Prevention at home in older persons with (pre-)frailty: analysis of participants' recruitment and characteristics of the randomized controlled PromeTheus trial.

BACKGROUND: The "PromeTheus" trial is evaluating a home-based, multifactorial, interdisciplinary prevention program for community-dwelling (pre-)frail older adults. These individuals often suffer from reduced participation, which can complicate the recruitment and enrollment in a clinical trial. AIMS: The aim of this study was to evaluate different recruitment strategies and differences in participant characteristics in relation to these strategies. METHODS: This cross-sectional study used baseline data from the randomized-controlled PromeTheus trial, in which community-dwelling (pre-)frail older persons (Clinical Frailty Scale [CFS] 4-6 pt., ≥ 70 years) were recruited via general practitioners ("GP recruitment") or flyers, newspaper articles, and personalized letters ("direct recruitment"). Differences in the sociodemographic, clinical, physical, functional, mobility-related, psychological and social characteristics were analyzed in relation to the recruitment strategy. RESULTS: A total of 385 participants (mean age = 81.2, SD 5.9 years; women: n = 283, 73.5%) were enrolled, of which 60 (16%) were recruited by GPs and 325 (84%) through direct recruitment. Participants recruited via GPs had significantly higher subjective frailty levels (CFS), were more often physically frail (Fried Frailty Phenotype), and showed lower physical capacity (Short Physical Performance Battery), participation (disability component of the short version of the Late-Life Function and Disability Instrument), and life-space mobility (Life-Space Assessment) compared to those recruited via the direct approach (p = 0.002-0.026). Costs per randomized participant were 94€ for the GP recruitment strategy and €213 for the direct recruitment strategy. CONCLUSION: Different strategies may be required to successfully recruit (pre-)frail home-living older adults into preventive programs. Direct recruitment strategies, in which potential participants are directly informed about the prevention program, seem to be more promising than GP recruitment but may result in enrolment of persons with less functional impairment and higher recruitment costs. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00024638. Registered on March 11, 2021.

Predictors of 2-Year Post-Discharge Mortality in Hospitalized Older Patients.

BACKGROUND: Understanding prognostic factors for adverse health outcomes is clinically relevant for improving treatment decision-making processes, potentially leading to enhanced patient prognosis. This secondary analysis of a prospective observational study aimed to identify independent factors associated with 2-year post-discharge mortality in acutely hospitalized older patients. METHODS: All-cause mortality and date of death of 115 patients (83.3 ± 6.3 years, females: n = 75, 65.2%) admitted to acute geriatric wards were determined two years after hospital discharge through telephone interviews. Potential prognostic factors measured at hospital admission included demographic and clinical characteristics, nutritional, cognitive, and psychological status, Fried frailty phenotype, functioning in activities of daily living, locomotor capacity, and 24 h in-hospital mobility and objectively measured physical activity (PA) behaviors. RESULTS: The 2-year mortality rate was 36.7% (n = 41). Univariate and multivariate Cox proportional hazards regression models revealed that mean daily PA level (hazards ratio (HR) = 0.59, 95% confidence interval (CI) 0.90-1.00; p = 0.042), frailty (HR = 3.39, 95% CI 1.20-9.51; p = 0.020), and underweight, in contrast to overweight (HR = 3.10, 95% CI 1.07-9.01; p = 0.038), at hospital admission were independently predictive of post-discharge mortality. CONCLUSION: PA, frailty, and underweight at hospital admission should be considered when evaluating long-term survival prognosis, establishing risk profiles, and developing personalized care pathways in acute hospital care of older adults.

[Therapy of physical frailty]. / Therapie der physischen Frailty.

As an overarching geriatric syndrome, frailty describes a potentially reversible transitional stage between functional autonomy and irreversible disability. Thus, frailty addresses a "window of opportunity" in which functional limitations can be successfully treated. This article provides an overview of the therapeutic approaches and their scientific evidence.

Clinical teaching in applied health science: effects of a student-led journal club on aging and physical activity.

