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Published in: BMC Geriatrics 1/2015

Open Access 01-12-2015 | Research article

Benefits for elders with vulnerable health from the Chronic Disease Self-management Program (CDSMP) at short and longer term

Authors: Angèle A. G. C. Jonker, Hannie C. Comijs, Kees C. P. M. Knipscheer, Dorly J. H. Deeg

Published in: BMC Geriatrics | Issue 1/2015

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Abstract

Background

When health declines, older persons may benefit from an intervention program that strengthens their self-management and empowers them to keep in control of their own body and life. Therefore we conducted a Randomized Controlled Trial using the Chronic Disease Self-Management Program (CDSMP) in a sample of 169 older persons in frail health and in need of elderly care.

Methods

We assessed psychological coping resources and wellbeing, pre- and posttreatment and at 6-month follow-up, and investigated whether specific subgroups would benefit in particular from the intervention.

Results

The CDSMP appeared effective with respect to sense of mastery but only in the lower educated participants (p < .05). Furthermore, the intervention stabilized valuation of life in participants, whereas in the controls valuation of life decreased. The high appreciation score and low drop-out are indicative for the applicability of the CDSMP for this specific target group.

Conclusions

We recommend integration of the ingredients of the program into the daily healthcare practice of professionals working with vulnerable older persons. This would involve professional guidance starting from interpersonal equality and emphasising a persons possibilities given their physical or cognitive limitations. This will help older vulnerable persons to focus on their own attainable goals and to experience being successful.

