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Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 4 uppsatser.

Diss. Luleå : Luleå tekniska univ., 2008. / Härtill 4 uppsatser.

abstract: The treatment of individuals with multiple chronic conditions represents the single largest driver of Medicare costs. The use of prescription drugs is a major component in the treatment/management of chronic disease in the United States. Medication nonadherence, however, is a common problem among older adults and leads to significant morbidity and mortality. Whereas, the problem of medication nonadherence has been a primary focus of research for the last thirty years, much is still unknown about which older adults are most at risk for medication nonadherence, as well as what are effective theory-based interventions to improve a person's medication self-management. The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2014

Introduction: Frailty is characterized by vulnerability to declining health and increased risk for adverse health outcomes. Measuring frailty would be beneficial for developing interventions and assessing healthcare resource needs. No standardized measurement tool for frailty has been established. The objective of this thesis was to evaluate the frailty of participants in the Canadian Longitudinal Study on Aging (CLSA). Methods: A Frailty Index (FI) was constructed for CLSA participants based on the cumulative deficit theory of frailty. Exploratory factor analysis was conducted to study the underlying constructs of frailty and identify key factors. A hypothesized measurement model for frailty was specified. The model was modified and tested using structural equation modelling (SEM) to improve goodness-of-fit. A new frailty measurement tool was created and the construct validity of the new tool and the Frailty Index were evaluated. Results: A FI was calculated for 20,874 CLSA participants (Mean 0.14 SD 0.07). The maximum FI value was 0.68. A model containing all hypothesized variables had good fit of the data, and all variables contributed significantly. A simplified model also showed good fit and included four domains: upper-body strength, lower-body strength, dexterity, and depressive symptoms. These results persisted in an independent dataset. A Simplified Frailty (SF) score was created based on this simplified model. The FI and SF scores showed significant agreement and associations with sociodemographic variables were as predicted. Conclusions: A FI was simple to construct in the CLSA, having good fit of the data and construct validity. These results are consistent with previous research on the cumulative deficit theory of frailty. A simplified frailty model revealed key domains of frailty and resulted in a potentially useful short screening tool. The FI is recommended as a valid and reproducible approach for measuring frailty in the CLSA and similar population datasets. / Thesis / Master of Science (MSc)

Yes / Objective To explore the barriers/facilitators to deprescribing in primary care in England from the perspectives of clinicians, patients living with frailty who reside at home, and their informal carers, drawing on the Theoretical Domains Framework to identify behavioural components associated with barriers/facilitators of the process. Design Exploratory qualitative study. Setting General practice (primary care) in England. Participants 9 patients aged 65+ living with frailty who attended a consultation to reduce or stop a medicine/s. 3 informal carers of patients living with frailty. 14 primary care clinicians including general practitioners, practice pharmacists and advanced nurse practitioners. Methods Qualitative semistructured interviews took place with patients living with frailty, their informal carers and clinicians. Patients (n=9) and informal carers (n=3) were interviewed two times: immediately after deprescribing and 5/6 weeks later. Clinicians (n=14) were interviewed once. In total, 38 interviews were undertaken. Framework analysis was applied to manage and analyse the data. Results 6 themes associated with facilitators and barriers to deprescribing were generated, respectively, with each supported by between two and three subthemes. Identified facilitators of deprescribing with patients living with frailty included shared decision-making, gradual introduction of the topic, clear communication of the topic to the patient and multidisciplinary working. Identified barriers of deprescribing included consultation constraints, patients' fear of negative consequences and inaccessible terminology and information. Conclusions This paper offers timely insight into the barriers and facilitators to deprescribing for patients living with frailty within the context of primary care in England. As deprescribing continues to grow in national and international significance, it is important that future deprescribing interventions acknowledge the current barriers and facilitators and their associated behavioural components experienced by clinicians, patients living with frailty and their informal carers to improve the safety and effectiveness of the process.

