Raphaël Grandjean - Academia.edu (original) (raw)
Papers by Raphaël Grandjean
Presse medicale, 2006
OBJECTIVES Driving is an important part of everyday life for the elderly today. Older drivers are... more OBJECTIVES Driving is an important part of everyday life for the elderly today. Older drivers are suspected to be involved in more automobile accidents than younger adults. Although healthcare professionals are aware of specific diseases and impairments that increase accident risks, they cannot distinguish safe from unsafe drivers among the healthy elderly population in general practice. Previous English studies of younger populations differentiate three main types of bad driving that are associated with accident involvement: violations, errors, and lapses. The aim of this study was to assess the driving behavior associated with car crashes in a healthy elderly population. METHOD This prospective survey of healthy drivers aged 65 years or older living in the community asked subjects about their habitual driving and accident history in the past three years. Subjects also completed the French version of the Manchester Aging Driver Questionnaire, which contains 24 items, scored from 0 ...
Douleur et Analgésie, 2004
Résumé Objectif évaluer l’impact du cycle menstruel sur le seuil de la douleur en réponse a un s... more Résumé Objectif évaluer l’impact du cycle menstruel sur le seuil de la douleur en réponse a un stimulus électrique chez 23 volontaires sains de sexe féminin avec et sans contraception orale. Méthode nous avons suivi et comparé l’évolution longitudinale (3x/semaine durant un cycle menstruel complet) du réflexe nociceptif RIII, et du seuil subjectif de la douleur chez 23 volontaires, 13 avec et
Recherche en soins infirmiers, 2008
When old people suffering from chronic diseases are hospitalized, they need some wellness as youn... more When old people suffering from chronic diseases are hospitalized, they need some wellness as younger people. Anxiety and depression associated to the hospitalisation and the disease are very lound. The need for any attention, touch and encouragement is sometimes not clearly expressed among the elderly, Aesthetic care may valorise old patients as healthy people. This has not been reported. Our study has evaluated 47 voluntary old women. Mini mental state was considered. They had one aesthetic care during their hospitalisation. The care evaluation's questionnaire proved the wellness feeling however the desire to open themselves to others was not significant. The depression, health state scales could not be influenced by only one such a care. Aesthetic care was generally very well accepted by the institution and health care professionals as a tool for hospital quality of life.
Recherche en soins infirmiers, 2008
Distribution électronique Cairn.info pour Association de Recherche en Soins Infirmiers. © Associa... more Distribution électronique Cairn.info pour Association de Recherche en Soins Infirmiers. © Association de Recherche en Soins Infirmiers. Tous droits réservés pour tous pays. La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.
Revue du Rhumatisme, 2011
Mots clés : Douleurs dorsales et cervicales Épidémiologie Lieu de travail Facteurs de risque r é ... more Mots clés : Douleurs dorsales et cervicales Épidémiologie Lieu de travail Facteurs de risque r é s u m é Objectifs.-Explorer les facteurs de risque de douleurs du rachis en lien avec le personnel et le travail parmi les employés d'un hôpital. Examiner l'effet des variables en lien avec le personnel et le travail sur les conséquences des douleurs du rachis, telles que les consultations chez le médecin ou les congés maladie. Méthodes.-Une enquête par courrier a été menée auprès d'un échantillon de 2700 employés tirés au sort et stratifiés sur les catégories professionnelles (personnel administratif, infirmières, aides-soignantes, médecins, employés à la logistique et autres pluriprofessionels de santé). Le questionnaire évaluait les douleurs vertébrales autorapportées, les conséquences de la douleur et les caractéristiques du travail effectué. Résultats.-Le taux de réponse a été de 48,1 % (1298/2700). La prévalence annuelle des rachialgies était de 67,3 %, la plus élevée parmi les infirmières (75,6 %) et la plus faible parmi les employés à la logistique (54,9 %). Les caractéristiques du poste de travail associées aux rachialgies incluaient : travailler fréquemment à un poste de travail mal adapté (odds ratio (OR) 1,90 [1,24-2,93]) et devoir rester longtemps dans la même position (OR 1,71 [1,25-2,34]). Aucune corrélation significative n'a été observée avec les actions de soulever, manipuler des patients, manipuler du matériel ou travailler en équipe de nuit. Les arrêts de travail dus au mal de dos étaient significativement associés à la durée de l'épisode douloureux (OR 4,08 pour plus de trois mois comparé à moins de dix jours) et avec la catégorie professionnelle (OR 2,58 pour les aides-soignantes en comparaison avec les infirmières). Conclusion.-Dans cette population d'employés hospitaliers, être infirmière, travailler à un poste estimé mal adapté, et devoir fréquemment maintenir longtemps certaines positions, étaient corrélés de faç on indépendante aux rachialgies. Les aides-soignantes présentaient un risque plus élevé d'absentéisme.
