Publications by authors named "Anette Hylen Ranhoff"

91 Publications

Management of Older Outpatients during the COVID-19 Pandemic: The GeroCovid Ambulatory Study.

Gerontology 2021 Jun 28:1-6. Epub 2021 Jun 28.

Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy.

Objectives: The GeroCovid Study is a multi-setting, multinational, and multi-scope registry that includes the GeroCovid home and outpatients' care cohort. The present study aims to evaluate whether outpatient and home care services with remote monitoring and consultation could mitigate the impact of the COVID-19 pandemic on mental and affective status, perceived well-being, and personal capabilities of outpatients and home care patients with cognitive disorders.

Methods: Prospectively recorded patients in an electronic web registry provided by BlueCompanion Ltd. Up to October 31, 2020, the sample included 90 patients receiving regular care from the Center for Cognitive Disorders and Dementia in Catanzaro Lido, Italy. It was made of 52 ambulatory outpatients and 38 home care patients, mean age 83.3 ± 7.54 years. Participants underwent a multidimensional assessment at baseline (T0) and after 90 days (T1). For each patient, we administered the Mini-Mental State Examination (MMSE) for cognitive functions, the Activities of Daily Living (ADL) and Instrumental ADL (IADL) scales for functional capabilities, the Cumulative Illness Rating Scale (CIRS) for comorbidities and their impact on patients' health, the 5-items Geriatric Depression Scale (GDS) for mood, and the Euro Quality of Life (EuroQoL) for perceived quality of life. Contacts with both ambulatory and home care patients were managed in person or via telephone, preferably through video calls (WhatsApp or FaceTime).

Results: Contacts with patients were kept at T0 through telephone. At T1, visits were made in person for over 95% out of the cases. The ADL, IADL, CIRS, GDS, MMSE, and EuroQoL changed slightly between T0 and T1. Most of the patients were clinically stable over time on the majority of the scales explored, but behavioral changes were found in 24.4% of patients and anxiety and insomnia in 17.7% of patients.

Conclusion: Our study suggests that contacts through telephone and video consultations are likely associated with a health status preservation of the patients.
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http://dx.doi.org/10.1159/000516969DOI Listing
June 2021

Refeeding syndrome occurs among older adults regardless of refeeding rates: A systematic review.

Nutr Res 2021 Jul 21;91:1-12. Epub 2021 May 21.

Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo 0130, Norway; Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo 0424, Norway. Electronic address:

Refeeding syndrome is a life-threatening clinical disorder that can occur when treating malnutrition. The aim was to examine the current knowledge of refeeding syndrome in patients ≥ 65 + years with special focus on the incidence of hypophosphatemia (HP) in relation to refeeding rate (kcal/kg/day), number of days until the lowest level of phosphate occurs (day of nadir), refeeding rates and adverse events, and death. Specifically, we hypothesized that higher energy provision would cause a higher incidence of HP. A search was conducted in the available databases. Two cohort studies, 1 case control, and a total of 12 case series/case reports, which accounted for 19 individual patient cases, were eligible. The incidence of HP (<0.5 mmol/L) was 15% and 25% in the 2 cohort studies and 4% in the case control study. The mean day of nadir was between days 2 and 3 in the cohort studies, day 11 in the case control study, and day 3 in the cases series/case reports. Importantly, a rapid drop in phosphate occurred receiving both 30 kcal/kg/day and 8 to 10 kcal/kg/day. The cohort studies reported high death rates-26% and 23%-using both 10 and 20 kcal/kg/day, respectively. Adverse events were noted in most all case series/case reports. Clinicians should be aware that HP may occur in up to 25% of older hospitalized adults, and importantly, it occurs even when refeeding cautiously. Hence, electrolytes should be closely monitored, especially between days 2 and 4, which is when the day of nadir occurs most frequently.
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http://dx.doi.org/10.1016/j.nutres.2021.05.004DOI Listing
July 2021

Associations between health-related quality of life and physical function in older adults with or at risk of mobility disability after discharge from the hospital.

Eur Geriatr Med 2021 Jun 9. Epub 2021 Jun 9.

Institute of Physiotherapy, OsloMet-Oslo Metropolitan University (OsloMet), St. Olavs Plass, PO Box 4, 0130, Oslo, Norway.

Purpose: To optimise the treatment for older adults after hospitalisation, thorough health status information is needed. Therefore, we aimed to investigate the associations between health-related quality of life (HRQOL) and physical function in older adults with or at risk of mobility disability after hospital discharge.

