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PubMed1976

Psychological perception of nursing aides' work. An attitude study in a geriatric hospital.

To evaluate the psychological perception of nursing aides' work a questionnaire study was performed in a long-term care (geriatric) hospital. 233 out of 273 nursing aides participated (85.4%). Seven scales were obtained: relation with supervisors and workmates, perceived need for information, satisfaction with the work itself, perceived need for education, perceived demand for physical and psychic strength, perceived strain, adjustment to geriatric work. Differences were found between young and older nursing aides, e.g. the young nursing aides percerived less demand for physical and psychic strength and the older nursing aides had a better adjustment to geriatric work. The most important factors for the overall satisfaction with the work were satisfaction with the work itself, perceived strain, and adjustment to geriatric work. Comparisons were also made between the nursing aides and industrial workers and employees.

Adolescent↗
PubMedDate not supplied

Assessment and treatment of geriatric depression in primary care settings.

OBJECTIVE: To examine primary care physicians' practices relating to the diagnosis and management of geriatric depression, attitudes regarding responsibilities for and barriers to management, self-assessments of their needs in providing this care, and physician characteristics that correlate with attitudes and practices. DESIGN: Descriptive and analytic needs assessment. SETTING: A midwestern city and surrounding county and the suburb of another midwestern city. MEASUREMENTS: A self-administered survey consisting mainly of close-ended, Likert scale questions. PARTICIPANTS: One hundred forty-one family physicians and general internists (53.2%) responded. Respondents were 75.4% male and 50.8% general internists and ranged in age from 29 to 75 years (mean, 43 years; SD, 11 years). RESULTS: No standard test to screen for depression was used by 66.7% of respondents. The 2 most common laboratory studies ordered were thyroid studies (41.1%) and chemistry panels (37.6%). Selective serotonin reuptake inhibitors were most commonly prescribed for depression (53.2%). Although 98.6% of respondents agreed that treatment of depression in elderly patients was important, 29.0% reported that depressed elderly patients frustrated them, and 24.2% were too pressured for time to routinely investigate depression in the elderly. The most frequently identified needs in caring for these patients were increased time with patients (97.1%); increased reimbursement for counseling (87.8%); greater emphasis in medical training on the link between physical and mental health (85.6%); improved patient compliance with treatment (84.3%); and more training and attention to depression in residency (82.1%). In general, family physicians were more active and positive in their approach toward geriatric depression. CONCLUSIONS: Potential interventions to improve the diagnosis and management of geriatric depression include the following: use of screening instruments in a more efficient and timely manner; increased reimbursement for counseling of patients; more educational programs at the undergraduate, graduate, and continuing medical education levels; and clinical practice guidelines specific to geriatric depression.

Aged↗
PubMed1997

Cognitive impairment in geriatric chronic schizophrenic patients: a cross-national study in New York and London.

Severe cognitive impairment has been reported in large numbers of geriatric chronic schizophrenic patients in the US, with this impairment also being related to severe negative symptoms and adaptive deficits. It is not clear if this impairment is related to the particular environment of the American state hospitals and would not generalize to other countries. In this study, a sample composed of geriatric (age > 70) chronic schizophrenic patients in London, who were assessed by the Team for Assessment of Psychiatric Services (TAPS) (N = 137), and a group of geriatric chronic schizophrenic patients in a New York psychiatric center (N = 86) were compared for the severity of cognitive impairment and on measures of adaptive functioning. Patients received essentially identical Mini-Mental State Examination (MMSE) scores, but differed on 3/4 measures of adaptive functioning. The correlations among all four aspects of adaptive deficit and MMSE scores were very similar in the two samples, suggesting that cognitive deficits and their relationship with adaptive impairments are relatively invariant across different psychiatric systems of care, while adaptive functioning deficits are more variable and possibly more influenced by environmental factors. These data add to previous results suggesting that cognitive impairment is a common feature in poor outcome geriatric patients with schizophrenia.

Aged↗
PubMed1987

Prescribing digoxin in geriatric units: the unexplained variability in dosage requirements.