BACKGROUND: This project aims to investigate the effects of a student-led journal club on students' critical thinking and clinical application skills in the academic field of aging and physical activity. METHODS: A pre-post design analysis with data collected in four successive cohorts of the program M.Sc. Sport and Movement Gerontology was conducted. Each student assigned himself/herself to a study, and then led the journal club discussion and published a summary of the journal club via graphical abstract on social media. The students rated their perceived confidence in the beginning (T0) and after the semester (T1) via questionnaire and 5-point Likert scales addressing their ability to review and summarize the evidence, to present it in a journal club and to lead the discussion. RESULTS: 41 students (32 women, M = 25 years SD 1.9 years) were included. The journal club was rated as "very good" (median 2, IQR 1). Students' confidence on participating, leading the journal club and transferring the results into clinical practice improved significantly (r ≥ 0.6, p < 0.01) - e.g.: "I feel confident in leading a discussion on the literature presented", T0: "undecided" (median 3, IQR 2) to T1: "rather agree" (median 4, IQR 1, Z= -5.41, r = 0.85, p < 0.01). DISCUSSION: The student-led journal club shows to be an effective teaching approach for the field of aging and physical activity within applied health science education. Especially the students' self-assignment to the studies and involving the scientific community via social media was rated as useful and highly motivating for students and lecturers.

Circadian aspects of mobility-related behavior in patients with dementia: An exploratory analysis in acute geriatric psychiatry.

BACKGROUND: Analyzing patients' mobility-related behavior may improve the assessment of motor behavior in dementia, however, few studies addressed circadian aspects of mobility. This cross-sectional explorative study analyzed the timing of peak mobility-related behavior, the prevalence of mobility-related sundowning and nocturnal mobility-related behavior and associated clinical characteristics in acute geriatric psychiatry. METHODS: Mobility-related behavior of 73 patients (M: 81 years) was measured over 48 h using lower-back worn hybrid motion sensors. We derived the start of the 30-min period with peak gait activity (highest number of steps) for each day and the number of nocturnal steps taken from 10PM to 7AM. Professional caregiver ratings of the patients' motor behavior were conducted within the Neuropsychiatric Inventory (NPI). RESULTS: The mean start time of peak gait activity was 2:37PM, but large variations in timing were found (range: 3:25AM-9:30PM). Twenty-five patients (34%) were identified as "sundowners". Nocturnal mobility-related behavior was measured in 35 patients (53%), whereas professional caregivers assessed night-time disorders in only 19 patients (26%). Clinical characteristics of "sundowners" were not significantly different from other patients, except for lower doses of antipsychotics as compared to non-sundowners (M:1.6 mg/day; p = 0.015). The number of nocturnal steps was significantly associated to corresponding NPI ratings (Spearman's rho = 0.4; p < 0.001). CONCLUSION: Analyzing the timing of peak gait activity and nocturnal step-count seem to provide clinical applicable information on the circadian aspects of mobility-related behavior in acute geriatric psychiatry. Even though the clinical validity needs to be evaluated, objective information on the individual circadian aspects of mobility-related behavior could help to personalize treatment with benefits for patients and caregivers.

Physical activity monitoring-based interventions in geriatric patients: a scoping review on intervention components and clinical applicability.

OBJECTIVE: To identify and analyze the components applied in interventions using physical activity (PA) monitoring in geriatric patients and determine their feasibility and applicability. METHODS: A systematic search in six databases (PubMed, Embase, SPORTDiscus, CINAHL, Web of Science, and GeroLit) was conducted to identify studies reporting interventions that included the application of a PA monitor in adults aged ≥ 60 years with a clinical diagnosis. PA monitor interventions were analyzed regarding their feedback, goal-setting and behavior change technique (BCT) components. To determine the feasibility and applicability of interventions, the participants' adherence to the intervention, their experience as well as adverse events were analyzed. RESULTS: Seventeen eligible studies, applying 22 interventions, were identified. Studies included a total of 827 older patients with a median age of 70.2 years. In thirteen interventions (59%), the PA monitor was embedded in a structured behavioral intervention, an indication-specific intervention or usual care. Most frequently applied intervention components were goal setting and self-monitoring (n = 18), real-time PA monitor feedback complemented by feedback from the study team (n = 12), use of further BCTs (n = 18), and regular counseling with the study team (n = 19). Comprehensive information on the participants' intervention adherence and experience were reported for 15 (68%) and 8 (36%) interventions, respectively. CONCLUSION: The components included in PA monitoring-based interventions varied considerably especially regarding the extent, frequency, and content of feedback, goal setting and BCTs counseling. Future research should evaluate which components are most effective and clinically applicable to promote physical activity in geriatric patients. To be able to precisely analyze the effects, trials should seek to report details on intervention components, adherence and adverse events, while future reviews may use the findings of this scoping review to conduct analyses with less heterogeneity in study characteristics and intervention strategies.

Dance-Specific Activity in People Living With Dementia: A Conceptual Framework and Systematic Review of Its Effects on Neuropsychiatric Symptoms.