Methods: This cross-sectional study recruited 89 home-dwelling older people while inpatients within medical wards at a general hospital in Oslo, Norway. HRQOL [the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36)] and physical function [the Short Physical Performance Battery (SPPB)] were measured a median of 49 [interquartile range (IQR) 26-116] days after discharge. Simple linear regression analyses were conducted, and multivariable regression models were fitted.

Results: The mean age of the patients was 78.3 years; 43 (48.9 %) were females. Multivariable regressions showed positive associations between SPPB and the physical subscales {physical functioning [B (95% CI) 4.51 (2.35-6.68)], role physical [B (95% CI) 5.21 (2.75-7.67)], bodily pain [B (95% CI) 3.40 (0.73-6.10)] and general health [B (95% CI) 3.12 (1.13-5.12)]}. Univariable regressions showed no significant associations between SPPB and the mental subscales {vitality [B (95% CI) 1.54 (- 0.10-3.18)], social functioning [B (95% CI) 2.34 (- 0.28-4.96)], role emotional [B (95% CI) 1.28 (- 0.96-3.52)] and mental health [B (95% CI) 1.00 (- 0.37-2.36)]}.

Conclusion: The results reinforce that physical function and physical HRQOL are strongly linked, and interventions improving physical function might improve physical HRQOL. However, this hypothesis would have to be tested in a randomised controlled trial.

Trial Registration: ClinicalTrials.gov. Registered 19 September 2016 (NCT02905383).
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http://dx.doi.org/10.1007/s41999-021-00525-0DOI Listing
June 2021

A comparison of two different refeeding protocols and its effect on hand grip strength and refeeding syndrome: a randomized controlled clinical trial.

Eur Geriatr Med 2021 Jun 4. Epub 2021 Jun 4.

Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

Purpose: Optimal refeeding protocols in older malnourished hospital patients remain unclear. We aimed to compare the effect of two different refeeding protocols; an assertive and a cautious protocol, on HGS, mortality and refeeding syndrome (RFS), in patients ≥ 65 years METHODS: Patients admitted under medical or surgical category and at risk of RFS, were randomized to either an enteral nutrition (EN) refeeding protocol of 20 kcal/kg/day, reaching energy goals within 3 days (intervention group), or a protocol of 10 kcal/kg/day, reaching goals within 7 days (control group). Primary outcome was the difference in hand grip strength (HGS) at 3 months follow-up, in an intention to treat analysis. RFS (phosphate < 0.65 mmol/L) during the hospital stay and mortality rates at 3 months were secondary outcomes.

Results: A total of 85 patients were enrolled, with mean (SD) age of 79.8(7.4) and 54.1% female, 41 in the intervention group and 44 in the control group. HGS was similar at 3 months with mean change of 0.42 kg (95% CI - 2.52 to 3.36, p = 0.78). Serum phosphate < 0.65 mmol/L was seen in 17.1% in the intervention group and 9.3% in the control group, p = 0.29. There was no difference in mortality rates (39% vs 34.1%, p = 0.64). An indication of more respiratory distress was found in the intervention group, 53.6% vs 30.2%, p = 0.029.

Conclusion: A more assertive refeeding protocol providing 20 kcal/kg/day did not result in improved HGS measured 3 months after discharge compared with a cautious refeeding (10 kcal/kg/day) protocol. No difference in incidence of mortality or RFS was found.

Trial Registration: ClinicalTrials.gov Protocol Record 2017/FO148295, Registered: 21st of February, 2017.
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http://dx.doi.org/10.1007/s41999-021-00520-5DOI Listing
June 2021

Nursing home deaths after COVID-19 vaccination.

Tidsskr Nor Laegeforen 2021 05 19;141. Epub 2021 May 19.

Background: In the period 27 December 2020 to 15 February 2021, about 29 400 of Norway's roughly 35 000 nursing home patients were vaccinated with the mRNA vaccine BNT162b2. During the same period, the Norwegian Medicines Agency received 100 reports of suspected fatal adverse reactions to the vaccine. An expert group has examined the reports and assessed the extent of a causal link between vaccination and death.

Material And Method: The expert group worked in two pairs, each of which examined 50 anonymised reports. Each member first examined the reports alone and classified the causality as unlikely, possible, probable, certain or unclassifiable. Each pair then discussed their results until they reached a consensus. All four experts assessed a random sample of 20 reports. The degree of agreement was assessed using weighted kappa and McNemar's test of symmetry.

Results: The mean age of the patients was 87.7 years (range 61-103 years). Among 100 reported deaths, a causal link to the vaccine was considered probable in 10 cases, possible in 26 and unlikely in 59. Five were unclassifiable. Weighted kappa was 0.40 and 0.38 in the two expert pairs, respectively.

