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  • 1.
    Fristedt, Sofi
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Nystedt, Paul
    Jönköping University, Jönköping International Business School, JIBS, Economics. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Skogar, Örjan
    Futurum - The Academy for Health and Care, Jönköping, Sweden.
    Mobile geriatric teams – A cost-effective way of improving patient safety and reducing traditional healthcare utilization among the frail elderly? A randomized controlled trial2019In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, p. 1911-1924Article in journal (Refereed)
    Abstract [en]

    Background: Demographic changes combined with costly technological progress put a financial strain on the healthcare sector in the industrialized world. Hence, there is a constant need to develop new cost-effective treatment procedures in order to optimize the use of available resources. As a response, the concept of a Mobile Geriatric Team (MGT) has emerged not only nationally but also internationally during the last decade; however, scientific evaluation of this initiative has been very scarce. Thus, the objective of this study was to perform a mixed methods analysis, including a prospective, controlled and randomized quantitative evaluation, in combination with an interview-based qualitative assessment, to measure the effectiveness and user satisfaction of MGT.

    Materials and methods: Community-dwelling, frail elderly people were randomized to an intervention group (n=31, mean age 84) and a control group (n=31, mean age 86). A two-year retrospective quantitative data collection and a prospective one-year follow-up on healthcare utilization were combined with qualitative interviews. Non-parametric statistics and difference-in-difference (DiD) analyses were applied to the quantitative data. Qualitative data were analyzed using content analysis.

    Results: No significant group differences in healthcare utilization were found before inclusion. Post intervention, primary care contact (including MGTs) increased for the MGT group. Inpatient care decreased dramatically for both groups. Hence, the increase in primary care contact for MGT patients was not accompanied by a reduction in inpatient care compared to the control group. Utilization of non-primary care was lower (p< 0.01) post-intervention in both groups.

    Conclusion: There appears to be a “natural” variation in healthcare needs over time among frail elderly people. Hence, it is vital to perform open, controlled clinical studies in tandem with the implementation of new caregiving strategies. The MGT initiative was clearly appreciated but did not fully achieve the desired reduction in healthcare utilization in this study.

    Trial registration: Retrospectively registered 09/10/2018, ClinicalTrials.gov ID NCT03662945.

  • 2.
    Fristedt, Sofi
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Skogar, Örjan
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Nystedt, Paul
    Jönköping University, Jönköping International Business School, JIBS, Economics. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Mobile Geriatric Teams: a cost-effective way of improving patient safety and reducing health care u2018Conference paper (Other academic)
  • 3.
    Lindholm, Beata
    et al.
    Lund University, Lund, Sweden and Skåne University Hospital, Malmö, Sweden.
    Eek, Frida
    Lund University, Lund, Sweden.
    Skogar, Örjan
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Karolinska Institutet, Stockholm, Sweden.
    Hansson, Eva E.
    Lund University, Lund, Sweden.
    Dyskinesia and FAB score predict future falling in Parkinson’s disease2019In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 139, no 6, p. 512-518Article in journal (Refereed)
    Abstract [en]

    A growing body of research highlights the importance of cognition for prediction of falls in Parkinson's disease (PD). However, a previously proposed prediction model for future near falls and falls in PD, which includes history of near falls, tandem gait, and retropulsion, was developed without considering cognitive impairment. Therefore, by using a sample of 64 individuals with relatively mild PD and not excluding those with impaired cognition we aimed to externally validate the previously proposed model as well as to explore the value of additional predictors that also consider cognitive impairment. Since this validation study failed to support the proposed model in a PD sample including individuals with impaired global cognition, extended analyses generated a new model including dyskinesia (item 32 of Unified PD Rating Scale) and frontal lobe impairment (Frontal Assessment Battery—FAB) as significant independent predictors for future near falls and falls in PD. The discriminant ability of this new model was acceptable (AUC, 0. 80; 95% CI 0.68‐0.91). Replacing the continuous FAB scores by a dichotomized version of FAB with a cut‐off score ≤14 yielded slightly lower but still acceptable discriminant ability (AUC, 0. 79; 95% CI 0.68‐0.91). Further studies are needed to test our new model and the proposed cut‐off score of FAB in additional samples. Taken together, our observations suggest potentially important additions to the evidence base for clinical fall prediction in PD with concomitant cognitive impairment.

  • 4.
    Skogar, Örjan
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). FUTURUM, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Nilsson, Mats
    FUTURUM, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Distribution of non-motor symptoms in idiopathic parkinson’s disease and secondary parkinsonism2018In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 11, p. 525-534Article in journal (Refereed)
    Abstract [en]

    Background: Non-motor symptoms (NMS) are frequent in patients with idiopathic Parkinson’s disease (IPD). Clinical expressions, postulated pathophysiological mechanisms, and responsiveness to antiparkinson medication represent differences between IPD and secondary Parkinsonism (SP).

    Objective: To evaluate NMS expressions in IPD, SP, and a matched control group.

    Methods: The accepted criteria for IPD and SP were controlled for the participants who were consecutively recruited at two outdoor patient clinics. The Well-Being Map™ was used as the evaluation instrument. These were completed by the participants before their visit. The controls consisted of non-Parkinsonian individuals who were matched by age and gender.

    Results: A total of 185 participants participated in the study, IPD/SP/controls; n=73/53 and 59, respectively. The mean age was 74 years, and the median duration of disease was 6/3 years. Differences were shown between the combined IPD/SP groups and the controls. Limited differences between the IPD and SP groups could be demonstrated. Symptoms such as pain, decreased taste, as well as sleep and bladder disturbances were more frequent in the IPD group. When more than minor problems with moving were reported, disturbances in sleep and digestion were also noted to a large extent.

    Conclusion: Despite differences in the pathophysiological mechanisms between IPD and SP, the study showed only minor differences in the expression of NMS. IPD and SP reported statistically more significant problems in all items compared to the controls. Sleeping problems were strongly associated with symptoms from the gastrointestinal tract, but sleep was only affected by longer disease duration to a minor extent. Motor symptoms, such as morning stiffness, were common in all three groups. Neurodegenerative diseases might have more complex expressions in common than what we have known before and it is certainly not a part of normal aging. 

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