La Presse Médicale, 2006
Healthy elderly drivers are more likely to commit errors or lapses than violations Survey of 904 ... more Healthy elderly drivers are more likely to commit errors or lapses than violations Survey of 904 volunteers Objectives > Driving is an important part of everyday life for the elderly today. Older drivers are suspected to be involved in more automobile accidents than younger adults. Although healthcare professionals are aware of specific diseases and impairments that increase accident risks, they cannot distinguish safe from unsafe drivers among the healthy elderly population in general practice. Previous English studies of younger populations differentiate three main types of bad driving that are associated with accident involvement: violations, errors, and lapses. The aim of this study was to assess the driving behavior associated with car crashes in a healthy elderly population. Method > This prospective survey of healthy drivers aged 65 years or older living in the community asked subjects about their habitual driving and accident history in the past three years. Subjects also completed the French version of the Manchester Aging Driver Questionnaire, which contains 24 items, scored from 0 (never) to 5 (nearly all the time) and yields three sub-scales: errors, violations, and lapses. Simple logistic tome 35 > n°6 > juin 2006 > cahier 1 Article original Les conducteurs âgés en bonne santé font plus d'erreurs et d'oublis que d'infractions
Joint Bone Spine, 2011
Objectives: 1) To explore the staff-and work-related risk factors for spinal pain among hospital ... more Objectives: 1) To explore the staff-and work-related risk factors for spinal pain among hospital employees, 2) to investigate the effect of staff-and work-related variables on the consequences of spinal pain, such as doctor visits and sick leave. Methods: A mailed survey was carried out in a random sample of 2700 employees stratified for occupational categories (administration staff, nurses, nurse assistants, physicians, support staff and allied health professionals). The questionnaire measured self-reported spinal pain, consequences of pain, and work characteristics. Results: The response rate was 48.1% (1298/2700). The one-year prevalence of spinal pain was 67.3%, highest among nurses (75.6%) and lowest among support staff (54.9%). Reported work characteristics associated with spinal pain included frequent work at a poorly adapted work station (odds ratio (OR) 1.90 [1.24-2.93]) and having to maintain a position for a long time (OR 1.71 [1.25-2.34]). No significant correlations were observed with lifting, patient handling, material handling, or working on nightshift. Sickness leave due to spinal pain was significantly associated with duration of pain episode (OR 4.08 for > 3 months compared to less than 10 days), and with work categories (OR 2.58 for nurse assistants compared to nurses). Conclusion: In this population of hospital employees, being a nurse, working at a poorly adapted work place, and having to maintain positions for a long time were related independently to spinal pain. Nurse assistants had a higher risk of work absenteeism.
