The structure and functional correlates of social support networks of people in advanced old age living in chosen urban and rural areas in Poland: a cross-sectional study.

The purpose of the study was to identify the different types of social support networks (SSNs) among community-dwelling people aged 75+ years in selected areas of Poland, and to evaluate any associations between the network type and demographic and health variables of the population studied. The two most prevalent SSN types identified using the Practitioner Assessment of Network Type were "family dependent" (35.8%) and "locally integrated" (32.2%). "Local self-contained" (6.4%), "wider community focused" (2.8%) and "private restricted" (5.6%) SSNs were observed less frequently. In 17.2% of cases, it was not possible to identify the type of network unequivocally. Older people with a locally integrated SSN, in contrast to the family dependent type, were generally younger, living alone, and less likely to be homebound, rate their health as poor, suffer from depression or dementia, and had lower levels of functional disability. Locally integrated SSNs are recognized in the literature as being the most robust in terms of facilitating well-being and providing sufficient support to help maintain the older person in the community. This may reflect the higher levels of independence of older people able to sustain these support networks, which are then transformed into family-dependent types as their health deteriorates, but confirmation of this would require prospective studies. An improved understanding of the prevalence of different types of social networks among older people in Poland would help to guide a systematic approach to recognizing unmet needs in this population and provide crucial information in the planning of formal services.

Determinants of anticoagulant therapy in atrial fibrillation at discharge from a geriatric ward: cross sectional study.

Oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), but they are often underused in this particularly high-risk population. The aim of the study was to identify health and functional determinants of oral anticoagulant therapy (OA) in AF at discharge from a geriatric sub-acute ward. A cross-sectional study was conducted and patients who presented with atrial fibrillation were analyzed. They were interviewed, examined, assessed with comprehensive geriatric assessment protocol, and had their hospital records analyzed. Relative risks for OA were counted and multivariable logistic regression model was built. 95 patients took part in the study (22.8% of 416 consecutively admitted to the department, 31.9% men, 73.7% 80 + year-old). 25.8% of them were on antiplatelet drugs and 58.9% on OACs. The percentage on OACs increased significantly to 73.7% at discharge (p = 0.004), mainly due to the new OACs prescription (from 11.8 to 33.3%; p < 0.001). Severe frailty (7 point Clinical Frailty Scale ≥ 6) and anemia presence, but not the risk of bleeding according to the HAS-BLED score, significantly decreased the probability of OACs prescription at discharge. There was also a trend for an association of OACs prescription with the higher total score of CHA2DS2-VASc scale. We conclude that in the real-life population of patients with AF comprehensive geriatric assessment might allow to increase significantly the number of patients on OACs, but it is limited by patient's frailty status and anemia diagnosis.

Health and Functional Determinants of Orthostatic Hypotension in Geriatric Ward Patients: A Retrospective Cross Sectional Cohort Study.

OBJECTIVE: Orthostatic hypotension (OH) is a common problem in older people. Although it is indicated that OH can be a marker of frailty there are no studies that evaluate this relationship in hospitalized patients. The aim of the study was to assess the prevalence of OH in geriatric ward patients and its association with health and functional ability characteristics and patients' frailty status. DESIGN AND SETTING: A retrospective cross-sectional cohort study was conducted among patients aged 60 or over hospitalized in the geriatric ward. PARTICIPANTS: Patients' medical records were analyzed and those with Active Standing Test (AST) results were included in the study. MEASUREMENTS: Orthostatic hypotension was defined by a drop in blood pressure of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure within 3minutes of standing up in AST. The database included sociodemographic characteristics, nutritional, functional and cognitive state, comorbidity and medical treatment. Frailty syndrome was diagnosed with Clinical Frailty Scale. Correlations with OH were counted and multivariable logistic regression models were built. RESULTS: 416 patients were hospitalized in the study period and 353 (84.9%) were included, 78 (22.1%) men and 298 (84.4%) 75+ year-old. AST was not available in patients significantly more dependent in ADL and more frail. OH was diagnosed in 57 (16.2%) patients, significantly more frequently in men (systolic- 45,5%, systolic-diastolic- 40,0%). The significant independent predictors of OH were lower diastolic blood pressure at admittance, nutritional risk in MNA-SF, Parkinson disease, α1-blockers, neuroleptics and memantine, and not the frailty syndrome diagnosed with Clinical Frailty Scale. CONCLUSIONS: OH affects a significant percentage of patients in the geriatric ward, although this problem may be underestimated due to limitations in the performance of AST in very frail and functionally dependent patients.