A fragilidade cursa com importante alterações biológicas, dentre as quais destacam-se uma considerável perda de massa, força e função muscular. O consumo de proteínas aliado ao treinamento de força, parece atuar como uma estratégia promissora para atenuar alguns danos morfofuncionais decorrentes do envelhecimento. Portanto, a presente tese tem como objetivo central investigar os efeitos de diferentes fontes de suplementação de proteínas (Soja versus whey) combinadas ao treinamento de força sobre a massa e força muscular em idosos com pré-fragilidade e fragilidade. Esta tese faz parte de um grande ensaio clínico registrado na plataforma clinicaltrial.gov (NCT01890382), intitulado \"Protein Intake and Resistance Training in Aging: The Pro Elderly Study\", com desenho aleatorizado, duplo-cego, controlado por placebo e de grupos paralelos. Os voluntários foram randomicament alocados para compor os três grupos experimentais, placebo (PLA, n = 21), Whey (n = 22) e Soja (n = 22). Todas as análises seguiram o princípio de intenção de tratamento (ITT) através do Mixed Model (SAS) para análises de medidas repetidas e, quando pertinente, post hoc de Tukey para comparações múltiplas. Os resultados demonstraram que a média de ingestão protéica total; PC;; nos grupos whey e soja, respectivamente) não foi capaz de gerar diferenças entre as fontes ou superioridade ao placebo no tocante a massa, força e função muscular dos idosos com pré-fragilidade e fragilidade. Todos os grupos apresentaram aumento na massa magra (+ 0,4 kg), massa apendicular (+ 0,3 kg), ganhos de força muscular nos testes de 1RM no Leg-Press (+ 13 kg) e no supino (+ 5,0 kg), aumento do PT (+ 8,5 N.m) e da TDF geral (+ 60 N.m.;& sup1;), aumento na AST dos músculos reto femoral ( + 0,04 cm²) e vasto lateral (+1,3 cm²), melhora da resistência muscular de membos inferiores (+ 1,1 u.a) e melhora na qualidade de vida, sem ddistinção entre PLA, whey e soja. Portanto, não foram observadas diferenças entre as fontes protéicas em resposta ao TF sobre a massa, força ou função muscular de idosos pré-frágeis e frágeis / Frailty is a geriatric syndrome characterized by progressive biological decline and associated with decreased muscle mass, strength, and functional capacity. Protein consumption in ideal amounts and of high biological value, combined with resistance training, has been shown promising to attenuate age-related damages. Although, the present research aimed to investigate the chronic effects of different sources of protein supplementation (Soy versus whey) combined with resistance training in pre-frail and frail elderly. This thesis is part of a large clinical trial enrolled on the clinicaltrial.gov platform (NCT01890382) entitled Protein Intake and Resistance Training in Aging: \"The Pro Elderly Study\", in a randomized, doubleblind, placebo-controlled and parallel-group design. Experimental design were randomly composed of three groups, placebo (PLA, n = 21), Whey (n = 22) and Soy (n = 22. All analyzes were evaluated in intention to treat procedure throughout Mixed Model (SAS), was used for analysis of repeated measures and, when appropriate, post hoc Tukey for multiple comparisons. The mean total protein intake (1.2 and 1.3 & sup1; in the whey and soy groups, respectively) was not able to induce different responses between protein sources and superiority to placebo in muscle mass, strength and function in pre-frail and frail elderly. All groups increased lean mass (+ 0.4 kg), appendicular mass (+ 0.3 kg), muscle strength gains during 1-RM test in Leg-Press (+ 13 kg) and chest-press (+5,0 kg), increased peak torque (+ 8.5 Nm) and general PTO (+ 60 Nm & sup1;), CSA of rectus femoris (+ 0.04 cm²) and vastus lateralis (+1.3 cm²), timed-stands (+ 1.1 a.u) and improved quality of life for PLA, whey and soy. Therefore, no differences were observed between protein sources in response to ST on muscle mass, strength or function in pre-frail and frail elderly