Some physicians regard patients of Geriatric Units as a homogeneous population with respect to digoxin dosage requirements. Others advocate the use of pharmacokinetic models in prescribing digoxin for the elderly. Sixty in-patients of Geriatric Units were studied and the results compared with those previously obtained from 129 patients of other adult Units; all were receiving maintenance digoxin. For each patient the dose required to achieve a mean steady-state serum digoxin concentration of 1.6 nmol X l-1, the standardized dose, was calculated, assuming proportionality between the dose given and the concentration achieved. A mean of four estimates of standardized dose for each individual was used in the analysis. Threefold ranges of standardized dose covered the requirements of approximately 85% of patients both of Geriatric Units (62.5 to 187.5 micrograms per day) and of other adult Units (125 to 375 micrograms per day). The variables, serum creatinine concentration, sex, age, and body weight were of relatively little value in predicting the standardized dose for the patients in Geriatric Units. There was a sub-group of these in-patients for whom the standardized dose was extremely large.

Adult↗
PubMedDate not supplied

Pharmacokinetics of oxiracetam in elderly patients after 800 mg oral doses, comparison with non-geriatric healthy subjects.

The pharmacokinetics of oxiracetam have been studied in eighteen elderly patients and in six healthy non-geriatric adults. A 800 mg single oral dose was administered in the morning of the first day and repeatedly, every 12 h, from day 2 evening to day 10 morning, to the elderly patients. The healthy non-geriatric adults were given a 800 mg single oral dose of oxiracetam. In healthy non-geriatric subjects after a single oral administration of 800 mg, the normalized plasma levels of oxiracetam for 1 mg/kg dose were similar to those already recorded after a 2000 mg single dose of oxiracetam. Therefore, there was no tendency towards non-linear pharmacokinetics of oxiracetam between 800 and 2000 mg single doses in healthy subjects. After the single oral dose, the mean area under the plasma concentration-time curve of oxiracetam in elderly patients was increased by a factor of two as compared to that observed in non-geriatric healthy subjects whereas the maximum concentration (Cmax) was almost not modified and slightly delayed. This can be explained by a slower absorption and elimination in the elderly patients. The highest oxiracetam levels were predominantly recorded in the oldest patients. The slower elimination (mean T1/2 = 12.3 h in elderly and 7.7 h in healthy subjects) could be attributed to a physiological decrease of the renal function. The volume of distribution was not significantly modified in the elderly patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1993

Continuous geriatric care in orthopedic wards: a valuable alternative to orthogeriatric units.

The aim of this study was to assess whether assigning a geriatrician to provide daily medical care to geriatric patients in the orthopedic ward can improve the prognosis and reduce the length of stay. Time series analysis was performed in two parts: 1) prospective analysis of two years' workload, and 2) retrospective analysis of data collected over the 4 years prior to the intervention. Intervention and control populations were pooled, and the effects of geriatric care and patient-related factors on outcome measures were assessed by logistic regression analysis. All subjects were patients aged > or = 70 years who attended the orthopedic ward in a university hospital in years 1989-90 (studied group: 287 cases) and in years 1985-88 (control group: 474 cases). In the study period, mortality was 8.4% compared to 18% in 1985-86 (p < 0.0006) and 14% in 1987-88 (p < 0.01). The operation rate in the study period was 89.9% vs 83.8% in 1985-86 (p < 0.02) and 81.8% in 1987-88 (p < 0.005). Length of stay was 26.2 +/- 14.4 days vs 32.9 +/- 30.9 days in 1985-86 (p < 0.05) and 26.9 +/- 16.5 days in 1987-88 (NS). Length of stay was more strikingly shortened in the subset of patients with femoral fracture undergoing surgical management (28.5 +/- 12.7 vs 37.6 +/- 32.6 days in 1985-86, p < 0.003, and 30.8 +/- 15 days in 1987-88, p < 0.02). Given the positive relationship between geriatric care and operation rate (o.r. = 1.5, CI = 1.1-1.9), the protective effect of surgical treatment on mortality (o.r. = 0.6, CI = 0.4-0.8) to some extent may mask the collinear effect of geriatric care. We conclude that assigning a geriatrician to assist with the medical care of elderly orthopedic patients in orthopedic wards is associated with increased operation rate, decreased mortality and shortened length of stay.

Aged↗
PubMed1996

Nutritional support and functional status in undernourished geriatric patients during hospitalization and 6-month follow-up.

