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Th Nikolaus

Publications and source records attributed to Th Nikolaus.

14 recordsLinked to original sources
PubMed2006

A follow-up study on fall and fracture incidence in long-term care including the role of formal caregiver time on fall incidence rates.

OBJECTIVE: To examine the impact of a fall prevention programme over a 12 month follow-up period after the introduction of a RCT and to describe possible differences between incidence density rate of falls associated with caregiver time during weekends and ordinary working days. DESIGN: Prospective observational study, duration 12 months. SETTING: Six community nursing homes, Germany. PARTICIPANTS: Long-stay residents (n=881); 771 resident years; median age 85.0 years (min 60; max 101); 79.1% female. MEASUREMENTS: Incidence density rate of falls and fractures, staff time per resident. RESULTS: The incidence density rate over all days was 1367/1000 resident years (RY) for falls [95% confidence interval 1041;1693]. The incidence density rate of hip fractures was 29/1000 RY [95% confidence interval 12;45] and 29/1000 RY [95% confidence interval 12;45] for non-hip fractures. The incidence density rate showed similar results comparing weekends/ public holidays vs normal working days; falls 1193 vs 1447/ 1000 RY; hip fractures 25 vs 30/ 1000 RY and other fractures 16 vs 34/1000 RY. CONCLUSION: During the period, we observed a marked decline of the fracture rate compared with the controlled phase of the intervention trial. A lower number of nursing care hours on weekends was not associated with a higher incidence density rate for falls, fallers, or any type of fracture.

Accidental Falls↗
PubMed2005

Factors relating to the use of physical restraints in psychogeriatric care: a paradigm for elder abuse.

The purpose of this study was to address one component of the complex topic "elder abuse". A prospective observational study in the psychogeriatric unit of an acute psychiatric hospital demonstrated that 30% (n=37) of all included patients (n=122) were physically restrained. The highest incidence (48%) was found in elderly patients with severe cognitive impairments (diagnosis of dementia and/or delirium) (n=60). The most commonly used devices of physical restraints were bed rails (100%), belts (trunk 93%, limbs 40%) and chair-tables ("gerichair") (41%). Most restraints occurred at the beginning of hospitalization (83%). Physical restraints were continued for many days and on average of many hours a day. Patients with low cognitive status and serious mobility impairments showed a very high risk of being restrained (p=0.015; OR 32.0 [95% CI:2.0-515.1]). Inability to perform ADL activities increased the frequency of restraint use (p=0.035; OR27.7 [95%CI: 1.3-604.1]). As possible co-factors repetitive disruptive behaviors were found. There was no significant difference between the frequency of falls in restrained or unrestrained patients during the observational period, but fall-related fractures (n=2) only occurred in restrained patients. It is possible that restraints increase the use of benzodiazepines and classical neuroleptics. These results confirm that physical restraints remain a common practice in psychogeriatric care. No evidence-based data support the value of restraints in regard to fall prevention and control of behavioral disturbances in elderly people with serious mental illness. In contrast, these devices can have serious adverse effects and mean one of the most severe interventions in fundamental human rights.

Accidental Falls↗
PubMed2005

[Effectiveness of a multifactorial intervention to reduce physical restraints in nursing home residents with dementia].

At present, observational studies and expert opinion are the best evidence for the use of physical restraints. Large regional and national disparities are described in acute and long-term care. Epidemiological data demonstrate a prevalence of 3-5% body-fixed or near body restraint devices. The hip fracture rate in Germany are approximately 50 per 1000 resident years. Between 40-50% of the residents in nursing homes are treated with psycho-tropic medication potentially limiting their physical mobility. The presented study protocol was designed to test the effectiveness of a multifactorial intervention to reduce physical restraints in long-term care (LTC) residents particularly with cognitive impairment. The intervention consists of an educational and an organizational part to empower staff members to improve their skills and practice in using restraints. Technical devices to reduce fall related injuries are additionally offered to the LTC facilities. The study population includes 200 LTC residents in 54 facilities in three states in Germany. The sample size calculation was based upon a 5% prevalence rate in the control group and an expected reduction of 50% in the intervention group. The protocol is a waiting-list control design. All waiting facilities will be offered to participate after their waiting period. Primary endpoints are the number of restrained residents and resident time (hours) of being restrained. The use of psychotropics, falls, fall-related injuries and the incidence of residents newly being restrained is being monitored. The study starts with a baseline documentation of all facilities followed by randomization and a three month intervention. Change agents will be responsible for the intervention. Technical devices will include a newly developed soft hip protector and sensor mats which notice the intent of leaving the bed. The aim of the study is to develop an evidence-based model for a knowledge transfer project to implement minimum restraint environments in LTC.

Accidental Falls↗
PubMed2005

[European Academy for Medicine of Ageing (EAMA)].

The European Academy for Medicine of Ageing was founded in 1995 by a nucleus group of European professors: Duursma (Utrecht, NL), Evans (Oxford, GB), Michel (Geneve, CH) and Stähelin (Basel, CH). The aim was to get an adequate postgraduate training under the auspices of an international faculty. A whole curriculum consists of four one-week sessions over a period of two years. In each session student's state of the art lectures, group discussions followed by plenary presentations, as well as the lectures of members of the Executive Board and invited experts are scored and analyzed. Meanwhile EAMA is in its sixth session. The evaluation (comparison of first with last part) shows its great success with an overall improvement of 32%, content of take home messages (28%), scientific lectures (31%) and techniques of presentation (37%). The EAMA has achieved one of its major goals to attract young geriatricians not only from Europe but also from North and Latin America, Africa and Near East. Several networking groups have been established on special fields of interest (e. g. falls, dementia, diabetes mellitus). A recently performed survey showed that about two thirds of the former students have meanwhile taken over a leading (academic) position in geriatrics in their countries.