OBJECTIVES: Dance as a non-pharmacological therapy is commonly used in dementia care, although the evidence of its effects remains unclear. This study systematically reviewed the effects of dance interventions on neuropsychiatric symptoms (NPS) in people living with dementia. To systematically identify and evaluate dance interventions, a standardized terminology for Dance-Specific Activity (DSA) is proposed. METHODS: Literature search was conducted on electronic databases until April 30th 2021. Studies were included when they quantified the effects of DSA on NPS in people with clinical diagnosis of dementia. Included studies were analyzed in detail for NPS. Study quality was assessed by PEDro scale (German version). RESULTS: 4 studies were included. The studies differed in study design, intervention protocols, dance styles, or measurement tools, and were generally of low study quality. Two trials showed improvements in NPS and 2 trials showed no exacerbation of NPS after DSA. CONCLUSIONS: The results of the 4 available trials indicate a positive tendency towards the effects of DSA, but considering the limitations of the few available studies, a clear statement about the effects of DSA is not possible yet. Based on the included trials, the following implications for clinical research and routine care can be derived: (1) DSA seems to be a practical terminology for identifying dance interventions (2) DSA seems to be a safe intervention for people living with dementia. (3) Different dance styles can be used. (4) DSA approaches should be better structured by differentiating between the domains type, content, intention, and protocol of the intervention.

Short-term aerobic exercise for depression in acute geriatric psychiatry: study protocol for a randomized controlled trial.

BACKGROUND: Major depression is one of the main mental illnesses in old age, with acute exacerbated episodes requiring treatment in geriatric psychiatry. A meta-analysis showed that aerobic exercise in moderate intensity has large effects in older adults with major depression, but there is no evidence of aerobic exercise in geriatric psychiatry. Therefore, this study aims to analyze the feasibility and effects of an ergometer-based aerobic exercise on depressive symptoms. METHODS: A single-center randomized controlled trial will be conducted in an acute geriatric psychiatric hospital. Inpatients allocated to the intervention group will receive a 2-week aerobic ergometer program. The control group will receive seated flexibility exercise in addition to usual care. The overall effects on the patients' depressive symptoms will be measured by clinical global impression of change (CGI) as the primary outcome. Changes in depressive symptom domains, physical (in)activity, and aerobic performance as well as the dosage of applied antidepressants will be examined as secondary outcomes. DISCUSSION: This short-term aerobic exercise program is expected to decrease depressive symptoms in acute exacerbated periods in older adults. The results may increase the evidence for implementing physical activity interventions in acute hospital settings. The disease-related motivation for exercise in acute exacerbated depressive periods will be the most challenging aspect. The treatment of depression requires new cost-effective approaches, especially in acute geriatric psychiatry with potential benefits for patients, family members, and clinicians. TRIAL REGISTRATION: German Clinical Trial Register ID: DRKS00026117 TRIAL STATUS: Protocol Version 1.2 dated February 23, 2022. By February 23, 2022, the trial had recruited a total of 15 participants in two wards at the Department of Geriatric Psychiatry at the LVR-Hospital Cologne. Recruitment started on November 12, 2021. The recruitment is expected to continue for at least 12 months.

Post-discharge Mortality in Patients With Delirium and Dementia: A 3-Year Follow Up Study.

Background: Delirium and dementia are prominent psychiatric diseases in old age and connected with poor outcomes for people affected. Nevertheless, there is a lack of knowledge concerning the long-term prognosis of patients with dementia and delirium. This study analyzes mortality, readmission rates and discharge destinations of patients with dementia or delirium superimposed on dementia (DSD) within 3 years after discharge from hospital. Methods: A cross-sectional, monocentric cohort study was conducted at the department of geriatric psychiatry of the LVR hospital cologne, using structured telephone interviews and analyses from the clinical information system. All patients with dementia and DSD, admitted between December 2014 and November 2015, were screened for eligibility. Results: In total, 113 patients were included, 49 patients with dementia (M 80 years, female 49%) and 64 with DSD (M 82 years, female 47%). Three years after discharge, 66 patients (58%) had died (95% CI 91.9-112.5; p = 0.53). Within the first 3 months, 9 patients (14%) with DSD deceased, but no patient from the dementia group (95% CI 11.3-12.7; p = 0.01). Out of all patients, 17 patients were readmitted and nursing homes were the predominant discharge destination (55%). Conclusions: This analysis revealed a high post-discharge mortality rate of patients with dementia and DSD. For patients with DSD, a close clinical monitoring, mainly within the first 3 months after discharge, should challenge the significantly increased acute-mortality. These findings should set the pattern for a comprehensive analysis of long-term effects of dementia and DSD. More studies are required for better understanding and comparability in this field of research and healthcare.