Interpretation: Most nursing home patients have a short remaining life expectancy, but vaccination may, in a few cases, have accelerated a process of dying that had already begun. Nursing home patients should still be given priority for vaccination, but the benefits versus risk must be carefully weighed up for the frailest patients.
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http://dx.doi.org/10.4045/tidsskr.21.0383DOI Listing
May 2021

The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity.

Eur Geriatr Med 2021 Apr 4. Epub 2021 Apr 4.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim, Norway.

Purpose: Delirium is common and associated with poor outcomes, partly due to underdetection. We investigated if the delirium screening tool 4 A's test (4AT) score predicts 1 year mortality and explored the sensitivity and specificity of the 4AT when applied as part of a clinical routine.

Methods: Secondary analyses of a prospective study of 228 patients acutely admitted to a Medical Geriatric Ward. Physicians without formal training conducted the index test (the 4AT); a predefined cut-off ≥ 4 suggested delirium. Reference standard was delirium diagnosed by two geriatricians using the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). We calculated hazard ratios (HR) using Cox regression based on the groups 4AT = 0, 1-3, 4-7 and ≥ 8, first unadjusted, then adjusted for the covariates age, comorbidity, and personal activities of daily living. We calculated sensitivity, specificity, and the area under the receiver operating curve (AUC).

Results: Mean age of patients was 86.6 years, 139 (61.0%) were female, 78 (34.2%) had DSM-5 delirium; of these, 56 had 4AT-delirium. 1 year mortality was 27.6% (63 patients). Compared to 4AT score 0, the group 4AT ≥ 8 had increased 1 year mortality (HR 2.86, 95% confidence interval 1.28-6.37, p = 0.010). The effect was reduced in multiadjusted analyses (HR 1.69, 95% confidence interval 0.70-4.07, p = 0.24). Sensitivity, specificity, and AUC were 0.72, 0.84, and 0.88, respectively.

Conclusions: 4AT ≥ 8 indicates increased mortality, but the effect was reduced in multiadjusted analyses. 4AT had acceptable sensitivity and specificity when applied as a clinical routine.
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http://dx.doi.org/10.1007/s41999-021-00489-1DOI Listing
April 2021

Assessing the impact of COVID-19 on the health of geriatric patients: The European GeroCovid Observational Study.

Eur J Intern Med 2021 05 31;87:29-35. Epub 2021 Jan 31.

Geriatrics Unit, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy.

Background: Despite the growing evidence on COVID-19, there are still many gaps in the understanding of this disease, especially in individuals in advanced age. We describe the study protocol of GeroCovid Observational, a multi-purpose, multi-setting and multicenter initiative that aims at investigating: risk factors, clinical presentation and outcomes of individuals affected by COVID-19 in acute and residential care settings; best strategies to prevent infection in long-term care facilities; and, impact of the pandemic on neuropsychologic, functional and physical health, and on medical management in outpatients and home care patients at risk of COVID-19, with a special focus on individuals with dementia.

Methods: GeroCovid involves individuals aged ≥60 years, at risk of or affected by COVID-19, prospectively or retrospectively observed since March 1, 2020. Data are collected in multiple investigational sites across Italy, Spain and Norway, and recorded in a de-identified clinical e-Registry. A common framework was adapted to different care settings: acute wards, long-term care facilities, geriatric outpatient and home care, and outpatient memory clinics.

Results: At September 16, 2020, 66 investigational sites obtained their Ethical Committee approval and 1618 cases (mean age 80.6 [SD=9.0] years; 45% men) have been recorded in the e-Registry. The average inclusion rate since the study start on April 25, 2020, is 11.2 patients/day. New cases enrollment will ended on December 31 , 2020, and the clinical follow-up will end on June 30, 2021.

Conclusion: GeroCovid will explore relevant aspects of COVID-19 in adults aged ≥60 years with high-quality and comprehensive data, which will help to optimize COVID-19 prevention and management, with practical implications for ongoing and possible future pandemics.

Trial Registration: NCT04379440 (clinicaltrial.gov).
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http://dx.doi.org/10.1016/j.ejim.2021.01.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847394PMC
May 2021

Octogenarian patients' sleep and delirium experiences in hospital and four years after aortic valve replacement: a qualitative interview study.

BMJ Open 2021 01 7;11(1):e039959. Epub 2021 Jan 7.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

Objectives: Sleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients' long-term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.

Design: An explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.

Setting: Patients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.

Participants: Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.

Results: For the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; . Whereas three subthemes described the patients' experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep and . Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.

Conclusions: For octogenarian patients, sleep disturbances and delirium are long-term burdens and need a greater attention in order to improve patient care.
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http://dx.doi.org/10.1136/bmjopen-2020-039959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797265PMC
January 2021

Effects of a multicomponent high intensity exercise program on physical function and health-related quality of life in older adults with or at risk of mobility disability after discharge from hospital: a randomised controlled trial.