The International Journal of Lower Extremity Wounds, 2007
Patients with diabetes and chronic neurological disorders are most commonly “at-risk” with foot p... more Patients with diabetes and chronic neurological disorders are most commonly “at-risk” with foot problems. The identification of that population is therefore mandatory to prevent severe foot lesions. However, not all health care providers (HCPs) are involved in the screening process in institutions. The authors' aim was to develop and evaluate an educational program for HCP in the field of at-risk foot. All HCPs of the Loëx Hospital (Department of Rehabilitation and Geriatrics, University Hospitals of Geneva) participated in a longitudinal prospective study. Different professions of HCP (doctors, nurses, nursing aides, physiotherapists, occupational therapists, speech-language therapists, and psychologists) attended a structured educational program during a 1-year period based on a specific consultation that the authors developed. During the sessions, risk factors and therapeutic and preventive interventions are discussed with both the patient and care givers. A questionnaire was...
International Journal of Geriatric Psychiatry, 2009
Background Dementia is often considered a predictor of adverse hospitalization outcomes. However,... more Background Dementia is often considered a predictor of adverse hospitalization outcomes. However, the relative contributions of dementia and other risk factors remain unclear. Objective To assess, in a prospective study, the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 AE 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. Results Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. Conclusions Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.
Gait & Posture, 2008
The GAITRite 1 system is a validated portable gait analysis system that allows simple objective g... more The GAITRite 1 system is a validated portable gait analysis system that allows simple objective gait measurements. The limited length of the active area of the GAITRite 1 system may be a limitation in obtaining reliable measures of stride-to-stride variability. In contrast, the SMTEC 1 footswitches system provides a continuous measurement of temporal step parameters for a long distance and a long period (around 24 h). The aim of the study was to examine the concurrent validity of the SMTEC 1 footswitches system with the GAITRite 1 system for the measurement of temporal steps parameters. Step, stride, swing and stance time were simultaneously recorded using SMTEC 1 and GAITRite 1 systems while walking at normal, slow and fast self-selected walking speed among 13 healthy young adults. The level of agreement between both systems was high as for the stride time with intra-class correlation coefficients (ICC) between 0.95 and 0.99 (P < 0.001) and repeatability coefficients (RC) between 1.1% and 1.5% of mean values, whereas the lowest level of agreement was shown at fast self-selected walking speed and for stance time (ICC = 0.52 with P < 0.001 and RC = 4.9%). Furthermore, the measurement of individual footstep data was excellent with an agreement ranging between À0.04 and 0.04 s (Pitman's test of difference in variance: r = À0.009, P = 0.772). The present results suggest that the SMTEC 1 footswitches system provides a valid and reliable measurement of temporal gait parameters in healthy young adults.
Aging Clinical and Experimental Research, 2008
Background and aims: Increased gait variability is associated with a high risk of falling in olde... more Background and aims: Increased gait variability is associated with a high risk of falling in older community-dwellers, but no information exists about the relationship between increased gait variability and falls occurring in older hospitalized patients. We therefore sought to determine, in an acute geriatric setting, whether gait variability in single-(i.e., usual walking) or dual-task conditions can predict inpatient falls. Methods: Stride time variability was calculated in both single-task (i.e., usual walking) and dual-task conditions with a GAITRite ®-System in 13 male and 44 female patients (mean age=85.0, SD=6.6 yrs) consecutively admitted to the acute care geriatric department of Geneva University Hospitals, Switzerland. All participants were able to walk without assistive devices at day 3 post-admission. Falls during hospital stay were identified through the hospital accident reporting system. Results: Ten fallers and 47 non-fallers were identified. The first fall events were significantly associated with the coefficient of variation of stride time in both walking conditions during hospital stay (OR 13.3, (95% CI 1.6-113.6), p=0.018 for usual walking; OR 8.6, (95% CI 1.9-39.6), p=0.006 for dual-task walking). Furthermore, the time elapsing between the first day of hospitalization and the first fall was significantly shorter when the cutoff value of stride time variability was calculated for dual-tasking compared with usual walking. The Cox regression model revealed that only the coefficient of variation of stride time during dual-task walking was significantly associated with the occurrence of the first fall event (p=0.006). Conclusion: Our results suggest that the degree of stride time variability in dual-task walking conditions distinguished fallers from non-fallers in a group of independently walking, older inpatients.
