Systematic Review and Meta-analysis of Outcome after Mild Traumatic Brain Injury in Older People.

OBJECTIVE: Older age is often identified as a risk factor for poor outcome from traumatic brain injury (TBI). However, this relates predominantly to mortality following moderate-severe TBI. It remains unclear whether increasing age exerts risk on the expected recovery from mild TBI (mTBI). In this systematic review of mTBI in older age (60+ years), a focus was to identify outcome through several domains - cognition, psychological health, and life participation. METHODS: Fourteen studies were identified for review, using PRISMA guidelines. Narrative synthesis is provided for all outcomes, from acute to long-term time points, and a meta-analysis was conducted for data investigating life participation. RESULTS: By 3-month follow-up, preliminary findings indicate that older adults continue to experience selective cognitive difficulties, but given the data it is possible these difficulties are due to generalised trauma or preexisting cognitive impairment. In contrast, there is stronger evidence across time points that older adults do not experience elevated levels of psychological distress following injury and endorse fewer psychological symptoms than younger adults. Meta-analysis, based on the Glasgow Outcome Scale at 6 months+ post-injury, indicates that a large proportion (67%; 95% CI 0.569, 0.761) of older adults can achieve good functional recovery, similar to younger adults. Nevertheless, individual studies using alternative life participation measures suggest more mixed rates of recovery. CONCLUSIONS: Although our initial review suggests some optimism in recovery from mTBI in older age, there is an urgent need for more investigations in this under-researched but growing demographic. This is critical for ensuring adequate health service provision, if needed.

Function focused care in hospital: A mixed-method feasibility study.

Background: During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidence-based intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally participate in functional and physical activity during all care interactions. FFC was adapted to the Dutch Hospital setting, which led to Function Focused Care in Hospital (FFCiH). FFCiH consists of four components: (1) 'Environmental and policy assessment'; (2) 'Education'; (3) 'Goal setting with the patient' and (4) 'Ongoing motivation and mentoring'. The feasibility of FFCiH in the Dutch hospital setting needs to be assessed. Objective: Introduce FFCiH into Dutch hospital wards, to assess the feasibility of FFCiH in terms of description of the intervention, implementation, mechanisms of impact, and context. Design: Mixed method design. Settings: A Neurological and a Geriatric ward in a Dutch Hospital. Participants: 56 Nurses and nursing students working on these wards. Methods: The implementation process was described and the delivery was studied in terms of dose, fidelity, adaptions, and reach. The mechanisms of impact were studied by the perceived facilitators and barriers to the intervention. Qualitative data were collected via focus group interviews, observations, and field notes. Quantitative data were collected via evaluation forms and attendance/participation lists. Results: A detailed description of FFCiH in terms of what, how, when, and by whom was given. 54 Nurses (96.4%) on both wards attended at least 1 session of the education or participated in bedside teaching. The nurses assessed the content of the education sessions with a mean of 7.5 (SD 0.78) on a 0-10 scale. The patient files showed that different short and long-term goals were set. Several facilitators and barriers were identified, which led to additions to the intervention. An important facilitator was that nurses experienced FFCiH as an approach that fits with the principles underpinning their current working philosophy. The experienced barriers mainly concern the implementation elements of the FFCiH-components 'Education' and 'Ongoing motivation and mentoring'. Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were activities added to FFCiH to improve future implementation. Conclusions: FFCiH is feasible for the Dutch hospital setting. Strong emphasis on team involvement, nursing leadership, and the involvement of patients and their families is recommended to optimize future implementation of FFCiH in Dutch hospitals.What is already known•Function Focused Care is an evidence-based intervention that prevents functional decline among hospitalized elderly;•It is proven to be effective in assistant living facilities, nursing homes, home care, and acute care settings in the United States;•It is unknown if the intervention can be implemented in the Dutch Hospital Setting.What this paper adds•This study showed the feasibility of Function Focused Care in Hospital and the challenges in some elements of the intervention;•Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were added to FFCiH to improve future implementation.•This feasibility study can guide the use of process evaluation in examining the feasibility of an intervention in daily practice.

Correlación de pruebas funcionales con la escala Scopa-Motor para evaluar la función motora de pacientes con enfermedad de Parkinson / Correlation of functional tests with the SCOPA-Motor scale to evaluate the motor function of Parkinson's disease patients

RESUMEN INTRODUCCIÓN: La enfermedad de Parkinson (EP) es la segunda patología degenerativa más prevalente. Es importante establecer la utilidad de pruebas funcionales para evaluar objetivamente la función motora en la consulta médica del paciente con EP MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo analítico de corte trasversal, en el que se establecieron correlaciones entre la escala Scopa-Motor y los resultados de la prueba de rotación de la moneda, el Up and Go test y el giro de 360° en pacientes con EP. Se utilizó un análisis no paramétrico con la aplicación del coeficiente de correlación de Spearman. RESULTADOS: En total se evaluaron 16 pacientes. La correlación más fuerte se encontró entre el giro de 360° y dominio de las actividades de la vida diaria (AVD) (r = 0,768, p < 0,01). Las otras variables presentaron una relación más modesta pero estadísticamente significativa, lo que sugiere la utilidad de estas pruebas para una valoración objetiva de los pacientes con EP. CONCLUSIÓN: Este estudio sugiere que el giro de 360°, el Up and Go test y la rotación de la moneda son pruebas válidas para evaluar a los paciente con EP de forma objetiva y cuantitativa sin requerir de la Scopa-Motor en la consulta médica cotidiana.

SUMMARY INTRODUCTION: Parkinson disease (PD) is the second most prevalent neurodegenerative disorder. Establishing the usefulness of functional tests in order evaluate motor function in the clinical setting is essential. MATERIALS AND METHOD: This is a descriptive analytical cross-section study, which correlates the SCOPA-Motor scale with results of the rotation coin test, the Up and Go test and the 360 degrees turn test in patients with PD. A non-parametric analysis was performed, using Spearman correlation coefficient. RESULTS: Sixteen patients were evaluated. The highest correlation was found between the 360 degrees turn and activities of daily living domain (r = 0.768, P <0.01). Other variables had a moderate but statistically significant correlation. This means that these tests can be used as objective evaluation of patients with PD. CONCLUSION: This study suggests that the 360 degrees turn test, Up and Go test and coin rotation test are validated tests to evaluate Parkinson's Disease patients in an objective and quantitative way without using SCOPA-Motor during a routine medical follow up.