The objective of this study, designed as a randomized controlled prospective intervention study, was to evaluate the effect of nutritional supplementation on functional status and need of care in undernourished geriatric patients during hospitalization, and up to 6 months after discharge. Participants consisted of 46 undernourished geriatric patients from a geriatric acute care hospital aged 75 years or older without malignant disease, or need for tube feeding or parenteral nutrition. Patients in the supplement group (SG, N = 20) were offered 400 mL (2100 kJ) daily of a liquid supplement during hospital stay and 200 mL (1050 kJ) per day for the following 6 months at home. Patients in the control group (CG, N = 26) had usual care without supplements. The main outcome measure was functional status based on the Barthel Activities of Daily Living score (ADL) at hospital admission, discharge and after 6 months, with higher scores indicating greater independence and a maximum score of 100 points. In supplemented patients with good acceptance (SG+, N = 11), a median improvement of 20 points was observed between admission and discharge, and a further improvement of 5 points at home. Median changes were 0 and -10 points in supplemented patients with poor acceptance (SG-, N = 9) and 5 and 2.5 points in CG, respectively. In SG+, the proportion of independent patients (> 65 points) increased continuously from 36% at admission to 63% at discharge, to 72% after 6 months, and was significantly higher compared to CG at discharge (63% vs 19%, p < 0.05) and after 6 months (72% vs 39%, p < 0.05). 64% of the patients in SG+ improved during hospitalization, compared to 23% in CG (p < 0.05). In the six months at home, 18% of SG+ improved; none of SG+ deteriorated in hospital or at home. In contrast, deterioration of the ADL score occurred in considerable proportions of SG- (22% in hospital, 22% at home) and CG (4% at hospital, 12% at home) patients. The proportion of patients who improved was smaller in SG- (44% at hospital, 22% at home) as well as in CG (23% at hospital, 35% at home), compared to SG+. In conclusion, a positive functional course was evident in supplemented patients with good acceptance during hospitalization, and further improvement was observed during the following 6 months at home. Nutritional support may contribute to reconvalescence and recovery of undernourished geriatric patients.

Activities of Daily Living↗
PubMed1996

Urinary incontinence in elderly inpatients in Japan: a comparison between general and geriatric hospitals.

This is the first multi-hospital epidemiological study to elucidate the prevalence and characteristics of urinary incontinence in elderly inpatients throughout Japan. Of the 2586 subjects to whom questionnaires were issued, 1563 (60.4%) (65 to 102 years old, 598 men, 965 women) were suitable for the study. A total of 817 patients were hospitalized in geriatric hospitals; that is, geriatric facilities under the regulation of the Department of Health and Welfare. All patients were evaluated by medical doctors for the following items: age, sex, duration of hospitalization, activities of daily living, medical diagnosis, presence or absence of urinary incontinence, type of urinary incontinence, and therapy for urinary incontinence. The prevalence of urinary incontinence in patients under 70, 70-79, 80-89, and over 90 years old was 59.3%, 67.7%, 79.8%, and 82.2%, respectively. Overall, 1142 patients (72.0%) suffered from urinary incontinence. Cerebrovascular disease was the major cause of admission to hospital in patients with urinary incontinence (37.0%). The most frequent type of urinary incontinence was functional urinary incontinence in patients who were mentally and/or physically unable to go to the bathroom without aid (21.5%). Specifically, 38.1% of patients in geriatric hospitals were diagnosed as having functional urinary incontinence, in contrast to only 3.9% of patients in non-geriatric units. In patients with dementia, 88.7% were incontinent, whereas in patients without dementia, the prevalence of urinary incontinence was much lower (51.5%, p < 0.001). Another predisposing factor for urinary incontinence was urinary tract infection. The prevalence of urinary incontinence in patients with and without urinary tract infection was 87.8% and 59.5%, respectively (p < 0.001). Almost all patients with poor activities of daily living (who were bedridden) suffered from urinary incontinence (98.5%). On the other hand, urinary incontinence was not so frequent in patients who could walk (26.9%). Pad (42.8%) and indwelling bladder catheter (18.3%) were the major means of management of incontinence, whereas behavioral therapy (4.9%) and surgery (0.5%) were not common. These results suggest that elderly patients with treatable urinary incontinence do not receive adequate therapy in Japan.

Activities of Daily Living↗
PubMed2005

[Female geriatric patients with urinary incontinence symptoms and their control over pelvic floor muscles].