Age and Ageing, 2007
Background demented patients have been reported to be healthier than other old people of the same... more Background demented patients have been reported to be healthier than other old people of the same age. Objectives to assess comorbid conditions, functional and nutritional status in medically ill hospitalised patients with normal cognition or affected by dementia of various causes and severities, or mild cognitive impairment (MCI). Design and Setting a prospective study was carried out, between January and December 2004, in the Rehabilitation and Geriatric Hospital (HOGER). Methods activities of daily living (ADL), instrumental activities of daily living (IADL) and mini nutritional assessment (MNA) scores were assessed as a function of the status of the patient two weeks before admission to hospital. On admission, cognitive status was assessed by a systematic battery of neuropsychological tests, comorbid conditions were assessed with the Charlson comorbidity index (CCI), and body mass index (BMI) and functional independence measure (FIM) were determined. BMI and FIM were also determined on discharge. Results we studied 349 patients (mean age 85.2 ± 6.7; 76% women): 161 (46.1%) cognitively normal, 37 (10.6%) with MCI and 151 (43.3%) demented (61 Alzheimer's disease (AD), 62 mixed dementia (MD) and 17 vascular dementia (VaD)). ADL, IADL, FIM and MNA scores on admission decreased with cognitive status, regardless of the type of dementia. Functionality at discharge remained significantly lower in demented patients than in other patients. CCI was high and similar in all three groups (mean 4.6 ± 2.7). Patients with VaD had poorer health than other demented patients, with a higher average comorbidity score, more frequent hypertension, stroke and hyperlipidaemia. Comorbidity did not increase with severity levels of dementia. Conclusions in this cohort of very old inpatients, demented patients, non-demented patients and patients with MCI had similar levels of comorbidity, but demented patients had a poorer functional and nutritional status.
Presse medicale, 2006
OBJECTIVES Driving is an important part of everyday life for the elderly today. Older drivers are... more OBJECTIVES Driving is an important part of everyday life for the elderly today. Older drivers are suspected to be involved in more automobile accidents than younger adults. Although healthcare professionals are aware of specific diseases and impairments that increase accident risks, they cannot distinguish safe from unsafe drivers among the healthy elderly population in general practice. Previous English studies of younger populations differentiate three main types of bad driving that are associated with accident involvement: violations, errors, and lapses. The aim of this study was to assess the driving behavior associated with car crashes in a healthy elderly population. METHOD This prospective survey of healthy drivers aged 65 years or older living in the community asked subjects about their habitual driving and accident history in the past three years. Subjects also completed the French version of the Manchester Aging Driver Questionnaire, which contains 24 items, scored from 0 ...
Douleur et Analgésie, 2004
Résumé Objectif évaluer l’impact du cycle menstruel sur le seuil de la douleur en réponse a un s... more Résumé Objectif évaluer l’impact du cycle menstruel sur le seuil de la douleur en réponse a un stimulus électrique chez 23 volontaires sains de sexe féminin avec et sans contraception orale. Méthode nous avons suivi et comparé l’évolution longitudinale (3x/semaine durant un cycle menstruel complet) du réflexe nociceptif RIII, et du seuil subjectif de la douleur chez 23 volontaires, 13 avec et
Recherche en soins infirmiers, 2008
When old people suffering from chronic diseases are hospitalized, they need some wellness as youn... more When old people suffering from chronic diseases are hospitalized, they need some wellness as younger people. Anxiety and depression associated to the hospitalisation and the disease are very lound. The need for any attention, touch and encouragement is sometimes not clearly expressed among the elderly, Aesthetic care may valorise old patients as healthy people. This has not been reported. Our study has evaluated 47 voluntary old women. Mini mental state was considered. They had one aesthetic care during their hospitalisation. The care evaluation's questionnaire proved the wellness feeling however the desire to open themselves to others was not significant. The depression, health state scales could not be influenced by only one such a care. Aesthetic care was generally very well accepted by the institution and health care professionals as a tool for hospital quality of life.
