Fear of Falling Appearing after Post-Acute Rehabilitation is Associated with Reduced Functional Status

Objective: To investigate the association between fear of falling appearing within one month after discharge from post-acute rehabilitation and functional status in elderly patients. Methods: Participants (N=180, mean age 81.37.1 years, 75.6% women) were patients consecutively admitted to rehabilitation over a 6-month period. Demographics, functional, cognitive and affective status were assessed upon admission; functional status was assessed at discharge; history of falls since discharge, functional and affective status were assessed by phone one month after discharge. Fear of falling was assessed using the question: "Are you afraid of falling?". Results: Among patients without fear of falling at discharge (N=95), 20.0% (N=19) reported new fear of falling one month after discharge. Living alone (adjOR=4.9, 95%CI 1.04-23.16, P=.045), functional status at discharge (adjOR=0.5, 95%CI 0.32-0.88, P=.014), and depressive symptoms (adjOR=5.4, 95%CI 1.20-24.32, P=.028) independently predicted fear of falling at one month. There was weak evidence that history of falls since discharge (adjOR=4.1, 95%CI 0.81-21.31, P=.088) was associated with new fear of falling. Developing fear of falling was also associated with reduced functional status at one month (mean basic ADL score: fearful 5.20.8; confident: 5.80.4,P<.001). This association remained after controlling for demographics, functional status at discharge, depressive symptoms, and history of falls since discharge (coef =-0.4, 95%CI -0.73 to -0.16, P=.003). Conclusion: Fear of falling appearing within one month after discharge from post-acute rehabilitation was associated with reduced functional status in elderly patients. Further studies should determine whether early interventions targeting specifically fear of falling in these patients would improve their functional status.

Unplanned nursing home short stay : elderly patients characteristics and 3-month outcomes.

Background: Nursing home short stays (NHSS) in the canton of Vaud have been introduced for respite care purpose. However, a growing number of older patients are urgently admitted from home (within 24h) or directly after hospital discharge (58% of all admissions in 2010). NHSS appears therefore as an increasingly important component of the health care system, but the characteristics of admitted patients have not been previously described. A better knowledge would contribute to identify specific care needs and enhance their care. Objectives: 1) To describe the characteristics of patients admitted in unplanned NHSS ( after hospital stay or urgently from home); 2) To determine living disposition 3-month after NHSS discharge. Method: Over a 18-month period, elderly patients with unplanned NHSS admission to 2 facilities in Lausanne were identified. Demographic, social, health, and functional data, as well as main reason for admission were collected. Death and place of living at 3-months were collected using the administrative database. Results: Overall, 114 patients (mean age 83.1 ± 6.2 years, 77% women, 84% living alone) were assessed, 80% being admitted from hospital. Mean score in Lawton's instrumental ADL before NHSS admission was 4.6 ± 2.5 and 69% of the patients were home care recipients (median number of weekly visits: 5 ± 3). Patients reported going out 4.2 ± 1.3 times/week and 56% reported at least one fall over the past year. Among the 91 patients coming from the hospital, main reason for admission was injury/limb immobilization (58%), recuperation (13%) and functional impairment in basic ADL (10%). Mean score at Katz's Basic ADL at admission was 3.7 ± 1.9. Overall, 90% of patients were identified with gait and balance impairment, 78% with cognitive impairment and 70% with polypharmacy (>6 different drugs). At 3-month after NHSS discharge (N = 92), 72% patients were living at home, 16% had been admitted to long term care, and 6% died. Among patients living at home at follow-up, 11% had been readmitted to hospital during the follow-up period. Conclusion: Older patients with unplanned NHSS admission show a high prevalence of functional, mobility, and cognitive impairments, as well as other geriatric syndromes. Specific measures should be considered during these stays to prevent further functional decline and, possibly, hospital readmission. Patients admitted with basic ADLs impairment might be candidate for higher levels of care (rehabilitation).

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.

Emission of carbon nanofiber (CNF) from CNF-containing composite adsorbents

In spite of numerous applications of carbon nanofibers (CNFs) in a variety of fields, the potential release of airborne CNF during their special application, which could lead to workers or end-users exposure, has not been well investigated. In this study, the potential release of CNF from an organic vapour respirator cartridge was evaluated by carbon analysis and microscopy analysis. The cartridge consisted of an AC (Activated Carbon)/CNF composite adsorbent and different types of particulate filters. The composite adsorbent CNF were prepared by chemical vapour deposition (CVD). Air was passed through the prepared cartridge for 12 hours at 12 l/min and particles were collected on sampling filters suitable for measuring organic and elemental carbon (OC/EC) by carbon analysis based on the NIOSH 5040 method. Breakthrough of CNFs was also checked by scanning and transmission electron microscopy (SEM/TEM). This study found only minimal amounts of released elemental carbon while passing the air through the cartridge. Meanwhile TEM photos showed a few CNF structures for AC/CNF composite adsorbents which were not in the critical range in terms of length, aspect ratio, or number. [Authors]