UNLABELLED: Not only do anatomy and function of the pelvic floor play an important role as possible causes of female urinary incontinence, they are also crucial for its therapy. The aim of this case control study of female geriatric patients with symptoms of urinary incontinence was to determine the knowledge about their pelvic floor and to assess their ability to contract pelvic floor muscles voluntarily and reflexly. METHODS: A total of 377 female geriatric patients with symptoms of urinary incontinence were investigated in a Basis Assessment for Urinary incontinence. The ability to contract their pelvic floor muscles was examined by a digital vaginal palpation. The extent of the registered muscle strength was graded by the Modified Oxford Grading Scale by Laycock (1994). RESULTS: Of the patients, 65.5% were not aware of their pelvic floor and were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock), 22% had an inaccurate knowledge and only performed an insufficient pelvic floor muscle contraction (Grade 2 by Laycock). Only 12.5% could contract their pelvic floor muscles properly (Grade 3 to 4 by Laycock). A subgroup of 83 patients had already absolved pelvic floor exercises in the past, 80 patients with conventional instructions, 3 patients with digital vaginal control. In this subgroup 54.2% of the patients were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock) 25.3% only performed an insufficient contraction (Grade 2 by Laycock), while 20% were able to perform a sufficient and powerful contraction (Grade 3 to 4 by Laycock). The three patients in the past controlled by a digital vaginal palpation were part of this group and managed a pelvic floor muscle strength Grade 4 by Laycock. A high percentage of female geriatric patients with symptoms of urinary incontinence have a lack of understanding regarding the position and function of their pelvic floor. These results suggest that conventional pelvic floor muscle exercises without specific control are not an appropriate method to improve geriatric patients' ability to contract their pelvic floor muscles and to prevent urine leakage.

Aged↗
PubMed2006

[Patient satisfaction and geriatric care - an empirical study].

Patients' satisfaction has become a central concept in quality assurance. Despite progress in research in this area is still a lack of data for geriatric patients. Referring to the consumer model, satisfaction can be described as a difference between expectations and assessed performance. The aim of this study is to analyze satisfaction among geriatric patients in an in-patient setting. A personal interview was performed 1-2 days before discharge. Patients suffering for dementia or with problems to communicate were excluded. 124 of 268 geriatric patients who were discharged in 2003 were included (inclusion rate 46.3%). 119 were willing to participate (response rate 96.0%). Respondents were between 61 and 96 years old, 39% were male and 42% had serious functional limitations at time of admission. Multiple linear regression analysis revealed three significant predictors of a combined index of satisfaction and expectations: a) quality of hotel services; b) experience of neglect; c) provision of medical information and skills. In summary, standardized personal questionnaires can provide valid and reliable data of geriatric patients. Satisfaction of elderly patients is negatively affected by neglect and positively influenced by provision of medical information and a good hotel services.

Aged↗
PubMed2001

[Overview of health care services in clinical and rehabilitation geriatrics and their development in Germany].

A survey of the 2000 statistics about the existing geriatric care structures in Germany showed that the number of inpatient geriatric care centers rose from 84 in 1993 to 318 in 2000. The number of day clinics rose in the same timeframe from 13 to 136. However, there are serious deficits in the area of ambulant geriatrics; in 2000 there were only 11 such institutions. The question is discussed as to why there are three different care structures for acute geriatrics, neurological early rehabilitation, and general early rehabilitation in hospitals. It is suggested how the existing care structures could be sensibly integrated.

Aged↗
PubMed2004

[Pain assessment in the geriatric patient. Part I: pain diagnostics].

The geriatric pain patient is a frail patient at risk of losing the ability to take care of him/herself and, therefore, at risk of losing personal independence. There is a growing probability of comorbidity and of cognitive impairment with increasing age. One of the main objectives of geriatrics is the preservation and promotion of the capacity to perform everyday tasks (activity) and to participate in social life (participation). Comorbidity impacts on disability to a higher degree than pain does. Cognitive restrictions contribute to a decreased validity of the assessment instruments. For these reasons, geriatric assessment has to be multidimensional and has to take into account the patient's psychological and social situation in addition to the pain and physical status. In geriatrics, a set of standardized instruments is used to accomplish this task. It may not be practical to handle the whole set in the practice of the pain specialist; nevertheless, some simple measures for the assessment of functional as well as cognitive status should be incorporated into the diagnostic procedure for the elderly pain patient. Written questionnaires should not be used in cases of sensory or cognitive impairment of the patient. The adequate tool for these patients is a structured pain interview.