Recherche en soins infirmiers, 2008
Distribution électronique Cairn.info pour Association de Recherche en Soins Infirmiers. © Associa... more Distribution électronique Cairn.info pour Association de Recherche en Soins Infirmiers. © Association de Recherche en Soins Infirmiers. Tous droits réservés pour tous pays. La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.
Revue du Rhumatisme, 2011
Mots clés : Douleurs dorsales et cervicales Épidémiologie Lieu de travail Facteurs de risque r é ... more Mots clés : Douleurs dorsales et cervicales Épidémiologie Lieu de travail Facteurs de risque r é s u m é Objectifs.-Explorer les facteurs de risque de douleurs du rachis en lien avec le personnel et le travail parmi les employés d'un hôpital. Examiner l'effet des variables en lien avec le personnel et le travail sur les conséquences des douleurs du rachis, telles que les consultations chez le médecin ou les congés maladie. Méthodes.-Une enquête par courrier a été menée auprès d'un échantillon de 2700 employés tirés au sort et stratifiés sur les catégories professionnelles (personnel administratif, infirmières, aides-soignantes, médecins, employés à la logistique et autres pluriprofessionels de santé). Le questionnaire évaluait les douleurs vertébrales autorapportées, les conséquences de la douleur et les caractéristiques du travail effectué. Résultats.-Le taux de réponse a été de 48,1 % (1298/2700). La prévalence annuelle des rachialgies était de 67,3 %, la plus élevée parmi les infirmières (75,6 %) et la plus faible parmi les employés à la logistique (54,9 %). Les caractéristiques du poste de travail associées aux rachialgies incluaient : travailler fréquemment à un poste de travail mal adapté (odds ratio (OR) 1,90 [1,24-2,93]) et devoir rester longtemps dans la même position (OR 1,71 [1,25-2,34]). Aucune corrélation significative n'a été observée avec les actions de soulever, manipuler des patients, manipuler du matériel ou travailler en équipe de nuit. Les arrêts de travail dus au mal de dos étaient significativement associés à la durée de l'épisode douloureux (OR 4,08 pour plus de trois mois comparé à moins de dix jours) et avec la catégorie professionnelle (OR 2,58 pour les aides-soignantes en comparaison avec les infirmières). Conclusion.-Dans cette population d'employés hospitaliers, être infirmière, travailler à un poste estimé mal adapté, et devoir fréquemment maintenir longtemps certaines positions, étaient corrélés de faç on indépendante aux rachialgies. Les aides-soignantes présentaient un risque plus élevé d'absentéisme.
