OBJECTIVES: To investigate the effect of an educational program for preventive healthcare professionals in routine primary care on functional ability, nursing home admissions, and mortality in older adults. DESIGN: A prospective, controlled 3-year follow-up study (1999-2001) in primary care with randomization and intervention at the municipality level and outcomes measured at the individual level in two age cohorts. SETTING: Primary care. PARTICIPANTS: Of 81 eligible municipalities in four counties, 34 agreed to participate. A total study population of 5,788 home-dwelling subjects aged 75 and 80 were asked to participate. Written consent was obtained from 4,060 persons (70.1%), of whom 2,104 were living in 17 intervention municipalities and 1,956 were living in 17 matched control municipalities. INTERVENTION: Intervention municipality visitors received ongoing education, and local general practitioners were introduced to a short geriatric assessment program early in the study period. Control municipalities visitors and general practitioners received no education. MEASUREMENTS: At the 3-year follow-up, the outcome measures of mortality and nursing home admissions were obtained from all, and the outcome measure of functional ability was obtained from 3,383 (95.6%) of 3,540 surviving participants. RESULTS: Education improved functional ability (odds ratio=1.20, 95% confidence interval (CI)=1.01-1.42, P=.04) in intervention municipality participants, notably in the 80-year-olds. There were no differences in mortality (relative risk (RR)=1.06, 95% CI=0.87-1.28, P=.59) or rates of nursing home admissions after 3 years (RR=0.74, 95% CI=0.50-1.09, P=.13). Subjects aged 80 benefited from accepting and receiving in-home assessment with regular follow-ups. CONCLUSION: A brief, feasible educational program for primary care professionals helps preserve older people's functional ability.

Activities of Daily Living↗

PubMed2004

[The elderly patient, the accidental fall].

Explore the source record for details and available documents.

Accidental Falls↗

PubMed2004

Structured home visits to older people. Are they only of benefit for women? A randomised controlled trial.

OBJECTIVE: To investigate whether education of primary care professionals improved functional ability in home-dwelling older people, with special focus on gender differences. DESIGN: A prospective controlled three-year follow-up study (1999-2001) with randomisation and intervention at municipality level and outcomes measured at individual level. Intervention municipality visitors received regular education and GPs were introduced to a short assessment programme. Control municipalities received no education but conducted the preventive programme in their own way. SETTING: Primary care, 34 municipalities. SUBJECTS: 5788 home-dwelling 75- and 80-year-olds were invited. 4060 (70.1%) participated: 2104 in 17 intervention- and 1956 in 17 matched control-municipalities. The main outcome measure was obtained from 3383 (95.6%) of 3540 surviving participants. MAIN OUTCOME MEASURE: Functional ability. RESULTS: Municipality intervention in coordination with GPs was associated with better functional ability in women (OR: 1.26; CI95: 1.08-1.47, p=0.004), but not in men (OR: 1.04; CI95: 1.85-1.27). Accepting and receiving free preventive home visits was associated with better functional ability among women (OR: 1.36; CI95: 1.16-1.60, p=0.0002), but not among men (OR: 0.98; CI95: 0.80-1.21). CONCLUSION: A brief, feasible educational intervention for primary care professionals and to accept and receive preventive home visits may have effect in older women, but not in older men.

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PubMed2003

Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities.

BACKGROUND: in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs. OBJECTIVE: to examine whether tiredness in daily activities is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women. DESIGN: a prospective study with 1 1/2-year follow-up. SETTING: 34 communities in four counties in Denmark. SUBJECTS: 1396 older non-disabled adults (74-75 and 80 years old) living in 17 of the participating communities. METHODS: questionnaire surveys at baseline and at 1 1/2-year follow-up. Tiredness in daily activities was measured by questions about tiredness in six mobility activities. Onset of mobility disability was measured as onset of need for help in one to six mobility activities. RESULTS: men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up, when adjusted by the covariates. In addition, low social participation, poor psychological function, and physical inactivity were independent risk factors of onset of mobility disability among men, and home help, low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women. CONCLUSION: older people who complain about tiredness are at higher risk of becoming disabled than others. This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective.

Activities of Daily Living↗

PubMed2002

[Effect of physical exercise on bone mass in the elderly].

Reduced physical activity or immobilisation have several negative effects on the skeleton. Significant reductions in bone mass have been observed after prolonged bed rest, in patients with injury to the spinal cord and hemiplegia, and after transitory immobilisation of the extremities, for instance after fractures. The aim of this literature review was to evaluate the effect of exercise on bone mass in elderly people and to determine whether exercise programmes could be appropriate in the prevention of fractures in this segment of the population. We identified four randomised and two non-randomised, prospective studies for the analysis of the effect of exercise on bone mass. Four studies reported a statistically significant difference in the intervention group, as compared to the control group, whereas two studies failed to find any significant differences in bone mass. We conclude that exercise has a beneficial and measurable effect on bone mass in the elderly, which may lead to a decline in the rate of fractures.

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PubMed2002

Preventive home visits to older people in Denmark: methodology of a randomized controlled study.

BACKGROUND AND AIMS: Preventive home visits were introduced by legislation in Denmark in 1998. This ongoing randomized controlled intervention study introduces a model where preventive home visits to elderly people are carried out in a standardized way, focusing on early signs of disability and on physical activity. The study includes general practitioners (GPs) in relevant parts of the assessment and endeavors coordinated interdisciplinary follow-up. Our main aim was to investigate whether this model gives enhanced active life expectancy, but the focus of the present paper is the design of the study. METHODS: The design was a prospective, controlled, follow-up study conducted over a 3-year period (1999-2001) with randomization and intervention at the community level, and outcomes measured at an individual level among people living in those communities. The study included 17 pairs of intervention and control communities (34 in total), including 2104 persons aged 75-80 years in the intervention communities (participation rate, 70.8%) and 1956 persons in the control communities (p.r. 70.3%). The main outcome measure is change in functional ability after 1.5 and 3 years. Other outcomes are mortality, and hospital and nursing home admissions. Intervention communities received systematic education and written materials; two key representatives from each community also attended bi-annual follow-up meetings. Control communities did not receive any intervention but were allowed to conduct a preventive program completely on their own. RESULTS: Baseline characteristics were similar in the intervention and control communities with regard to size, rural and urban characteristics and geriatric services, and the individual characteristics of participating persons living in these communities were also comparable. The intervention was well accepted and feasible. CONCLUSIONS: When results become available, the study should reveal the most important factors for preventive home visits to elderly people.

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PubMed2002

Primary health care and geriatric medicine in Denmark.

In Denmark with its population of 5.1 million, 15% of inhabitants are people aged over 65 and--just like in other European countries--the percentage of elderly people has increased in the recent years. A model of geriatric care in Denmark was presented in this study. The Danish health care system has been briefly described in respect of the care for the elderly. Life conditions of the elderly people in Denmark as well as social and health care services provided for them were discussed.

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