Aged↗
PubMed2001

[Palliative care - also in geriatrics?].

Red Cross Clinic is the largest geriatric center in Norway (240 beds). Major parts of the center are: long time geriatric ward (215 beds), rehabilitation and acute ward (25 beds), day clinic (45 patients) and a teaching and research unit. A palliative care unit (10 beds) will be opened in spring 2000. In mai 1998 a national project: Palliative care for the elderly was opened at our center. The projects main goal is to develop and support proper palliative care to all severe ill and dying patients in Norway. In a prospective study we examined 179 consecutive deaths between 1998 and 1999. Average age was 84.5. Major symptom problems were pain, dyspnoea, death-rattle and anxiety. In the last 24 hours 83% of the patients received opioids, 67% of the cases morphine (mean daily dosage 31.8 mg). 37% of the patients received scopolamine (mean daily dosage 0.8 mg), 12% benzodiazepines and 3% of the patients haloperidol. 152 (85%) of the deaths were expected, 27 (15%) unexpected. In 137 patients (77%) open, honest, frank communication with patient or their nearest kin regarding the imminent death was possible. In our experience it is a myth that the relatives want doctors to practise "maximal therapy". All old patients in geriatric clinics and nursing homes need palliative care. We have found no international textbooks of geriatrics with chapters on palliative care or textbooks on palliative care with chapters on the elderly. They need doctors and nurses who are properly trained and educated in palliative care. In most countries in Europe this training and education is not provided.

Aged↗
PubMed1995

Brain morphology assessed by computed tomography in patients with geriatric depression, patients with degenerative dementia, and normal control subjects.

To determine whether patients with geriatric depression have specific alterations in brain morphology, internal (ventricles) and external (frontal, temporal, and parieto-occipital) components of the cerebrospinal fluid (CSF) spaces were examined. Planimetric measurements of computed tomographic (CT) scans from patients with geriatric depression were compared with measurements from two age- and sex-matched control groups: normal control subjects and patients with primary degenerative dementia. Scans of 34 patients (6 men, 28 women; mean age = 70.7 years) who met DSM-III-R diagnostic criteria for major depression, 29 patients with DSM-III-R primary degenerative dementia (8 men, 21 women; mean age = 71.2 years), and 43 nonpsychiatric control subjects (10 men, 33 women; mean age = 70.8 years) were evaluated. The areas of the frontal and parieto-occipital sulci, the Sylvian fissures, and the lateral and third ventricles were measured separately for the right and left hemispheres. Compared with the control subjects, patients with geriatric depression revealed a remarkable enlargement (up to 125%) of the left Sylvian fissure on several levels and a more subtle enlargement of the ventricles, cortical sulci, and right Sylvian fissure (20-50%). The laterality index differed significantly between depressed patients and normal control subjects (but not between the demented patients and the normal control group) only for the Sylvian fissure. Demented patients showed a considerable brain atrophy that affected all CSF components (enlargement of 30-160%) but the left temporal region was less affected than in the depressed patients. Compared with the findings in geriatric depression, ventricular enlargement was significant in dementia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Geriatric pharmacology.

When faced with the geriatric dog or cat, the practitioner should consider the following: 1. Avoid using any drugs at all unless there are definite therapeutic indications. If the patient has some degree of renal insufficiency, try to select drugs that are hepatically metabolized and excreted in bile rather than eliminated by the kidneys (eg, doxycycline, tolfenamic acid). If hepatic insufficiency is present, select drugs that do not undergo metabolism before renal excretion (eg, penicillins, cephalosporins). 2. If therapeutic drug monitoring is available, tailor the drug dosage regimen to that specific patient (eg, phenobarbital, digoxin, amino-glycosides). 3. If therapeutic drug monitoring is unavailable, determine if there are clinically proven adjusted dosage regimens for specific drugs. The package insert on human pharmaceutics often gives guidelines for adjusting dosages in geriatric patients. 4. If the drug has not been sufficiently studied to have dosage adjustment recommendations, determine if there is sufficient information about its kinetics to estimate the proper drug dose in a geriatric patient. Some general guidelines for commonly used drugs in geriatric veterinary patients are provided in Table 1. In general, if the Vd changes in your patient, change the dose. If the elimination half-life changes, change the dosing interval. 5. Carefully monitor treated patients for signs of efficacy and toxicity.