La Presse Médicale, 2006
Healthy elderly drivers are more likely to commit errors or lapses than violations Survey of 904 ... more Healthy elderly drivers are more likely to commit errors or lapses than violations Survey of 904 volunteers Objectives > Driving is an important part of everyday life for the elderly today. Older drivers are suspected to be involved in more automobile accidents than younger adults. Although healthcare professionals are aware of specific diseases and impairments that increase accident risks, they cannot distinguish safe from unsafe drivers among the healthy elderly population in general practice. Previous English studies of younger populations differentiate three main types of bad driving that are associated with accident involvement: violations, errors, and lapses. The aim of this study was to assess the driving behavior associated with car crashes in a healthy elderly population. Method > This prospective survey of healthy drivers aged 65 years or older living in the community asked subjects about their habitual driving and accident history in the past three years. Subjects also completed the French version of the Manchester Aging Driver Questionnaire, which contains 24 items, scored from 0 (never) to 5 (nearly all the time) and yields three sub-scales: errors, violations, and lapses. Simple logistic tome 35 > n°6 > juin 2006 > cahier 1 Article original Les conducteurs âgés en bonne santé font plus d'erreurs et d'oublis que d'infractions
Joint Bone Spine, 2011
Objectives: 1) To explore the staff-and work-related risk factors for spinal pain among hospital ... more Objectives: 1) To explore the staff-and work-related risk factors for spinal pain among hospital employees, 2) to investigate the effect of staff-and work-related variables on the consequences of spinal pain, such as doctor visits and sick leave. Methods: A mailed survey was carried out in a random sample of 2700 employees stratified for occupational categories (administration staff, nurses, nurse assistants, physicians, support staff and allied health professionals). The questionnaire measured self-reported spinal pain, consequences of pain, and work characteristics. Results: The response rate was 48.1% (1298/2700). The one-year prevalence of spinal pain was 67.3%, highest among nurses (75.6%) and lowest among support staff (54.9%). Reported work characteristics associated with spinal pain included frequent work at a poorly adapted work station (odds ratio (OR) 1.90 [1.24-2.93]) and having to maintain a position for a long time (OR 1.71 [1.25-2.34]). No significant correlations were observed with lifting, patient handling, material handling, or working on nightshift. Sickness leave due to spinal pain was significantly associated with duration of pain episode (OR 4.08 for > 3 months compared to less than 10 days), and with work categories (OR 2.58 for nurse assistants compared to nurses). Conclusion: In this population of hospital employees, being a nurse, working at a poorly adapted work place, and having to maintain positions for a long time were related independently to spinal pain. Nurse assistants had a higher risk of work absenteeism.
The International Journal of Lower Extremity Wounds, 2007
Patients with diabetes and chronic neurological disorders are most commonly “at-risk” with foot p... more Patients with diabetes and chronic neurological disorders are most commonly “at-risk” with foot problems. The identification of that population is therefore mandatory to prevent severe foot lesions. However, not all health care providers (HCPs) are involved in the screening process in institutions. The authors' aim was to develop and evaluate an educational program for HCP in the field of at-risk foot. All HCPs of the Loëx Hospital (Department of Rehabilitation and Geriatrics, University Hospitals of Geneva) participated in a longitudinal prospective study. Different professions of HCP (doctors, nurses, nursing aides, physiotherapists, occupational therapists, speech-language therapists, and psychologists) attended a structured educational program during a 1-year period based on a specific consultation that the authors developed. During the sessions, risk factors and therapeutic and preventive interventions are discussed with both the patient and care givers. A questionnaire was...
International Journal of Geriatric Psychiatry, 2009
Background Dementia is often considered a predictor of adverse hospitalization outcomes. However,... more Background Dementia is often considered a predictor of adverse hospitalization outcomes. However, the relative contributions of dementia and other risk factors remain unclear. Objective To assess, in a prospective study, the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 AE 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. Results Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. Conclusions Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.
Gait & Posture, 2008
The GAITRite 1 system is a validated portable gait analysis system that allows simple objective g... more The GAITRite 1 system is a validated portable gait analysis system that allows simple objective gait measurements. The limited length of the active area of the GAITRite 1 system may be a limitation in obtaining reliable measures of stride-to-stride variability. In contrast, the SMTEC 1 footswitches system provides a continuous measurement of temporal step parameters for a long distance and a long period (around 24 h). The aim of the study was to examine the concurrent validity of the SMTEC 1 footswitches system with the GAITRite 1 system for the measurement of temporal steps parameters. Step, stride, swing and stance time were simultaneously recorded using SMTEC 1 and GAITRite 1 systems while walking at normal, slow and fast self-selected walking speed among 13 healthy young adults. The level of agreement between both systems was high as for the stride time with intra-class correlation coefficients (ICC) between 0.95 and 0.99 (P < 0.001) and repeatability coefficients (RC) between 1.1% and 1.5% of mean values, whereas the lowest level of agreement was shown at fast self-selected walking speed and for stance time (ICC = 0.52 with P < 0.001 and RC = 4.9%). Furthermore, the measurement of individual footstep data was excellent with an agreement ranging between À0.04 and 0.04 s (Pitman's test of difference in variance: r = À0.009, P = 0.772). The present results suggest that the SMTEC 1 footswitches system provides a valid and reliable measurement of temporal gait parameters in healthy young adults.
