compared with non-DMRs have more comorbid conditions, and a particularly higher incidence of cardiovascular diseases and obesity, PU, and severe UI. DMRs should be regarded as a specific group of residents who require an interdisciplinary approach in medical and nursing care.
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Comparative Study
Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies.
Both sarcopenia and physical frailty are geriatric syndromes causing loss of functionality and independence. This study explored the association between sarcopenia and physical frailty and the overlap of their criteria in older people living in different community (care) settings. Moreover, it investigated the concurrent validity of the FRAIL scale to assess physical frailty, by comparison with the widely used Fried criteria. ⋯ Sarcopenia and physical frailty were associated and partly overlap, especially on parameters of impaired physical function. Some evidence for concurrent validity between the FRAIL scale and Fried criteria was found. Future research should elicit the value of combining sarcopenia and frailty measures in preventing disability and other negative health outcomes.
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Randomized Controlled Trial Comparative Study
Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial.
Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture. ⋯ The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197).