Aging↗
PubMed1989

Geriatric nutrition.

In recent decades, veterinary medicine has become more successful in prolonging the healthy, useful lives of pets. As a result, the practitioner spends a greater part of each practice day caring for the geriatric animal, both healthy and unhealthy. Because of their longevity, older pets are typically regular family members, with owners who seek the finest health care possible for their pets. The practice of geriatric medicine most properly should begin not when the dog or cat reaches some specific "golden" age, but rather when the wiggly, robust puppy or kitten receives its first examination. Like all parts of a sound preventive program, geriatric nutrition best follows from a well-considered juvenile and adult nutrition program. Furthermore, once it becomes senior, the "well" geriatric is as much a candidate for a diet designed especially to accommodate old age changes as is his unhealthy contemporary. In fact, evidence suggests that appropriate dietary management of the healthy, but often subclinical, patient may help postpone the signs of dysfunction and increase quality and length of life. A knowledge of the most significant nutrients and the impact of each on aging systems is now, and will become increasingly more, important to the progressive, skillful veterinarian.

Aging↗
PubMed1998

A three compartment model of the patient flows in a geriatric department: a decision support approach.

As users of long term geriatric services occupy the beds for prolonged periods of time it is important that decision makers understand how clinical and social decisions interact to influence long term care costs. A flow modelling approach enables us to estimate current inpatient activity and to test different care options, thereby optimising decision making. In previous work we developed a two compartment model of patient flows within a geriatric hospital, where patients are initially admitted to an acute or rehabilitative state from which they either are discharged or die or are converted to a long-stay state. Long-stay patients are discharged or die at a slower rate. This initial research discussed the use of a compartmental model to describe flows through the hospital system. We now discuss a three compartment model where the compartments may be described as consisting of acute care, rehabilitation and long-stay care. A Markov model is then used to count and cost the movements of geriatric patients within a hospital system. Such an approach enables health service managers and clinicians to assess performance and evaluate the effect of possible changes to the system. By attaching costs to various parts of the system we may facilitate the evaluation and comparison of different strategies and scenarios. Using the model, we show that a geriatric medical service that improved the acute management of in-patients became more cost-efficient. Hospital planners may thus identify cost-effective options.

Aged↗
PubMed2001

Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls.

OBJECTIVE: To determine the safety and efficacy of an exercise protocol designed to improve strength, mobility, and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls. DESIGN: A randomized controlled 3-month intervention trial, with an additional 3-month follow-up. SETTING: Out-patient geriatric rehabilitation unit. PARTICIPANTS: Fifty-seven female geriatric patients (mean age 82 +/- 4.8 years; range 75-90) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture. INTERVENTION: Ambulatory training of strength, functional performance, and balance 3 times per week for 3 months. Patients of the control group attended a placebo group 3 times a week for 3 months. Both groups received an identical physiotherapeutic treatment 2 times a week, in which strengthening and balance training were excluded. MEASUREMENTS: Strength, functional ability, motor function, psychological parameters, and fall rates were assessed by standardized protocols at the beginning (T1) and the end (T2) of intervention. Patients were followed up for 3 months after the intervention (T3). RESULTS: No training-related medical problems occurred in the study group. Forty-five patients (79%) completed all assessments after the intervention and follow-up period. Adherence was excellent in both groups (intervention 85.4 +/- 27.8% vs control 84.2 +/- 29.3%). The patients in the intervention group increased strength, functional motor performance, and balance significantly. Fall-related behavioral and emotional restrictions were reduced significantly. Improvements persisted during the 3-month follow-up with only moderate losses. For patients of the control group, no change in strength, functional performance, or emotional status could be documented during intervention and follow-up. Fall incidence was reduced nonsignificantly by 25% in the intervention group compared with the control group (RR:0.753 CI:0.455-1.245). CONCLUSIONS: Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail, high-risk geriatric patients with a history of injurious falls.

Accidental Falls↗