Trial registration

The trial was registered in the Dutch Trial Register as NTR 1173 at 08-03-2008; ‘Is selfmanagement benefical for well-being of average older persons?’ http://​www.​trialregister.​nl/​trialreg/​admin/​rctview.​asp?​TC=​1173
Literature
1.
go back to reference Hoogendijk E, van der Horst H, Deeg DJH, Frijters DHM, Prins BAH, Jansen APD, et al. The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing. 2013;42:262–5. doi:10.1093/ageing/afsl 63.CrossRefPubMed Hoogendijk E, van der Horst H, Deeg DJH, Frijters DHM, Prins BAH, Jansen APD, et al. The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing. 2013;42:262–5. doi:10.1093/ageing/afsl 63.CrossRefPubMed
2.
go back to reference Puts MTE, Lips P, Ribbe MW, Deeg DJH. The effect of frailty on residential/nursing home admission in the Netherlands independent of chronic diseases and functional limitations. Eur J Ageing. 2005;2:264–74.CrossRef Puts MTE, Lips P, Ribbe MW, Deeg DJH. The effect of frailty on residential/nursing home admission in the Netherlands independent of chronic diseases and functional limitations. Eur J Ageing. 2005;2:264–74.CrossRef
3.
go back to reference Lee L, Heckman G, Molnar F. Frailty. Identifying elderly patients at high risk of poor outcomes. Can Fam Physician. 2015;61(3):227–31. PMC4369632.PubMedPubMedCentral Lee L, Heckman G, Molnar F. Frailty. Identifying elderly patients at high risk of poor outcomes. Can Fam Physician. 2015;61(3):227–31. PMC4369632.PubMedPubMedCentral
4.
go back to reference Pluijm SMF, Bardage C, Nikula S, Blumstein T, Jylhä M, Minicuci N, et al. A harmonized measure of activities of daily living was a reliable and valid instrument for comparing disability in older people across countries. J Clin Epidemiol. 2005;58:1015–23.CrossRefPubMed Pluijm SMF, Bardage C, Nikula S, Blumstein T, Jylhä M, Minicuci N, et al. A harmonized measure of activities of daily living was a reliable and valid instrument for comparing disability in older people across countries. J Clin Epidemiol. 2005;58:1015–23.CrossRefPubMed
5.
go back to reference Melzer D, Lan T-Y, Tom BDM, Deeg DJH, Guralnik JM. Variation in thresholds for reporting mobility disability between national population Sub-groups and studies. J Gerontol A Biol Sci Med Sci. 2004;59:1295–303.CrossRefPubMed Melzer D, Lan T-Y, Tom BDM, Deeg DJH, Guralnik JM. Variation in thresholds for reporting mobility disability between national population Sub-groups and studies. J Gerontol A Biol Sci Med Sci. 2004;59:1295–303.CrossRefPubMed
6.
go back to reference Kunzmann U, Little TD, Smith J. Is age-related stability of subjective well-being a paradox? Cross-sectional and longitudinal evidence from the Berlin Aging Study. Psychol Aging. 2000;15(3):511–26.CrossRefPubMed Kunzmann U, Little TD, Smith J. Is age-related stability of subjective well-being a paradox? Cross-sectional and longitudinal evidence from the Berlin Aging Study. Psychol Aging. 2000;15(3):511–26.CrossRefPubMed
7.
go back to reference Landau R, Litwin H. Subjective well-being among the old-old: the role of health, personality and social support. Int J Aging Hum Dev. 2001;52(4):265–80.CrossRefPubMed Landau R, Litwin H. Subjective well-being among the old-old: the role of health, personality and social support. Int J Aging Hum Dev. 2001;52(4):265–80.CrossRefPubMed
8.
go back to reference Jonker AGC, Comijs HC, Knipscheer CPM, Deeg DJH. Persistent Deterioration of Functioning (PDF) and change in well-being in older persons. Aging Clin Exp Res. 2008;20(5):461–8.CrossRefPubMed Jonker AGC, Comijs HC, Knipscheer CPM, Deeg DJH. Persistent Deterioration of Functioning (PDF) and change in well-being in older persons. Aging Clin Exp Res. 2008;20(5):461–8.CrossRefPubMed
9.
go back to reference Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.CrossRefPubMed Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.CrossRefPubMed
10.
go back to reference Folkman S, Newman S, Lamb R, Shipley M. Social relationships and psychological well-being in rheumatoid arthritis. Soc Sci Med. 1988;27:399–403.CrossRef Folkman S, Newman S, Lamb R, Shipley M. Social relationships and psychological well-being in rheumatoid arthritis. Soc Sci Med. 1988;27:399–403.CrossRef
11.
go back to reference Bisschop MI, Kriegsman DMW, Beekman ATF, Deeg DJH. Chronic diseases and depression: the moderator role of psychosocial resources. Soc Sci Med. 2004;59:721–33.CrossRefPubMed Bisschop MI, Kriegsman DMW, Beekman ATF, Deeg DJH. Chronic diseases and depression: the moderator role of psychosocial resources. Soc Sci Med. 2004;59:721–33.CrossRefPubMed
12.
go back to reference Jonker A, Comijs C, Knipscheer K, Deeg D. The role of coping resources on change in well-being during persistent health decline. J Aging Health. 2009;21(8):1063–82.CrossRefPubMed Jonker A, Comijs C, Knipscheer K, Deeg D. The role of coping resources on change in well-being during persistent health decline. J Aging Health. 2009;21(8):1063–82.CrossRefPubMed