Sarcopenia in geriatric psychiatry: feasibility of the diagnostic process and estimation of prevalence within a hospital context.

BACKGROUND: Sarcopenia is an age-related progressive and general skeletal muscle disease associated with negative consequences such as falls, disability, and mortality. An early-stage diagnosis is important to enable adequate treatment, especially in geriatric psychiatry. However, there presently is little information about the feasibility of diagnostic procedures and the prevalence of sarcopenia in clinical geriatric psychiatry settings. The aim of this study is to implement a diagnostic process for sarcopenia in a geriatric psychiatry hospital, to investigate its feasibility and to analyse the prevalence rates. METHODS: A single-centre cross-sectional study over 3 months was conducted in a geriatric psychiatry hospital. All admitted patients with a diagnosis of dementia, depression, or delirium were screened regarding the clinical impression of frailty and sarcopenia according to the current diagnostic algorithm of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). RESULTS: We found that short physical performance tests, such as the handgrip strength testing (91%) or 4 m walking test (91%), were applicable in our sample. The original standardized instructions of longer tests could not be performed appropriately, for example, in the five-times-sit-to-stand-test (32%), the timed-up-and-go-test (68%), and the 400 m walking test (38%). Muscle mass measurements using bioelectric impedance analysis were feasible in all patients (100%). The analysis revealed an estimated prevalence rate for sarcopenia of 65% for patients suffering from dementia and 36% for patients suffering from depression. In our final analysis, 15 patients suffering from dementia, 19 suffering from depression, and no patient suffering from delirium were included [22 female (64.7%) and twelve male (35.3%) patients]. The patients were on average 78.9 ± 7.7 years old, with the youngest patient being 61 years old and the oldest patient 93 years old. Out of the total sample, 14 patients suffering from dementia and eight patients suffering from depression were diagnosed with a severe stage of sarcopenia. CONCLUSIONS: The EWGSOP2 algorithm seems to be applicable in the clinical routine of a geriatric psychiatry hospital. The high estimated prevalence rates of sarcopenia highlight the need for an early and comprehensive screening for sarcopenia in geriatric psychiatry.

Quantifying Circadian Aspects of Mobility-Related Behavior in Older Adults by Body-Worn Sensors-An "Active Period Analysis".

Disruptions of circadian motor behavior cause a significant burden for older adults as well as their caregivers and often lead to institutionalization. This cross-sectional study investigates the association between mobility-related behavior and subjectively rated circadian chronotypes in healthy older adults. The physical activity of 81 community-dwelling older adults was measured over seven consecutive days and nights using lower-back-worn hybrid motion sensors (MM+) and wrist-worn actigraphs (MW8). A 30-min and 120-min active period for the highest number of steps (MM+) and activity counts (MW8) was derived for each day, respectively. Subjective chronotypes were classified by the Morningness-Eveningness Questionnaire into 40 (50%) morning types, 35 (43%) intermediate and six (7%) evening types. Analysis revealed significantly earlier starts for the 30-min active period (steps) in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p ≤ 0.01). The 120-min active period (steps) showed significantly earlier starts in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p = 0.02). The starting times of active periods determined from wrist-activity counts (MW8) did not reveal differences between the three chronotypes (p = 0.36 for the 30-min and p = 0.12 for the 120-min active period). The timing of mobility-related activity, i.e., periods with the highest number of steps measured by hybrid motion sensors, is associated to subjectively rated chronotypes in healthy older adults. The analysis of individual active periods may provide an innovative approach for early detecting and individually tailoring the treatment of circadian disruptions in aging and geriatric healthcare.

Validity and Reliability of the German Quality of Life-Alzheimer's Disease (QoL-AD) Self-Report Scale.