Falls efficacy predicts functional status on month after discharge in elderly patients undergoing post-accute rehabilitation

Objective: To investigate the relationship between falls efficacy at admission and functional status reported one month after discharge from post-acute rehabilitation in a cohort of elderly patients. Methods: Participants were elderly patients admitted to postacute rehabilitation in an academic geriatric facility. Data on demographics and affective status were collected upon admission; functional status and gait speed were measured at admission and at discharge; self-reported functional status and history of falls since discharge were collected one month after discharge (follow-up). Falls efficacy was measured using the Fall Efficacy Scale, that assesses confidence in performing 12 activities of daily living without falling (range 0 to 100, higher score indicating higher confidence). Patients were classified using the median FES score at baseline (95) as cut-off to divide the population into "confident" and "fearful" groups. Results: Participants' (N=180, mean age 81.3±7.1 years, 75.6% women) mean FES score was 92.3±8.7 at baseline (range 60-100). Basic ADL score averaged 3.5±1.6 at baseline, 4.7±1.3 at discharge, and 5.5±0.7 at follow-up (self-reported). Baseline FES score was positively correlated with basic ADL at follow-up (rho=0.35, p<.001). At follow-up, 58.7% of the patients were fully independent in basic ADL, this proportion being significantly higher in confident than fearful patients (70.7% vs 42.4%, p<.001). Compared to confident patients, those fearful had significantly lower odds (OR 0.3, 95%CI 0.2-0.6, p<.001) to report full independence at follow-up. This relationship remained (adjOR = 0.4, 95%CI 0.2-0.8, p=.01) after controlling for demographics, baseline gait speed, depressive symptoms, functional status at discharge, and history of falls since discharge. Conclusion: In this cohort of older rehab patients, poor falls efficacy at admission was associated with lower function reported one month after discharge even after controlling for initial mobility performance and functional status at discharge. Further studies should determine whether interventions aiming at falls efficacy improvement will also result in improved function in fearful subjects undergoing rehabilitation.

Self-perception of aging and vulnerability to adverse outcomes at the age of 65-70 years.

OBJECTIVES. This study examines the relationship between self-perception of aging and vulnerability to adverse outcomes in adults aged 65-70 years using data from a cohort of 1,422 participants in Lausanne, Switzerland. METHODS: A positive or negative score of perception of aging was established using the Attitudes Toward Own Aging subscale including 5 items of the Philadelphia Geriatric Center Morale Scale. Falls, hospitalizations, and difficulties in basic and instrumental activities of daily living (ADL) collected in the first 3 years of follow-up were considered adverse outcomes. The relationship between perception and outcomes were evaluated using multiple logistic regression models adjusting for chronic medical conditions, depressive feelings, living arrangement, and socioeconomic characteristics. RESULTS: The strongest associations of self-perception of aging with outcomes were observed for basic and instrumental ADL. Associations with falls and hospitalizations were not constant but could be explained by health characteristics. CONCLUSIONS: A negative self-perception of aging is an indicator of risk for future disability in ADL. Factors such as a low-economic status, living alone, multiple chronic medical conditions, and depressive feelings contribute to a negative self-perception of aging but do not explain the relationship with incident activities of daily living disability.

Asociaciones entre la red social y la discapacidad al comienzo de la vejez en las ciudades de Madrid y Barcelona en 2005

La pérdida de autonomía a edades avanzadas no se asocia únicamente con el envejecimiento sino también con características del entorno físico y social. Investigaciones recientes han demostrado que la red social, la integración social y la participación, actúan como predictores de la discapacidad en la vejez. El objetivo de este trabajo es nalizar el efecto de la red social sobre el nivel de autonomía(en términos de discapacidad instrumental y básica) en etapas iniciales de la vejez.

Protective effects of social networks on disability among older adults in Spain

The loss of autonomy at advanced ages is not only associated with ageing, but also with the characteristics of the physical and social environment. Recent investigations have shown that social networks, social engagement and participation act like predictors of disability among the elderly. The aim of this study is to determine whether social networks are related to the development and progression of disability in the early years of old age. The source of data is the first wave of the survey "Processes of Vulnerability among Spanish Elderly", carried out in 2005 to a sample of 1 244 individuals. The population object of study is the cohort aged 70 to 74 years in metropolitan areas (Madrid and Barcelona) and not institutionalized. Disability is measured by the development of basic activities of daily life (ADL), and instrumental activities of daily life (IADL). The structural aspects of the social relationships are measured through the diversity of social networks and participation. We used the social network index (SNI). For each point over the SNI, the risk of developing any type of disability decreased by 49% (HR = 0.51, 95%CI = 0.31-0.82). The SNI was a decisive factor in all forecasting models constructed with some hazard ratios (HR) that ranged from 0.29 (95%CI = 0.14-0.59) in the first model to 0.43 (95%CI 0.20-0.90) in the full model. The results of the present study showed a strong association between an active social life, emotional support provided by friends and confidents and disability. These findings suggest a protective effect of social networks on disability. Also, these results indicate that some family and emotional ties have a significant effect on both the prevalence and the incidence of disability.