BMC Geriatr 2020 11 11;20(1):464. Epub 2020 Nov 11.

Institute of Physiotherapy, OsloMet - Oslo Metropolitan University (OsloMet), PO Box 4, St. Olavs Plass, 0130, Oslo, Norway.

Background: Many older people suffer from mobility limitations and reduced health-related quality of life (HRQOL) after discharge from hospital. A consensus regarding the most effective exercise-program to optimize physical function and HRQOL after discharge is lacking. This study investigates the effects of a group-based multicomponent high intensity exercise program on physical function and HRQOL in older adults with or at risk of mobility disability after discharge from hospital.

Methods: This single blinded parallel group randomised controlled trial recruited eighty-nine home dwelling older people (65-89 years) while inpatient at medical wards at a general hospital in Oslo, Norway. Baseline testing was conducted median 49 (25 percentile, 75 percentile) (26, 116) days after discharge, before randomisation to an intervention group or a control group. The intervention group performed a group-based exercise program led by a physiotherapist twice a week for 4 months. Both groups were instructed in a home-based exercise program and were encouraged to exercise according to World Health Organisation's recommendations for physical activity in older people. The primary outcome, physical performance, was measured by the Short Physical Performance Battery (SPPB). Secondary outcomes were 6-min walk test (6MWT), Berg Balance Scale (BBS), grip strength, Body Mass Index (BMI), and HRQOL (the Short-Form 36 Health Survey (SF-36)). Data were analysed according to the intention-to-treat principle. Between-group differences were assessed using independent samples t-test.

Results: The groups were comparable at baseline. Intention-to-treat analysis showed that the intervention group improved their functional capacity (6MWT) and the physical component summary of SF-36 significantly compared to the control group. No further between group differences in change from baseline to 4 months follow-up were found.

Conclusions: A high intensity multicomponent exercise program significantly improved functional capacity and physical HRQOL in older adults with or at risk of mobility disability after discharge from hospital. The study suggests that this population can benefit from systematic group exercise after hospital-initial rehabilitation has ended.

Trial Registration: ClinicalTrials.gov . NCT02905383 . September 19, 2016.
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http://dx.doi.org/10.1186/s12877-020-01829-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656746PMC
November 2020

Orthogeriatrics: much more action is needed.

Eur Geriatr Med 2020 08;11(4):517-518

University of Bergen, Bergen, Norway.

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http://dx.doi.org/10.1007/s41999-020-00375-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416800PMC
August 2020

Weight changes and mobility in the early phase after hip fracture in community-dwelling older persons.

Eur Geriatr Med 2020 08 16;11(4):545-553. Epub 2020 Jun 16.

Department of Clinical Science, University of Bergen, Bergen, Norway.

Purpose: Hip fractures in older persons are associated with reduced mobility and loss of independence. Few studies address the nutritional status and mobility in the early phase after hip fracture. The objective of the present study was, therefore, to investigate weight changes and their effect on mobility during the first two months following hip fracture in community-dwelling older persons without dementia.

Methods: Patients (> 60 years) admitted for a first hip fracture were recruited from two tertiary referral hospitals in Bergen, Norway. The patients' weights and dietary intakes were determined in the hospital and at home after two months. Mobility was assessed based on the New Mobility Score (NMS) (scale 0-9, with values > 5 regarded as sufficient mobility).

Results: We included 64 patients (median age 80 years, 48 women, 16 men) with information on weight collected in the hospital. Follow-up measurements were available for 32 patients, corresponding to an attrition rate of 50%. The patients had a median weight loss of 1.8 kg (IQR = - 3.7, 0 kg). Most of them had reduced mobility at two months after the surgery [median NMS = 5 (IQR = 3-6)]. Both age and the weight change after surgery were predictors of the NMS at follow-up.

Conclusion: Bodyweight loss was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. The results should be interpreted with caution as half of the patients dropped out of the study and did not participate in the follow-up visit.
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http://dx.doi.org/10.1007/s41999-020-00342-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438288PMC
August 2020

Acutely ill older people in the corona era.

Tidsskr Nor Laegeforen 2020 04 25;140(6). Epub 2020 Mar 25.

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http://dx.doi.org/10.4045/tidsskr.20.0227DOI Listing
April 2020

No association between subnormal serum vitamin B12 and anemia in older nursing home patients.

Eur Geriatr Med 2020 04 28;11(2):247-254. Epub 2019 Nov 28.

Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway.

Purpose: Since evidence of an association between vitamin B12 (B12) deficiency and anemia in older people is limited and inconclusive, we wanted to investigate this association in old, frail nursing home patients.