13.
go back to reference Steverink N, Lindenberg S, Slaets J. How to understand and improve older people’s selfmanagement of well-being. Eur J Ageing. 2005;2:235–44.CrossRef Steverink N, Lindenberg S, Slaets J. How to understand and improve older people’s selfmanagement of well-being. Eur J Ageing. 2005;2:235–44.CrossRef
14.
go back to reference Lorig K, Stewart A, Ritter P, González V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks CA: Sage Publications; 1996. Lorig K, Stewart A, Ritter P, González V, Laurent D, Lynch J. Outcome measures for health education and other health care interventions. Thousand Oaks CA: Sage Publications; 1996.
15.
go back to reference Lorig K, Sobel D, Stewart A, Brown Jr B, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Off J Med Care Sect. 1999;37(1):5–14.CrossRef Lorig K, Sobel D, Stewart A, Brown Jr B, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Off J Med Care Sect. 1999;37(1):5–14.CrossRef
16.
go back to reference Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown B-WJ, Bandura A, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39:1217–23.CrossRefPubMed Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown B-WJ, Bandura A, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39:1217–23.CrossRefPubMed
17.
go back to reference Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4:256–62.PubMed Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4:256–62.PubMed
18.
go back to reference Elzen H, Slaets J, Snijders A, Steverink N. Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older persons in the Netherlands. Soc Sci Med. 2006;64:1832–41.CrossRef Elzen H, Slaets J, Snijders A, Steverink N. Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older persons in the Netherlands. Soc Sci Med. 2006;64:1832–41.CrossRef
19.
go back to reference Jonker A, Comijs C, Knipscheer K, Deeg D. Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP). Eur J Ageing. 2009;6:303–14.CrossRefPubMedPubMedCentral Jonker A, Comijs C, Knipscheer K, Deeg D. Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP). Eur J Ageing. 2009;6:303–14.CrossRefPubMedPubMedCentral
20.
go back to reference Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman and company. Times Book; 1997. Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman and company. Times Book; 1997.
21.
go back to reference Lorig K, Holman H, Sobel D, Laurent D, Gonzalez V. Living a healthy life with chronic conditions: self-management of heart disease, arthritis, stroke, diabetes, asthma, bronchitis, emphysema & others. Palo Alto (CA): Bull Publishing Company; 2000. Lorig K, Holman H, Sobel D, Laurent D, Gonzalez V. Living a healthy life with chronic conditions: self-management of heart disease, arthritis, stroke, diabetes, asthma, bronchitis, emphysema & others. Palo Alto (CA): Bull Publishing Company; 2000.
23.
go back to reference Smits C, Deeg D, Bosscher R. Well-being of control in older persons: the prediction of well-being from control measures. Int J Aging Hum Dev. 1995;40(3):237–51.CrossRefPubMed Smits C, Deeg D, Bosscher R. Well-being of control in older persons: the prediction of well-being from control measures. Int J Aging Hum Dev. 1995;40(3):237–51.CrossRefPubMed
24.
go back to reference Schieman S, Campbell J. Age variations in personal agency and self-esteem: the context of physical disability. J Aging Health. 2001;13(2):155–85.CrossRefPubMed Schieman S, Campbell J. Age variations in personal agency and self-esteem: the context of physical disability. J Aging Health. 2001;13(2):155–85.CrossRefPubMed
25.
go back to reference Penninx BWJH, van Tilburg TG, Boeke AJP, Deeg DJH, Kriegsman DMW, van Eijk JTM. Effects of social support and personal coping resources on depressive symptoms: differential in five chronic diseases? Health Psychol. 1998;17:551–8.CrossRefPubMed Penninx BWJH, van Tilburg TG, Boeke AJP, Deeg DJH, Kriegsman DMW, van Eijk JTM. Effects of social support and personal coping resources on depressive symptoms: differential in five chronic diseases? Health Psychol. 1998;17:551–8.CrossRefPubMed
27.
go back to reference Rosenberg M. Society and the adolescent self-image. Princeton University Press: Princeton; 1965.CrossRef Rosenberg M. Society and the adolescent self-image. Princeton University Press: Princeton; 1965.CrossRef
28.
go back to reference Sherer M, Maddux JE, Mercadente B, Prentice-Dunn S, Jacobs B, Rogers RW. The self-efficacy scale: construction and validation. Psychol Rep. 1982;51:663–71.CrossRef Sherer M, Maddux JE, Mercadente B, Prentice-Dunn S, Jacobs B, Rogers RW. The self-efficacy scale: construction and validation. Psychol Rep. 1982;51:663–71.CrossRef
29.
go back to reference Bosscher RJ, Smit JH. Confirmatory factor analysis of the general self-efficacy scale. Behav Res Ther. 1998;36:339–43.CrossRefPubMed Bosscher RJ, Smit JH. Confirmatory factor analysis of the general self-efficacy scale. Behav Res Ther. 1998;36:339–43.CrossRefPubMed