BACKGROUND: The Quality of Life-Alzheimer's Disease (QoL-AD) scale is a widely used measure of quality of life (QoL) in dementia. Although the instrument has been validated in several languages, the psychometric properties of the German self-report version have not yet been analyzed. OBJECTIVE: This study examines the internal consistency, test-retest reliability, and construct validity of the German QoL-AD self-report scale. METHODS: The sample included 30 patients suffering from mild to moderate Alzheimer's disease or vascular dementia (19 females; mean age 77.3 years; mean Mini-Mental State Examination (MMSE) score 19.7 points). To determine test-retest reliability, the QoL-AD self-report scale was re-administered four to seven days apart. For construct validity analysis, the Dementia Quality of Life instrument (DQoL), Geriatric Depression Scale (GDS), MMSE, and an adapted short form of the Neuropsychiatric Inventory (NPI) were used. RESULTS: The German QoL-AD self-report scale shows an internal consistency of α= 0.79 and a test-retest reliability of r = 0.75 (p < 0.01). Regarding construct validity, there was a significant positive correlation between the total scores of the QoL-AD and DQoL (r = 0.47, p < 0.05). The analysis revealed no significant correlations with the GDS or the adapted NPI. No association could be observed between the QoL-AD and the MMSE (r = 0.01), confirming divergent validity. CONCLUSION: The results indicate that the German QoL-AD self-report scale is a suitable instrument for assessing QoL in patients suffering from mild to moderate dementia, thus supporting its use in clinical practice and research.

Quantifying Habitual Physical Activity and Sedentariness in Older Adults-Different Outcomes of Two Simultaneously Body-Worn Motion Sensor Approaches and a Self-Estimation.

Applicable and accurate assessment methods are required for a clinically relevant quantification of habitual physical activity (PA) levels and sedentariness in older adults. The aim of this study is to compare habitual PA and sedentariness, as assessed with 1) a wrist-worn actigraph, 2) a hybrid motion sensor attached to the lower back, and 3) a self-estimation based on a questionnaire. Over the course of one week, PA of 58 community-dwelling subjectively healthy older adults was recorded. The results indicate that actigraphy overestimates the PA levels in older adults, whereas sedentariness is underestimated when compared to the hybrid motion sensor approach. Significantly longer durations (hh:mm/day) for all PA intensities were assessed with the actigraph (light: 04:19; moderate to vigorous: 05:08) when compared to the durations (hh:mm/day) that were assessed with the hybrid motion sensor (light: 01:24; moderate to vigorous: 02:21) and the self-estimated durations (hh:mm/day) (light: 02:33; moderate to vigorous: 03:04). Actigraphy-assessed durations of sedentariness (14:32 hh:mm/day) were significantly shorter when compared to the durations assessed with the hybrid motion sensor (20:15 hh:mm/day). Self-estimated duration of light intensity was significantly shorter when compared to the results of the hybrid motion sensor. The results of the present study highlight the importance of an accurate quantification of habitual PA levels and sedentariness in older adults. The use of hybrid motion sensors can offer important insights into the PA levels and PA types (e.g., sitting, lying) and it can increase the knowledge about mobility-related PA and patterns of sedentariness, while actigraphy appears to be not recommendable for this purpose.

A Structured Physical Exercise Program Reduces Professional Caregiver's Burden Caused by Neuropsychiatric Symptoms in Acute Dementia Care: Randomized Controlled Trial Results.

Physical exercise is an effective treatment approach for neuropsychiatric symptoms (NPS), but it is unknown whether the reduction of NPS has an impact on professional caregiver's burden. A randomized controlled trial in acute dementia care with N = 70 patients, n = 35 per group, was conducted. The intervention group (IG) received an exercise program, the control group a social stimulation program. The RM-ANOVA showed a significant group x time interaction with time effects for the IG and decreased caregiver burden due to the exercise program at follow-up. Physical exercise programs may not only be beneficial for the patients but also for their professional caregivers.

Assessment of Functional Performance in Acute Geriatric Psychiatry - Time for New Strategies?

OBJECTIVES: The aim of this study was to investigate the feasibility and reliability of functional performance tests in people living with dementia and depression. METHOD: A cross-sectional study was conducted in a geriatric psychiatry hospital. People living with dementia, depression, and healthy older adults were included. Feasibility of the timed up and go test (TUG), the short physical performance battery (SPPB), and the multisurface obstacle test for older adults (MSOT) was assessed based on valid test executions. Test-retest reliability was evaluated by mean difference (MD), coefficient of variation (CV), standardized MD, intraclass correlation coefficient (ICC), and correlation coefficient (rs). RESULTS: A total of 53 people in acute geriatric psychiatry and 21 healthy older adults were included. In people living with dementia (n = 23), feasibility was 65.2% (MSOT), 8.7% (TUG), and 8.7% (SPPB). In people living with depression (n = 30), feasibility was 83.3% (MSOT), 80.0% (TUG), and 46.7% (SPPB). Intraclass correlation coefficients and rs for the MSOT were high (ICC > 0.70) in both groups. Coefficient of variations of the MSOT were between 10.7% and 18.0% (dementia) and 7.1% and 17.0% (depression). Reliability of the TUG and SPPB was not analyzed in people living with dementia, due to low feasibility. In people living with depression, ICCs and rs were between 0.86 and 0.87 with CVs of 7.2% (TUG) and 0.69 and 0.95 with CVs of 7.8% and 15.1% (SPPB). CONCLUSION: Feasibility and reliability of established functional performance tests in acute geriatric psychiatry are limited, especially in people living with dementia. New strategies, for example, sensor-based approaches, may allow measurement of functional performance apart from standardized instruction-based test procedures in this clinical population.