Methods: The study includes patients admitted to short-term, post-acute care (n = 765) and residents in long-term care (LTC) (n = 1665), in the municipality of Bergen. Anemia was defined according to the WHO criteria: Hb < 13 g/dL in men and < 12 g/dL in women, and as Hb < 11 g/dL, in both sex (moderate/severe anemia). The presence of anemia was analyzed in patients with subnormal (< 250 pmol/L), normal (250-650 pmol/L) and high (> 650 pmol/L) B12, and the association between anemia and clinical parameters, and including B12, was analyzed using logistic regression models. The use of B12 supplementation was investigated in the LTC patients.

Results: Mean age of the 2430 patients was 86 ± 7 years. WHO-defined anemia was seen in 1023 (42%), and moderate/severe anemia in 384 (16%) of the patients. In multiple logistic regression analyses, we found no statistically significant associations of subnormal B12 with WHO-defined anemia or moderate/severe anemia. Renal insufficiency, iron deficiency and CRP > 10 mg/L were significantly associated with both types of anemia, (p < 0.001). Among the LTC residents, 405 (24%) received B12 supplements, 112 (7%) of them had elevated B12 > 650 pmol/L.

Conclusion: In older nursing home patients, no association was observed between subnormal B12 and anemia. Older patients in Western societies with mild/moderate anemia should not be treated with B12 supplements without further investigation.
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http://dx.doi.org/10.1007/s41999-019-00269-yDOI Listing
April 2020

Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study.

Aging Clin Exp Res 2021 Feb 19;33(2):345-352. Epub 2020 Mar 19.

Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.

Aims: The objective of this study was to examine baseline frailty status (including cognitive deficits) and important clinical outcomes, to inform shared decision-making in older adults receiving transcatheter aortic valve implantation (TAVI).

Methods And Results: We conducted a prospective, observational study of 82 TAVI patients, recruited 2013 to 2015, with 2-year follow-up. Mean age was 83 years (standard deviation (SD) 4.7). Eighteen percent of the patients were frail, as assessed with an 8-item frailty scale. Fifteen patients (18%) had a Mini-Mental Status Examination (MMSE) score below 24 points at baseline, indicating cognitive impairment or dementia and five patients had an MMSE below 20 points. Mean New York Heart Association (NYHA) class at baseline and 6 months was 2.5 (SD 0.6) and 1.4 (SD 0.6), (p < 0.001). There was no change in mean Nottingham Extended Activities of Daily Living (NEADL) scale between baseline and 6 months, 54.2 (SD 11.5) and 54.5 (SD 10.3) points, respectively, mean difference 0.3 (p = 0.7). At 2 years, six patients (7%) had died, four (5%, n = 79) lived in a nursing home, four (5%) suffered from disabling stroke, and six (7%) contracted infective endocarditis.

Conclusions: TAVI patients had improvement in symptoms and maintenance of activity of daily living at 6 months. They had low mortality and most patients lived in their own home 2 years after TAVI. Complications like death, stroke, and endocarditis occurred. Some patients had cognitive impairment before the procedure which might influence decision-making. Our findings may be used to develop pre-TAVI decision aids.
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http://dx.doi.org/10.1007/s40520-020-01525-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914240PMC
February 2021

Electrolyte outpatient clinic at a local hospital - experience from diagnostics, treatment and follow-up.

BMC Health Serv Res 2020 Feb 28;20(1):154. Epub 2020 Feb 28.

Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.

Background: Electrolyte imbalances (EI) are common among patients. Many patients have repeated hospitalizations with the same EI without being investigated and treated. We established an electrolyte outpatient clinic (EOC) to diagnose and treat patients with EI to improve symptoms and increase their quality of life (QoL). In addition, we also wanted to reduce the number of admissions with the same EI.

Methods: Uncontrolled before-after study reporting experiences from this outpatient clinic as a quality assurance project. From October 2010 to October 2015, doctors at our local hospital and general practitioners could refer adult patients with EI to the EOC. Ninety patients with EI were referred, of whom 60 were included. Medical history, clinical examination and laboratory tests were performed, and results registered. Admissions with the same EI were recorded 1 year before and 1 year after consultation at the EOC. Patients responded to a questionnaire, composed by the authors, about symptoms before the first consultation, as well as symptom and QoL improvement after the last consultation.

Results: Hyponatremia was the reason for referral in 45/60 patients. The total number of admissions with the same EI 1 year before the first consultation was 71, compared with 20 admissions 1 year after the last consultation. Improvement of symptoms was reported by 60% of patients, and 62% reported improvement in QoL.