Academies and Institutes↗
PubMed2005

[Pain assessment and pain treatment in the geriatric patient. Part II: pain treatment].

A primary goal of pain treatment in geriatric patients consists of maintaining physical and mental function, which is a precondition of activity and participation. In patients with chronic pain, multidisciplinary treatment without excluding invasive procedures is the most effective approach. The medication ladder, suggested by the WHO initially for cancer pain, provides a guideline for pharmacological treatment. Due to age-dependent alterations in the kinetics and dynamics of pharmaceuticals, the titration of the medication follows the rule "start low and go slow." The same principle holds true for the maintenance or augmentation of physical activity in order to escape from the activity-deconditioning cycle. The training should be based on learning theories, include pain management strategies, and incorporate psychological approaches to facilitate the active participation of the patient in the treatment program. In hospitals and nursing homes, nurses play an important role in defining the need for pain treatment and in supervising the patient in the treatment process. Despite all these endeavors, a significant number of patients remains whose pain cannot be controlled sufficiently. Euthanasia on demand of the patient with untreatable pain is not admitted in Germany.

Aged↗
PubMed2004

[Influence of pain perception, morbidity and mood on functional impairment in elderly chronic pain patients].

The purpose of the study was to address the impact of pain perception, morbidity and mood on functional impairment in elderly chronic pain patients. Multimorbid pain patients beyond the age of 65 in two geriatric hospitals (n = 84), a pain clinic (n = 60) and three general practices (n = 117) provided information about pain perception, comorbidity, additional symptoms and mood by means of the "Structured Pain Interview for Geriatric Patients", the "Cumulative Illness Rating Scale" and a list of symptoms. Data analysis relied on stepwise multiple regression with variables of pain perception entered in the first step, of morbidity entered in the second step and of mood entered in the third step. Although patients believe that pain is the main reason for their functional impairment (71.3%), the data do not support this assumption. Increasing morbidity and bad mood have more impact to reduced functional performance than the pain perception. Our results support the recommendation that a multimodal program should be offered to even multimorbid and older people with chronic pain in order to achieve a maximum of functional rehabilitation.

Activities of Daily Living↗
PubMed2003

Risk indicators for falls in institutionalized frail elderly.

The aim of this study was to identify individual predisposing risk indicators for falls in a sample of institutionalized frail elderly in southern Germany. The design was a prospective observational study with a 1-year follow-up (October 1998-September 1999). The study population included 472 long-term-care residents whose mean age was 84 years; 77% were female. Risk indicators for accidental falls were analyzed by using logistic regression. Residents were found to have an incidence density rate of falls of 2,558 per 1,000 resident-years. Multiple logistic regression analysis revealed short-term memory loss, transfer assistance, urinary incontinence, positive fall history, and use of trunk restraints as predictors of falls. In a further logistic regression analysis, depressive symptoms, transfer assistance, urinary incontinence, and positive fall history were associated with frequent falls. Using these risk indicators as a screening procedure to identify fallers would be easy to administer and could be accomplished by nursing staff. Study results encourage specifically addressing urinary incontinence, cognitive impairment, use of restraints, depression, and transfer difficulties as modifiable predisposing risk factors for falls. Fall history represents an important nonmodifiable marker to identify residents at high risk.

Accidental Falls↗
PubMed2003

Elevated heels and adaptation to new shoes in frail elderly women.

Footwear is supposed to have influence on postural control and is a potential aspect to address in the prevention of falls in the elderly. This study aimed to show whether measurements of static balance and gait are different with habitual shoes compared to new special senior shoes with different heel height and whether these results change after adaptation. In a randomized controlled intervention study, 26 subjects (median age 87 years) were recruited from two nursing homes and one facility of assisted living. Measurements of static balance and gait were performed with habitual shoes and two types of new special senior shoes differing in heel height. Measurements were repeated after five weeks. There was no difference in static balance and gait with habitual shoes compared to either of the new footwear offered. Results of performance with higher heels were not different compared to lower heels. No further effect of adaptation after wearing a new shoe over five weeks could be demonstrated. With respect to static and dynamic balance, there seems to be a wide range of acceptable footwear as long as the heel height is below a critical value. A standardized shoe can be used in the assessment of balance because the effect of adaptation can be neglected.

Accidental Falls↗
PubMed2003

[Comorbidity, multiple medication, and well-being in elderly patients with chronic pain].

Consecutive patients with a minimum age of 65 years and at least one additional diagnosis participated in a standardized interview during the initial assessments in two geriatric hospitals ( n=86), a multidisciplinary pain center ( n=60), and three primary care practices ( n=117). The average age of the total sample was 76.29 years (SD=7.40); females constituted 73.3% of the sample. The average number of drugs consumed by the patients amounted to 7.31 (SD=2.66) with a maximum number of 19 drugs. Nearly three-quarters of the patients indicated a reduction in their pain by avoiding physical activity. Every second patient often felt depressed and without energy. The most frequent symptoms were a dry mouth, sleep disorders, fatigue, constipation, and dizziness. Patients from the geriatric hospitals were older and better educated, reported fewer painful body regions, indicated lower intensity and duration of pain as well as a lower number of pain medications. On the other hand, they were characterized by a higher intensity of comorbidity and by increased functional impairment. Patients from the pain clinic suffered more frequently from pain in the hip and the pelvis. They took stage I analgesics more often and admitted more frequently to adjusting the drug consumption to changes in well-being and situational factors. They felt the highest amount of impairment in their social activities. Nevertheless, they expressed the highest confidence in future improvement.

Aged↗