30.
go back to reference Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRef Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRef
31.
go back to reference Ranzijn R, Luszcz M. Measurement of subjective quality of life of elders. Int J Aging Hum Dev. 2000;50(4):263–78.CrossRefPubMed Ranzijn R, Luszcz M. Measurement of subjective quality of life of elders. Int J Aging Hum Dev. 2000;50(4):263–78.CrossRefPubMed
32.
go back to reference Deeg DJH. Health and quality of life. In: Mollenkopf H, Walker A, editors. Quality of life in old age. International and multidisciplinary perspectives. Heidelberg: Springer Verlag, 2007:195–213. Deeg DJH. Health and quality of life. In: Mollenkopf H, Walker A, editors. Quality of life in old age. International and multidisciplinary perspectives. Heidelberg: Springer Verlag, 2007:195–213.
33.
go back to reference Lawton MP, Moss C, Hoffman C, Kleban M, Ruckdeschel K, Winter L. Valuation of life: a concept and a scale. J Ageing Health. 2001;13(1):3–31.CrossRef Lawton MP, Moss C, Hoffman C, Kleban M, Ruckdeschel K, Winter L. Valuation of life: a concept and a scale. J Ageing Health. 2001;13(1):3–31.CrossRef
34.
go back to reference Knipscheer CPM, van Schoor NM, Penninx BWJH, Smit JH. Levenswaardering bij ouderen (LWO): de validering van een meetinstrument [Evaluation of life in the elderly (LWO): the validation of a measuring instrument]. Tijdschr Gerontol Geriatr. 2008;39:133–46.CrossRefPubMed Knipscheer CPM, van Schoor NM, Penninx BWJH, Smit JH. Levenswaardering bij ouderen (LWO): de validering van een meetinstrument [Evaluation of life in the elderly (LWO): the validation of a measuring instrument]. Tijdschr Gerontol Geriatr. 2008;39:133–46.CrossRefPubMed
35.
go back to reference Kriegsman DM, Penninx BW, Van Eijk JT, Boeke AJ, Deeg DJ. Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients self-report and on determinants of inaccuracy. J Clin Epidemiol. 1996;49:1407–17.CrossRefPubMed Kriegsman DM, Penninx BW, Van Eijk JT, Boeke AJ, Deeg DJ. Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients self-report and on determinants of inaccuracy. J Clin Epidemiol. 1996;49:1407–17.CrossRefPubMed
36.
go back to reference Folstein MF, Folstein SE, Mc Hugh PR. Mini mental state: a practical method for grading the cognitive state of patients for the clinic. J Psychiatr Res. 1975;12:189–98.CrossRefPubMed Folstein MF, Folstein SE, Mc Hugh PR. Mini mental state: a practical method for grading the cognitive state of patients for the clinic. J Psychiatr Res. 1975;12:189–98.CrossRefPubMed
37.
go back to reference Kempen G, Brilman E, Ormel J. De Mini-Mental State Examination. Normeringsgegevens en een vergelijking van een 12- en 20-item versie in een steekproef ouderen uit de bevolking [The Mini Mental Status Examination. Normative data and a comparison of a 12-item and 20-item version in a sample survey of community-based elderly]. Tijdschr Gerontol Geriatr. 1995;26:163–72.PubMed Kempen G, Brilman E, Ormel J. De Mini-Mental State Examination. Normeringsgegevens en een vergelijking van een 12- en 20-item versie in een steekproef ouderen uit de bevolking [The Mini Mental Status Examination. Normative data and a comparison of a 12-item and 20-item version in a sample survey of community-based elderly]. Tijdschr Gerontol Geriatr. 1995;26:163–72.PubMed
38.
go back to reference Jang Y, Haley W, Small B, Mortimer J. The role of mastery and social resources in the association between disability and depression in later life. Gerontologist. 2002;42(6):807–13.CrossRefPubMed Jang Y, Haley W, Small B, Mortimer J. The role of mastery and social resources in the association between disability and depression in later life. Gerontologist. 2002;42(6):807–13.CrossRefPubMed
39.
go back to reference Carpenter JS. Self-esteem and well-being among women with breast cancer and women in age-matched comparison group. J Psychosoc Oncol. 1997;15:59–60.CrossRef Carpenter JS. Self-esteem and well-being among women with breast cancer and women in age-matched comparison group. J Psychosoc Oncol. 1997;15:59–60.CrossRef
40.
go back to reference Dirksen SR. Perceived well-being in malignant melanoma survivors. Oncol Nurs Forum. 1989;16:252–8. Dirksen SR. Perceived well-being in malignant melanoma survivors. Oncol Nurs Forum. 1989;16:252–8.
41.
go back to reference Robinson-Smith G, Johnston MV, Allen J. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phys Med Rehabil. 2000;81:460–4.CrossRefPubMed Robinson-Smith G, Johnston MV, Allen J. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phys Med Rehabil. 2000;81:460–4.CrossRefPubMed
42.
go back to reference Schuurmans H. Promoting well-being in frail elderly people. Theory and intervention: Dissertation Rijksuniversiteit Groningen; 2004. Schuurmans H. Promoting well-being in frail elderly people. Theory and intervention: Dissertation Rijksuniversiteit Groningen; 2004.