A fragilidade cursa com importante alterações biológicas, dentre as quais destacam-se uma considerável perda de massa, força e função muscular. O consumo de proteínas aliado ao treinamento de força, parece atuar como uma estratégia promissora para atenuar alguns danos morfofuncionais decorrentes do envelhecimento. Portanto, a presente tese tem como objetivo central investigar os efeitos de diferentes fontes de suplementação de proteínas (Soja versus whey) combinadas ao treinamento de força sobre a massa e força muscular em idosos com pré-fragilidade e fragilidade. Esta tese faz parte de um grande ensaio clínico registrado na plataforma clinicaltrial.gov (NCT01890382), intitulado \"Protein Intake and Resistance Training in Aging: The Pro Elderly Study\", com desenho aleatorizado, duplo-cego, controlado por placebo e de grupos paralelos. Os voluntários foram randomicament alocados para compor os três grupos experimentais, placebo (PLA, n = 21), Whey (n = 22) e Soja (n = 22). Todas as análises seguiram o princípio de intenção de tratamento (ITT) através do Mixed Model (SAS) para análises de medidas repetidas e, quando pertinente, post hoc de Tukey para comparações múltiplas. Os resultados demonstraram que a média de ingestão protéica total; PC;; nos grupos whey e soja, respectivamente) não foi capaz de gerar diferenças entre as fontes ou superioridade ao placebo no tocante a massa, força e função muscular dos idosos com pré-fragilidade e fragilidade. Todos os grupos apresentaram aumento na massa magra (+ 0,4 kg), massa apendicular (+ 0,3 kg), ganhos de força muscular nos testes de 1RM no Leg-Press (+ 13 kg) e no supino (+ 5,0 kg), aumento do PT (+ 8,5 N.m) e da TDF geral (+ 60 N.m.;& sup1;), aumento na AST dos músculos reto femoral ( + 0,04 cm²) e vasto lateral (+1,3 cm²), melhora da resistência muscular de membos inferiores (+ 1,1 u.a) e melhora na qualidade de vida, sem ddistinção entre PLA, whey e soja. Portanto, não foram observadas diferenças entre as fontes protéicas em resposta ao TF sobre a massa, força ou função muscular de idosos pré-frágeis e frágeis / Frailty is a geriatric syndrome characterized by progressive biological decline and associated with decreased muscle mass, strength, and functional capacity. Protein consumption in ideal amounts and of high biological value, combined with resistance training, has been shown promising to attenuate age-related damages. Although, the present research aimed to investigate the chronic effects of different sources of protein supplementation (Soy versus whey) combined with resistance training in pre-frail and frail elderly. This thesis is part of a large clinical trial enrolled on the clinicaltrial.gov platform (NCT01890382) entitled Protein Intake and Resistance Training in Aging: \"The Pro Elderly Study\", in a randomized, doubleblind, placebo-controlled and parallel-group design. Experimental design were randomly composed of three groups, placebo (PLA, n = 21), Whey (n = 22) and Soy (n = 22. All analyzes were evaluated in intention to treat procedure throughout Mixed Model (SAS), was used for analysis of repeated measures and, when appropriate, post hoc Tukey for multiple comparisons. The mean total protein intake (1.2 and 1.3 & sup1; in the whey and soy groups, respectively) was not able to induce different responses between protein sources and superiority to placebo in muscle mass, strength and function in pre-frail and frail elderly. All groups increased lean mass (+ 0.4 kg), appendicular mass (+ 0.3 kg), muscle strength gains during 1-RM test in Leg-Press (+ 13 kg) and chest-press (+5,0 kg), increased peak torque (+ 8.5 Nm) and general PTO (+ 60 Nm & sup1;), CSA of rectus femoris (+ 0.04 cm²) and vastus lateralis (+1.3 cm²), timed-stands (+ 1.1 a.u) and improved quality of life for PLA, whey and soy. Therefore, no differences were observed between protein sources in response to ST on muscle mass, strength or function in pre-frail and frail elderly