Aging Clinical and Experimental Research, 2008
Background and aims: Increased gait variability is associated with a high risk of falling in olde... more Background and aims: Increased gait variability is associated with a high risk of falling in older community-dwellers, but no information exists about the relationship between increased gait variability and falls occurring in older hospitalized patients. We therefore sought to determine, in an acute geriatric setting, whether gait variability in single-(i.e., usual walking) or dual-task conditions can predict inpatient falls. Methods: Stride time variability was calculated in both single-task (i.e., usual walking) and dual-task conditions with a GAITRite ®-System in 13 male and 44 female patients (mean age=85.0, SD=6.6 yrs) consecutively admitted to the acute care geriatric department of Geneva University Hospitals, Switzerland. All participants were able to walk without assistive devices at day 3 post-admission. Falls during hospital stay were identified through the hospital accident reporting system. Results: Ten fallers and 47 non-fallers were identified. The first fall events were significantly associated with the coefficient of variation of stride time in both walking conditions during hospital stay (OR 13.3, (95% CI 1.6-113.6), p=0.018 for usual walking; OR 8.6, (95% CI 1.9-39.6), p=0.006 for dual-task walking). Furthermore, the time elapsing between the first day of hospitalization and the first fall was significantly shorter when the cutoff value of stride time variability was calculated for dual-tasking compared with usual walking. The Cox regression model revealed that only the coefficient of variation of stride time during dual-task walking was significantly associated with the occurrence of the first fall event (p=0.006). Conclusion: Our results suggest that the degree of stride time variability in dual-task walking conditions distinguished fallers from non-fallers in a group of independently walking, older inpatients.
Age and Ageing, 2007
Background demented patients have been reported to be healthier than other old people of the same... more Background demented patients have been reported to be healthier than other old people of the same age. Objectives to assess comorbid conditions, functional and nutritional status in medically ill hospitalised patients with normal cognition or affected by dementia of various causes and severities, or mild cognitive impairment (MCI). Design and Setting a prospective study was carried out, between January and December 2004, in the Rehabilitation and Geriatric Hospital (HOGER). Methods activities of daily living (ADL), instrumental activities of daily living (IADL) and mini nutritional assessment (MNA) scores were assessed as a function of the status of the patient two weeks before admission to hospital. On admission, cognitive status was assessed by a systematic battery of neuropsychological tests, comorbid conditions were assessed with the Charlson comorbidity index (CCI), and body mass index (BMI) and functional independence measure (FIM) were determined. BMI and FIM were also determined on discharge. Results we studied 349 patients (mean age 85.2 ± 6.7; 76% women): 161 (46.1%) cognitively normal, 37 (10.6%) with MCI and 151 (43.3%) demented (61 Alzheimer's disease (AD), 62 mixed dementia (MD) and 17 vascular dementia (VaD)). ADL, IADL, FIM and MNA scores on admission decreased with cognitive status, regardless of the type of dementia. Functionality at discharge remained significantly lower in demented patients than in other patients. CCI was high and similar in all three groups (mean 4.6 ± 2.7). Patients with VaD had poorer health than other demented patients, with a higher average comorbidity score, more frequent hypertension, stroke and hyperlipidaemia. Comorbidity did not increase with severity levels of dementia. Conclusions in this cohort of very old inpatients, demented patients, non-demented patients and patients with MCI had similar levels of comorbidity, but demented patients had a poorer functional and nutritional status.