43.
go back to reference Smith J, Borchelt M, Maier H, Jopp D. Health and well-being in the young old and oldest old. J Soc Issues. 2002;58(4):715–32.CrossRef Smith J, Borchelt M, Maier H, Jopp D. Health and well-being in the young old and oldest old. J Soc Issues. 2002;58(4):715–32.CrossRef
44.
go back to reference Haas M, Groupp E, Muench J, Kraemer D, Brummel-Smith K, Sharma R, et al. Chronic disease self-management program for low back pain in the elderly. J Manip Physiol Ther. 2005;28(4):228–37.CrossRef Haas M, Groupp E, Muench J, Kraemer D, Brummel-Smith K, Sharma R, et al. Chronic disease self-management program for low back pain in the elderly. J Manip Physiol Ther. 2005;28(4):228–37.CrossRef
45.
go back to reference Griffiths G, Motlib J, Azad A, Ramsay J, Eldridge G, Khanam R, et al. Randomized controlled trial of a lay-led self-management program for Bangladeshi patients with chronic disease. Br J Gen Pract. 2005;55:831–7.PubMedPubMedCentral Griffiths G, Motlib J, Azad A, Ramsay J, Eldridge G, Khanam R, et al. Randomized controlled trial of a lay-led self-management program for Bangladeshi patients with chronic disease. Br J Gen Pract. 2005;55:831–7.PubMedPubMedCentral
46.
go back to reference Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, et al. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trail. J Epidemiol Commun H. 2007;61:254–61.CrossRef Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, et al. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trail. J Epidemiol Commun H. 2007;61:254–61.CrossRef
47.
go back to reference Fu D, Fu H, McGowan P, Shen Y, Lizhen Z, Huiqin Y, et al. Implementation and quantitative evaluation of chronic disease self-management program in Shanghai, China: randomized controlled trial. Bull World Health Organ. 2003;81:174–82.PubMedPubMedCentral Fu D, Fu H, McGowan P, Shen Y, Lizhen Z, Huiqin Y, et al. Implementation and quantitative evaluation of chronic disease self-management program in Shanghai, China: randomized controlled trial. Bull World Health Organ. 2003;81:174–82.PubMedPubMedCentral
48.
go back to reference Lorig K, Ritter P, Gonzalez V. Hispanic chronic disease self-management. A randomized community-based outcome trial. Nurs Res. 2003;52(6):361–9.CrossRefPubMed Lorig K, Ritter P, Gonzalez V. Hispanic chronic disease self-management. A randomized community-based outcome trial. Nurs Res. 2003;52(6):361–9.CrossRefPubMed
49.
go back to reference Swerissen H, Belfrage J, Weeks A, Jordan L, Walker C, Furler J, et al. A randomised controlled trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Educ Couns. 2006;64:360–8.CrossRefPubMed Swerissen H, Belfrage J, Weeks A, Jordan L, Walker C, Furler J, et al. A randomised controlled trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Educ Couns. 2006;64:360–8.CrossRefPubMed
50.
go back to reference Gadalla TM. Determinants, correlates and mediators of psychological distress: a longitudinal study. Soc Sci Med. 2009;68:2199–205.CrossRefPubMed Gadalla TM. Determinants, correlates and mediators of psychological distress: a longitudinal study. Soc Sci Med. 2009;68:2199–205.CrossRefPubMed
51.
go back to reference Dalgard OS, Mykletun A, Rognerud M, Johansen R, Zalh PH. Education, sense of mastery and mental health: results from a nationwide health monitoring study in Norway. Bio Med Central Psychiatry. 2007;7:20.CrossRef Dalgard OS, Mykletun A, Rognerud M, Johansen R, Zalh PH. Education, sense of mastery and mental health: results from a nationwide health monitoring study in Norway. Bio Med Central Psychiatry. 2007;7:20.CrossRef
52.
go back to reference Beekman ATF, Deeg DJH, van Tilburg T, Smit JH, Hooijer C, van Tilburg W. Major and minor depression in later life: a study of prevalence and risk factors. J Affect Disorder. 1995;65:65–75.CrossRef Beekman ATF, Deeg DJH, van Tilburg T, Smit JH, Hooijer C, van Tilburg W. Major and minor depression in later life: a study of prevalence and risk factors. J Affect Disorder. 1995;65:65–75.CrossRef
53.
go back to reference Michie S, Abraham C. Interventions to change health behaviors: evidence-based or evidence inspired? Psychology and Health. 2004;19:29–49.CrossRef Michie S, Abraham C. Interventions to change health behaviors: evidence-based or evidence inspired? Psychology and Health. 2004;19:29–49.CrossRef
54.
go back to reference Pregner TV. What’s wrong with Bonferroni adjustments. Br Med J. 1998;316:1236–8.CrossRef Pregner TV. What’s wrong with Bonferroni adjustments. Br Med J. 1998;316:1236–8.CrossRef
Metadata
Title
Benefits for elders with vulnerable health from the Chronic Disease Self-management Program (CDSMP) at short and longer term
Authors
Angèle A. G. C. Jonker
Hannie C. Comijs
Kees C. P. M. Knipscheer
Dorly J. H. Deeg
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2015
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-015-0090-4

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