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

A síndrome da fragilidade surge no cenário do crescente número de idosos na população mundial, acometendo esses indivíduos, agravando suas condições de vida e saúde. Considerando que essa síndrome é multifatorial e multidimensional, que atinge idosos que vivem em diversas realidades, esta pesquisa buscou verificar a percepção de qualidade de vida de idosos residentes na comunidade e em Instituições de Longa Permanência, diante de sua condição de fragilidade. Por meio de um estudo epidemiológico descritivo do tipo transversal, com abordagem quantitativa, foram entrevistados 136 idosos, sendo metade deles residentes da comunidade, e a outra metade, residentes de Instituições de Longa Permanência para Idosos - ILPIs. Para o cálculo adotou-se nível de significância de 5% e poder do teste de 80% para se demonstrar uma correlação mínima de 0,35 são necessários 68 sujeitos para cada tipo de residência. Utilizou-se a Escala de Fragilidade de Edmonton (EFS) para identificar a presença de fragilidade e os questionários Whoqol Bref e Old para mensurar a percepção de qualidade de vida. Foi observado uma diferença notória entre o número de idosos frágeis moradores da comunidade (16,2%) e os residentes de ILPIs (51,5%), com significância estatística (p<0,001). A percepção de qualidade de vida também é melhor entre os domiciliados nos dois questionários, com destaque para os domínios relações sociais, meio ambiente e morte e morrer. O domínio autonomia apresentou a pior percepção, sobretudo entre os idosos institucionalizados. Entre os idosos frágeis estão as piores percepções de qualidade de vida na maioria dos domínios, para ambos os questionários. Os resultados mostram que a condição de fragilidade piora a qualidade de vida dos idosos e não são apenas os domínios relacionados à saúde física e mental que prejudicam a qualidade de vida. Fatores relacionados à intimidade, autonomia e relações sociais também se mostram associados à piora da percepção de qualidade de vida para as duas realidades, sobretudo para os institucionalizados. Assim, identifica-se que distinguir idosos frágeis de não frágeis é fundamental para a assertiva intervenção de saúde física ou mental. / The fragility syndrome appears in the scenario of the growing number of elderly people in the world population, affecting these individuals, aggravating their living conditions and health. Considering that this syndrome is multifactorial and multidimensional, reaching elderly people living in different realities, this research sought to verify the perception of quality of life of elderly residents in the community and in Long Stay Institutions, given their fragility condition. A descriptive epidemiological study of the transversal type, with a quantitative approach, interviewed 136 elderly people, half of whom were residents of the community; and the other half, residents of Long Stay Institutions for the Elderly (ILPIs). For the calculation, a significance level of 5% and 80% test power were used to demonstrate a minimum correlation of 0.35, 68 subjects were required for each type of residence. The Fragility Scale of Edmonton (EFS) was used to identify the presence of fragility and the Whoqol Bref and Old questionnaires to measure the perception of quality of life. A noticeable difference was observed between the number of fragile elderly in the community (16.2%) and the residents of ILPIs (51.5%), with statistical significance (p <0.001). The perception of quality of life is also better among those domiciled in the two questionnaires, especially in the areas of \"social relations\", \"environment\" and \"death and dying\". The domain \"autonomy\" presented the worst perception, especially among the institutionalized elderly. Among the fragile elderly are the worst perceptions of quality of life in most domains, for both questionnaires. The results show that the fragility condition worsens the quality of life of the elderly and it is not only the domains related to the physical and mental health that impairs the quality of life. Factors related to intimacy, autonomy and social relations are also associated with the deterioration of the perception of quality of life for both realities, especially for the institutionalized ones. Thus, it is identified that distinguishing fragile elderly from non-fragile individuals is fundamental for assertive physical or mental health intervention.