Prognostic factors of long-term survival in geriatric inpatients. Should we change the recommendations for the oldest people?

OBJECTIVES: Identification of optimal predictors of the 5.5-year survival in former geriatric inpatients.Investigation of the direction and shape of the relationship between mortality risk and its predictors. DESIGN: Retrospective survival analysis with the application of the Cox proportional hazards model. SETTING: Teaching geriatric unit. PARTICIPANTS: 478 inpatients (mean age 77.9; +6.8) discharged from geriatric ward during year 2008, without any exclusion criteria. MEASUREMENTS: Comprehensive geriatric assessment of numerous health variables, body mass index (BMI), clinical and biochemical findings, and outcomes of the final diagnosis. Records on the dates of deaths were obtained from the Provincial Office of Population Register. RESULTS: During the 5.5-year follow-up 209 (43.7%) patients died. In the multivariate setup, six risk factors with an independent impact on mortality were identified: age (p=0.036), cognitive functioning on the Blessed test (p=0.005), score on instrumental ADL (p<0.0001), score on Charlson comorbidity index (p<0.0001), cholesterol level (p<0.0001), BMI (p<0.0001), and hemoglobin level (p=0.02). The latter two predictors exhibited a significant inverted J-shaped association with mortality, i.e., considerably higher risk of death corresponds to the lower values of these variables in comparison to their higher levels. CONCLUSION: Older age, worse IADL and cognitive functioning, and higher comorbidity were recognized as endangering one's long-term survival. On the other hand, moderate obesity (BMI 36), higher cholesterol and the absence of anemia (hemoglobin 13.6 g/dL) are associated with longer survival. Therefore, irrespective of the individualized treatment and physical exercise, nutrient-dense food seems to be a key recommendation to prevent frailty or malnutrition in the oldest and comorbid population.

Determinants of nutritional status of older people in long-term care settings on the example of the nursing home in Bialystok.

PURPOSE: The aim of the study was the assessment of the nutritional status of older people living in the chosen long-term care setting in Poland as well as the determinants having an effect on the nutritional status of the examined subjects. MATERIALS AND METHODS: The subjects included older residents (aged 65 years and older) of the nursing home for the somatically ill adults in Bialystok. The MNA-Mini Nutritional Assessment test was used as an assessment tool to detect nutritional risk. The assessment included elements of clinical and functional evaluation (Katz Index, Instrumental Activities of Daily Living (ADL) scale, Geriatric Depression Scale, Abbreviated Mental Test Score, Norton scale and mobility scale). RESULTS: One hundred out of the 109 persons fulfilling the age criterion were examined. We found that 12% of them were malnourished, 61% were at risk of malnutrition and 27% were well nourished according to the MNA test. Malnutrition affected more often persons having difficulties with chewing, ADL dependent, with limited mobility, suspected of dementia, having suffered from cerebral stroke and who lived with other people coming to the nursing home. The risk of malnutrition was observed significantly more often in individuals suspected of depression and living in urban area before nursing home placement. The significant determinants of lower scores of MNA in the regression analysis were: suspected depression, IADL dependency, limited mobility, female gender and higher number of drugs. CONCLUSIONS: The study has confirmed that malnutrition remains a common problem among older people living in nursing homes. Malnutrition is an increasing hazard especially for women, for people taking higher number of drugs and for those with different mental and physical disabilities.

Falls amongst older people living in the community.