Conclusions: An EOC may be an appropriate way to organize the assessment and treatment of patients with EI.
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http://dx.doi.org/10.1186/s12913-020-5022-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048094PMC
February 2020

European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty-a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS).

Aging Clin Exp Res 2020 Apr 22;32(4):561-570. Epub 2020 Jan 22.

Hospital Universitario de Getafe, Getafe, Spain.

Background: Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level.

Aim: This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management.

Methods: Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development.

Results: The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning.

Discussion: This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems.

Conclusions: The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.
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http://dx.doi.org/10.1007/s40520-019-01455-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170812PMC
April 2020

Cognitive impairment influences the risk of reoperation after hip fracture surgery: results of 87,573 operations reported to the Norwegian Hip Fracture Register.

Acta Orthop 2020 04 13;91(2):146-151. Epub 2020 Jan 13.

Norwegian Hip Fracture Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen.

Background and purpose - About one-fourth of hip fracture patients have cognitive impairment. We investigated whether patients' cognitive function affects surgical treatment, risk of reoperation, and mortality after hip fracture, based on data in the Norwegian Hip Fracture Register (NHFR).Patients and methods - This prospective cohort study included 87,573 hip fractures reported to the NHFR in 2005-2017. Hazard rate ratios (HRRs) for risk of reoperation and mortality were calculated using Cox regression adjusted for sex, age, ASA class, fracture type, and surgical method.Results - Cognitive impairment was reported in 27% of patients. They were older (86 vs. 82 years) and had higher ASA class than non-impaired patients. There were no differences in fracture type or operation methods. Cognitively impaired patients had a lower overall reoperation rate (4.7% vs. 8.9%, HRR 0.71; 95% CI 0.66-0.76) and lower risk of reoperation after osteosynthesis (HRR 0.58; CI 0.53-0.63) than non-impaired patients. Cognitively impaired hip fracture patients had an increased reoperation risk after hemiarthroplasty (HRR 1.2; CI 1.1-1.4), mainly due to dislocations (1.5% vs. 1.0%, HRR 1.7; CI 1.3-2.1). Risk of dislocation was particularly high following the posterior approach (4.7% vs. 2.8%, HRR 1.8; CI 1.2-2.7). Further, they had a higher risk of reoperation due to periprosthetic fracture after uncemented hemiarthroplasty (HRR 1.6; CI 1.0-2.6). Cognitively impaired hip fracture patients had higher 1-year mortality than those without cognitive impairment (38% vs. 16%, HRR 2.1; CI 2.1-2.2).Interpretation - Our findings support giving cognitively impaired patients the same surgical treatment as non-impaired patients. But since the risk of hemiprosthesis dislocation and periprosthetic fracture was higher in cognitively impaired patients, they should probably not have posterior approach surgery or uncemented implants.
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http://dx.doi.org/10.1080/17453674.2019.1709712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144309PMC
April 2020

Interdisciplinary care of hip fractures.: Orthogeriatric models, alternative models, interdisciplinary teamwork.

Best Pract Res Clin Rheumatol 2019 04 30;33(2):205-226. Epub 2019 Apr 30.

Norwegian University of Science and Technology, Trondheim, Norway. Electronic address:

Hip fractures are common among older people, and the prognosis is serious in terms of mobility, independence in daily life activities, and cognition, with 42% of patients never achieving the same function as before the fracture. Norway has the highest incidence of hip fractures, and the important tasks are to improve patient care and prevent new fractures. The aim was to develop Norwegian Guidelines for Interdisciplinary Care for Hip Fractures, which included models of care, organization, and clinical issues. These guidelines were based on review of the literature, including existing guidelines such as the NICE guidelines, as well as clinical experience of the members of the group, where consensus was reached after discussions. The guidelines focus on interdisciplinary patient management through a clinical pathway from admission to discharge. Here, we will present a shortened and internationally adapted version of these guidelines, which has newly been released.
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http://dx.doi.org/10.1016/j.berh.2019.03.015DOI Listing
April 2019

The warm summer of 2018 - increased mortality among older people?

Tidsskr Nor Laegeforen 2019 Jun 13;139(10). Epub 2019 Jun 13.

Background: Heatwaves in Europe and the USA have been shown to cause excess mortality among older persons. The summer of 2018 was unusually hot in south-eastern Norway. The purpose of this study was to investigate whether more older persons died that summer compared with the average for the previous ten summers.

Material And Method: Temperature data from the Norwegian Meteorological Institute and mortality data for the summer of 2018 (June, July and August), divided into age groups and counties, were compared to the previous ten summers.

Results: For Norway as a whole, there was no increase in mortality among persons more than 75 years and 85 years of age in summer 2018. None of the counties in south-eastern Norway stood out as having elevated mortality for persons more than 75 years of age, apart from Vest-Agder county. Three counties, among them Aust-Agder, had somewhat lower mortality than expected.

