Comparison of Instrumental Activities of Daily Living assessment by face-to-face or telephone interviews: A randomized, crossover study

Purpose Complex endovascular aortic repair (EVAR) procedures provide a treatment option for patients with aortic aneurysms involving visceral branches. Good technical results and short-term outcomes have been reported. Whether complex EVAR provides acceptable functional outcomes is not clear. The current study aims to describe postoperative functional outcomes in complex EVAR patients—an older and relatively frail patient group. Materials and Methods A single-center retrospective cohort study was performed, using data from a computerized database of consecutive patients who underwent complex EVAR in the Leiden University Medical Center (LUMC, The Netherlands) between July 2013 and September 2020. As of May 2017, patients scheduled for complex EVAR were referred to a geriatric care pathway to determine (Instrumental) Activities of Daily Living ((I)ADL) scores at baseline and, if informed consent was given, after 12 months. For the total patient group, adverse functional performance outcomes were: discharge to a nursing home and 12-month mortality. For the patients included in geriatric follow-up, the additional outcome was the incidence of functional decline (defined by a ≥2 point increase in (I)ADL-score) at 12-month follow-up Results Eighty-two patients underwent complex EVAR, of which 68 (82.9%) were male. Mean age was 73.3 years (SD=6.3). Within 30 days postsurgery, 6 patients (7.3%) died. Mortality within 12 months for the total patient group was 14.6% (n=12). After surgery, no patients had to be discharged to a nursing home. Fifteen patients (18.3%) were discharged to a rehabilitation center. Twenty-three patients gave informed consent and were included in geriatric follow-up. Five patients (21.7%) presented functional decline 12 months postsurgery and 4 patients had died (17.4%) by that time. This means that 39.1% of the patients in the care pathway suffered an adverse outcome. Conclusion To our knowledge, this is the only study that examined functional performance after complex EVAR, using a prospectively maintained database. No patients were newly discharged to a nursing home and functional performance results at 12 months are promising. Future multidisciplinary research should focus on determining which patients are most prone to deterioration of function, so that efforts can be directed toward preventing postoperative functional decline.

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“…[19][20][21] Both the Katz ADL and Lawton IADL are of sufficient validity when conducted by phone. 22,23…”

Section: Patients and Proceduresmentioning

confidence: 99%

Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

et al. 2021

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Prevalence of atrial fibrillation, oral anticoagulation prescription and associated factors in Brazilian older adults

Oliveira

Mello

Costa

et al. 2020

Geriatr Gerontol Aging

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INTRODUCTION: Atrial fibrillation increases five times the risk of stroke. Anticoagulation reduces the incidence of cerebrovascular events. However, many patients do not receive thromboprophylaxis. OBJECTIVES: To estimate the prevalence of atrial fibrillation in the elderly at a Brazilian university hospital and the proportion of anticoagulation prescription. Secondary objectives were to identify the therapeutic options, the main reasons for non-prescription and the factors associated with ineffectiveness or lack of treatment. METHOD: cross-sectional study with a consecutive sample of 1,630 outpatients selected at Hospital de Clínicas de Porto Alegre between April and June of 2017. Atrial fibrillation was identified in 220 (13.50%) individuals. Medical records from 145 patients were accessed, followed by a telephone interview. The association between variables and outcomes was checked using the Mann-Whitney’s U Test and the binary logistic regression. RESULTS: The prevalence of atrial fibrillation was 13.50%. Anticoagulation therapy was prescribed in 77.93% of cases. In 76.11% of patients, warfarin was the chosen drug. There was a tendency towards no prescription in patients with previous bleeding (RR = 2.32; 95%CI 0.95 – 5.64; p = 0.06) and falls (RR = 2.02; 95%CI 0.82 – 5.03; p = 0.08). We found an association between reduced functional capacity (Barthel’s Activities of Daily Living Score < 80) and higher rate of anticoagulation in therapeutic aim (RR = 0.22; 95%CI 0.06 – 0.87; p = 0.04). CONCLUSION: The prevalence of atrial fibrillation in this population was 13.50% and in 77.93% of cases anticoagulant were prescribed. Functional impairment was associated with a higher rate of anticoagulation in therapeutic aim.

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Comparison of Instrumental Activities of Daily Living assessment by face-to-face or telephone interviews: A randomized, crossover study

Cited by 2 publications

References 29 publications

Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

Prevalence of atrial fibrillation, oral anticoagulation prescription and associated factors in Brazilian older adults

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