Prominent physical inactivity in acute dementia care: Psychopathology seems to be more important than the dose of sedative medication.

INTRODUCTION: To objectively quantify patients' physical activity and analyze the relationships between physical activity levels, psychopathology, and sedative medication in acute hospital dementia care. MATERIALS AND METHODS: In this cross-sectional study, we assessed the patients' physical activity based on data collection by hybrid motion sensors attached on their lower back. Daily doses of antipsychotics have been converted to olanzapine-equivalents and daily benzodiazepine medication is reported as diazepam-equivalents. We assessed patients' neuropsychiatric symptoms with the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. RESULTS: We analyzed motion sensor data from 64 patients (MMSE M = 18.6). On average, patients were lying for 11.5 hours, sitting/standing sedentary for 10.3 hours, sitting/standing active for 1.0 hours, and walking for 1.2 hours per day. The analysis revealed no correlations between patients' physical activity and antipsychotic or benzodiazepine medication. More severe neuropsychiatric symptoms were associated with a decrease in the patients' physical activity (r = .32, P = .01). In particular, patients with apathy symptoms were less physically active than patients without apathy symptoms. DISCUSSION: The results reveal that most of the patients in acute dementia care had very low levels of physical activity. Their physical inactivity may be due to the severity of their neuropsychiatric symptoms, especially apathy. Antipsychotic and benzodiazepine medication appeared to have less impact on patients' physical activity. Dementia care should pay more attention to prevent physical inactivity in patients.

Statistical learning of mobility patterns from long-term monitoring of locomotor behaviour with body-worn sensors.

Long term monitoring of locomotor behaviour in humans using body-worn sensors can provide insight into the dynamical structure of locomotion, which can be used for quantitative, predictive and classification analyses in a biomedical context. A frequently used approach to study daily life locomotor behaviour in different population groups involves categorisation of locomotion into various states as a basis for subsequent analyses of differences in locomotor behaviour. In this work, we use such a categorisation to develop two feature sets, namely state probability and transition rates between states, and use supervised classification techniques to demonstrate differences in locomotor behaviour. We use this to study the influence of various states in differentiating between older adults with and without dementia. We further assess the contribution of each state and transition and identify the states most influential in maximising the classification accuracy between the two groups. The methods developed here are general and can be applied to areas dealing with categorical time series.

Falls in hospitalized geriatric psychiatry patients: high incidence, but only a few fractures.

Fall rates from 3.2 to 17.1 falls per 1,000 hospital days in geriatric psychiatry facilities have been reported to date. Up to 5% of the falls result in severe injuries, but data concerning medical consequences are scare. This brief report presents a retrospective analysis of one year fall protocols from a geriatric psychiatry department focusing on consequences of falls. Fall-induced injuries were rated in four categories: no injuries, mild injuries (contusions, hematomas, abrasions), moderate injuries (lacerations, dislocations), and severe injuries (fractures, cerebral hemorrhages). In total, 510 falls were registered during the study period, indicating a fall rate of 17.7 falls per 1,000 hospital days. Overall, 375 falls (73.5%) resulted in no injuries, 67 (13.1%) resulted in mild injuries, 59 (11.6%) resulted in moderate injuries, and only 9 (1.8%) falls led to severe injuries (fractures and cerebral hemorrhages). These results indicate a quite high fall rate in our sample of hospitalized geriatric psychiatry patients with only a relatively small number of severe injuries resulting from the falls. These results raise the question about the use of physical restraints and the use of bedrails in geriatric patients to prevent falls as the medical implications of falls may be less problematic than previously thought.

Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT.

BACKGROUND: The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care. METHODS: Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents. RESULTS: Eighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication. CONCLUSIONS: This exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia. TRIAL REGISTRATION: German Clinical Trial Register DRKS00006740 . Registered 28 October 2014.