Interpretation: We are unable to show any increase in mortality among older persons in summer 2018 compared with the average for the period 2008-17. Due to climate change and prognoses of more frequent heatwaves, mortality should nevertheless be monitored and public warning systems considered.
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http://dx.doi.org/10.4045/tidsskr.19.0167DOI Listing
June 2019

Two-year changes in gait variability in community-living older adults.

Gait Posture 2019 07 7;72:142-147. Epub 2019 Jun 7.

Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway. Electronic address:

Background: Increases in stride-to-stride fluctuations (gait variability) are common among older adults, but little is known about the natural progression of gait variability with increasing age.

Research Question: Does gait variability change with increasing age in a group of community-living older adults?

Methods: The participants were community-living volunteers between 70-81 years, who were tested with a two-year interval between tests. They walked 6.5 m under four different conditions: At preferred speed, at fast speed, during a dual task condition and on an uneven surface. Trunk accelerations in the anteroposterior (AP), mediolateral (ML) and vertical (V) direction were captured using a body-worn sensor worn at the lower back. Gait variability was estimated using an autocorrelation procedure, where coefficients tending towards 1.0 indicated low variability and 0.0 as high variability. To estimate change, we used an ANOVA-procedure with baseline gait speed as a covariate.

Results: At baseline, 85 older adults were tested, and data for 56 of these were available for analysis over a two-year period of time. The average age at inclusion was 75.8 years (SD 3.43) and 60% were women. During preferred speed walking, variability increased in the AP direction (mean difference 0.05, p = .038), during fast speed walking it increased in the V direction (mean difference 0.04, p = .037) and during dual task-walking, it increased in the ML and V directions (mean differences 0.03, p = .032 and 0.09, p = .020 respectively).

Significance: The findings from this study could be helpful for discriminating between normal and pathological progression of gait variability in older adults.
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http://dx.doi.org/10.1016/j.gaitpost.2019.06.005DOI Listing
July 2019

Validation of orthopaedic surgeons' assessment of cognitive function in patients with acute hip fracture.

BMC Musculoskelet Disord 2019 Jun 1;20(1):268. Epub 2019 Jun 1.

Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway.

Background: About one fourth of patients with hip fracture have cognitive impairment. These patients are at higher risk of surgical and medical complications and are often excluded from participating in clinical research. The aim of the present study was to investigate orthopaedic surgeons' ability to determine the cognitive status of patients with acute hip fracture and to compare the treatment given to patients with and without cognitive impairment.

Methods: The cognitive function of 1474 hip fracture patients reported by the orthopaedic surgeons to the nationwide Norwegian Hip Fracture Register was compared with data registered in quality databases in two hospitals with orthogeriatric service on the same patients. Cognitive function registered in the quality databases was determined either by the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or by pre-fracture diagnosis of dementia. The information registered in the quality databases was defined as the reference standard. Cognitive function in the Norwegian Hip Fracture Register was reported as: Chronic cognitive impairment? "Yes", "Uncertain" or "No" by the orthopaedic surgeons. Sensitivity, specificity, negative and positive predictive values for chronic cognitive impairment reported to the Norwegian Hip Fracture Register by the orthopaedic surgeons was calculated. Baseline data and treatment of hip fractures in patients with and without cognitive impairment in the Norwegian Hip Fracture Register were compared.

Results: Orthopaedic surgeons reported chronic cognitive impairment in 31% of the patients. Using documented dementia or IQCODE > 4.0 as the reference, this assessment of cognitive impairment by the orthopaedic surgeons had a sensitivity of 69%, a specificity of 90%, a positive predictive value of 78%, and a negative predictive value of 84% compared to information registered in the two hospital quality databases. There were no differences in type of hip fracture or type of surgical treatment by cognitive function.

Conclusion: The treatment of hip fractures was similar in patients with chronic cognitive impairment and cognitively well-functioning patients. The surgeons had an acceptable ability to identify and report chronic cognitive impairment in the peri-operative period, indicating that the Norwegian Hip Fracture Register is a valuable resource for future registry-based research also on hip fracture patients with chronic cognitive impairment.
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http://dx.doi.org/10.1186/s12891-019-2633-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545206PMC
June 2019

Delirium and cognitive impairment among older patients in Norwegian emergency departments.

Tidsskr Nor Laegeforen 2019 Mar 13;139(6). Epub 2019 Mar 13.