PURPOSE: Falls (instability)--as well as immobility, incontinence, intellectual impairment, depression and visual and auditory impairment are considered to be serious problems in the field of geriatrics. They have multiple causes, tend to reoccur, have no simple cure and make the older person dependent on others for care. This paper presents the results of the study on the prevalence of falls and their determinants in communities of older people (aged 75 and over). MATERIAL AND METHODS: The study design: cross-sectional questionnaire study and survey. The studied population lived in two chosen areas (urban and rural). The questionnaire, as well as instruments to verify the respondent's skills and functional ability, were used. Doctors and nurses employed in the studied areas were interviewers. RESULTS: 457 randomly selected older people (228 from the rural area and 229 from the urban one) took part in the study. Falls in the course of the last year were reported by 45.1% of the group; more frequently by people living in the rural area (58.3% versus 31.9% in the urban one), by women (66.7% versus 44.8% in the men's group) and by people with different disabilities (cognitive impairment, locomotive disabilities, ADL-dependence, visual and auditory impairment), with poor self-reported health status and living arrangements. The score according to Tinetti's test--conducted in the rural areadetermined the frequency of the falls reported. CONCLUSIONS: The study has confirmed that falling is an increasing hazard for older people, especially for women, for people living in rural areas and for those with different mental and physical disabilities.

[Care of the frail elderly in population studies]. / Opiekunowie niedoleznych osób starszych w badaniu populacyjnym.

UNLABELLED: The paper is one of the publications presenting the Polish part of the study on the EASY-Care questionnaire. The study was carried out as the multi-centre project "Supporting Clinical Outcomes in Primary Care of the Elderly". The EASY-Care Questionnaire is an instrument to assess the health care needs and social situation of older people for use in primary care. OBJECTIVES: To identify the main providers of help to the frail community-dwelling elderly people aged 75 years and over. DESIGN: Cross-sectional questionnaire study, survey. SETTING: Community-dwelling elderly people living in the administrative borders one of the community health care centres in Bialystok-city. PARTICIPANTS: 117 randomly selected people aged 75 years and over; the interviewers were doctors and nurses, serving the studied area. MEASUREMENTS: Elderly Assessment System EASY-Care, version 1997,98. RESULTS: 81 persons of the studied group (69.2%) were ADL-dependent. Most of the elderly people in need of care were women, more often with the suspicion of depression and with cognitive impairment. Most of the caregivers (80%) of the frail community-dwelling elderly people 75 and over were family members living together (42%), living apart (21%) or it was wife/husband (17%). Almost 10% of the ADL-dependent elderly had no carer at all. The category of carers fulfilling all of the needs of the care recipient were more often the spouse. The role of the public care providers was marginal. CONCLUSIONS: The family is still the basic source of support and the central element in the care system for the elderly in Poland. The family is insufficiently supported by formal and informal carers.

[The assessment of the functional state of elderly people by family physician with the help of EASY-Care questionnaire]. / Ocena stanu funkcjonowania ludzi w podeszlym wieku przez lekarza rodzinnego za pomoca kwestionariusza. EASY-Care.

The multiplicity and complexity of diagnostic and therapeutical problems affecting elderly patients requires a special approach which has come to be known as the comprehensive geriatric assessment. This approach demands the interdisciplinary cooperation of several practitioners in the field of geriatric care, led by the family doctor. An essential prerequisite for their cooperation to be successful is that there should be some commonly acknowledged starting point in the form of a standardised assessment of the functional state of elderly patients, irrespective of the the number and type of chronic conditions from which they may be suffering. The aim of this paper is to put forward a short and straightforward instrument for assessment of the functional state of elderly people in the form of the EASY-Care questionnaire for the use of family doctors. EASY-Care is a system "picture" of the needs of elderly people. It focuses more on the quality of life of the elderly person rather than on his/her illnesses and takes into consideration the role played by family carers. EASY's main aim is to provide family doctors and other primary care practitioners with information to help them to improve the services that they provide for the elderly. Moreover, the data gained from the use of EASY may help to serve epidemiological purposes, by providing measures of the social and medical needs of the elderly together with information about the degree to which these are being met. Consequently, it also provides a rationale for the provision of funding, directing research and developing a policy for the care of the elderly. The EASY-Care questionnaire has been developed in order to promote a common approach in Europe for the assessment of the elderly.