Background: Delirium is common and underdiagnosed among patients in hospitals, and is associated with complications, increased mortality, onset of dementia and need for nursing home care. Cognitive impairment from other causes is also common among hospitalised elderly people and is a key risk factor for delirium. Since no relevant prevalence studies have been undertaken in Norwegian hospitals, we investigated the prevalence of delirium among elderly patients in Norwegian emergency departments on World Delirium Awareness Day, 14 March 2018.

Material And Method: We included patients ≥ 75 years who arrived in ten Norwegian emergency departments between 08:00 and 22:00 on that day. We identified delirium and cognitive impairment using the '4AT' screening tool and registered the patients' age and gender and the hospital and department to which they were admitted (internal medicine, surgery, orthopaedics, 'other').

Results: Of 118 included patients, 20 (17 per cent) showed signs of delirium and 36 (30 per cent) showed signs of other forms of cognitive impairment. All hospitals and all categories of departments received patients with signs of delirium and cognitive impairment.

Interpretation: Delirium and other forms of cognitive impairment are both common among elderly patients in Norwegian emergency departments. Our results indicate that all hospital departments who treat elderly patients frequently observe these issues. All departments should therefore have routines to identify and deal with patients who suffer from delirium and cognitive impairment.
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http://dx.doi.org/10.4045/tidsskr.18.0578DOI Listing
March 2019

Lower bone mineral density in older female endurance skiers - a cross-sectional, observational study.

Eur Rev Aging Phys Act 2018 17;15:12. Epub 2018 Nov 17.

Department of Clincal Science, University of Bergen, Diakonhjemmet Hospital, and National Institute of Public Health, Oslo, Norway.

Background: Physical activity (PA) is generally beneficial for bone health, but the effect of high levels of PA over many years, in older women, is unknown.

Methods: T-score from Dual-energy X-ray absorptiometry (DXA), and self-reported baseline characteristics were recorded for 24 female, cross-country-skiing-competitors, aged 68-76 years, from the Birkebeiner Ageing Study. Data from 647 women in the same age range from the Tromso-6 population study, with recorded DXA findings, were used for comparison.

Results: The athletes reported a median(range) of 9(1-34) participations in the 54 km, yearly ski-race, indicating long-term PA. They also reported more moderate and high levels of PA than women in the general population (52% vs. 12 and 30% vs. 0%, respectively). The athletes had lower body mass index (BMI) than the controls (mean BMI 21.7 vs 26.9 kg/m,  < 0.001). As many as 22/24(92%) of the athletes and 477/647(74%) of the controls had a low bone mineral density (BMD) (T-score < - 1), p 0.048, Pearson chi square test. Odds ratio (OR) of low BMD was 3.9 in athletes vs. controls (p 0.048, logistic regression), but adjusting for BMI largely diminished the effect estimate, which was no longer statistically significant (aOR 1.81, p 0.432). The proportion of self-reported fractures was the same in the two groups.

Conclusions: This pilot study suggests that long-term, high levels of PA are associated with low bone mineral density in older women, and the finding might be due to differences in BMI. Despite the lower bone mineral density the athletes did not report more fractures.
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http://dx.doi.org/10.1186/s11556-018-0202-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240258PMC
November 2018

European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

Age Ageing 2019 03;48(2):291-299

Department of Family Medicine, Faculty of Medicine, University of Ljubljana Korytkova ulica 2, Ljubljana, Slovenia.

Background: the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.

Methods: under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.

Results: the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item).

Conclusion: the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.
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http://dx.doi.org/10.1093/ageing/afy173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424375PMC
March 2019

Transitions and trajectories in frailty states over time: a systematic review of the European Joint Action ADVANTAGE.

Ann Ist Super Sanita 2018 Jul-Sep;54(3):246-252

Health Service Executive of Ireland (Social Care Division) and National University of Ireland (Discipline of Medicine), Galway, Ireland.

Introduction: Frailty is a dynamic syndrome and may be reversible. Despite this, little is known about trajectories or transitions between different stages of frailty.

Methods: A systematic review was conducted, selecting studies reporting frailty trajectories or transition states for adults in any settings in European ADVANTAGE Joint Action Member States.

Results: Only three papers were included. Data were from longitudinal community-based cohorts in the United Kingdom, Netherlands and Italy. The English study investigated the effect of physical activity on the progression of frailty over a 10-year period. Two presented data on the proportion of participants experiencing at least one frailty transition over time (32.6% in the Italian sample aged ≥ 65 years followed for 4.4 years; 34.3% in the Dutch sample aged 65-75 years, followed for 2 years).

Conclusions: Data on frailty trajectories and transition states were limited and heterogeneous. Well-designed prospective studies and harmonized approaches to data collection are now needed.
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http://dx.doi.org/10.4415/ANN_18_03_12DOI Listing
February 2019
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