Nursing intervention versus usual care to improve delirium among home-dwelling older adults receiving homecare after hospitalization: feasibility and acceptability of a Randomized Controlled Trail.

BACKGROUND: Delirium is an acute cognitive impairment among older hospitalized patients. It can persist until discharge and for months after that. Despite proof that evidence-based nursing interventions are effective in preventing delirium in acute hospitals, interventions among home-dwelling older patients is lacking. The aim was to assess feasibility and acceptability of a nursing intervention designed to detect and reduce delirium in older adults after discharge from hospital. METHODS: Randomized clinical pilot trial with a before/after design was used. One hundred and three older adults were recruited in a home healthcare service in French-speaking Switzerland and randomized into an experimental group (EG, n = 51) and a control group (CG, n = 52). The CG received usual homecare. The EG received usual homecare plus five additional nursing interventions at 48 and 72 h and at 7, 14 and 21 days after discharge. These interventions were tailored for detecting and reducing delirium and were conducted by a geriatric clinical nurse (GCN). All patients were monitored at the start of the study (M1) and throughout the month for symptoms of delirium (M2). This was documented in patients' records after usual homecare using the Confusion Assessment Method (CAM). At one month (M2), symptoms of delirium were measured using the CAM, cognitive status was measured using the Mini-Mental State Examination (MMSE), and functional status was measured using Katz and Lawton Index of activities of daily living (ADL/IADL). At the end of the study, participants in the EG and homecare nurses were interviewed about the acceptability of the nursing interventions and the study itself. RESULTS: Feasibility and acceptability indicators reported excellent results. Recruitment, retention, randomization, and other procedures were efficient, although some potentially issues were identified. Participants and nurses considered organizational procedures, data collection, intervention content, the dose-effect of the interventions, and methodology all to be feasible. Duration, patient adherence and fidelity were judged acceptable. Nurses, participants and informal caregivers were satisfied with the relevance and safety of the interventions. CONCLUSIONS: Nursing interventions to detect/improve delirium at home are feasible and acceptable. These results confirm that developing a large-scale randomized controlled trial would be appropriate. TRIAL REGESTRATION: ISRCTN registry no: 16103589 - 19 February 2016.

Muutosilmiöt soodakattilakeossa

Soodakattilan sulakeon epästationaarinen käyttäytyminen sekä keon pitkä jäähtymisaika alasajon jälkeen ovat aiheuttaneet ongelmia kattilan taloudellisessa käytettävyydessä. Keon käyttäytymisestä on luotu CFD-malleja, joiden tavoitteena on havainnollistaa keon lämpötilajakaumaa ja rakennetta. Mallien ongelmana on se, että niissä huomioidaan vain keon aktiivinen pintakerros. Keon sisäosan rakennetta ja siinä tapahtuvia prosesseja ei toistaiseksi tunneta kunnolla luotettavan, koko keon kattavan mallin luomiseen. Tässä työssä tutkittiin sulakeon käytön aikana havaittuja muutosilmiöitä, jotka vaikuttavat keon rakenteeseen ja ominaisuuksiin sekä tutkittiin ilmiöiden taustalla olevia tekijöitä. Näitä tekijöitä ovat keon sisässä tapahtuvat kemialliset ja fyysiset prosessit, jotka aiheuttavat muutoksia niin lämpöteknisesti kuin fyysisesti sekä ulkoapäin tulevat tekijät, jotka aiheutuvat ajotilanteiden seurauksena tapahtuvista muutoksista. Työn kokeellisena osana luotiin sulakeon jäähtymismalli käyttäen 1-dimensionaalista ADL-mallia. Mallin pohjana käytettiin StoraEnso Oy:ltä Oulun soodakattilan sulakeosta saatua mittausraporttia. ADL-mallin avulla luotiin keon jäähtymiskäyrät lämpötilan ja syvyyden funktiona. Saadut käyrät täsmäsivät hyvin mittausraportin tuloksiin. Mallin avulla keolle saatiin muodostettua energiatase, jonka tuloksena keosta 12 tunnin aikana poistuva lämpövirta pinnalla oli noin 9.8kW/m2 ja pinnan lämmönsiirtokerroin 58.3W/m²°C. Pohjan poistuvaksi lämpövirraksi saatiin 14.1kW/m2 ja lämmönsiirtokertoimeksi 75.4W/m²°C. Termiseksi diffuusiokertoimeksi saatiin 3.9•10-7m²/s.

Fractures in older people - incidence, predictors and consequences

In older populations, fractures are common and the consequences of fractures may be serious both for an individual and for society. However, information is scarce about the incidence, predictors and consequences of fractures in population-based unselected cohorts including both men and women and a long follow-up. The objective of this study was to analyse the incidence and predictors of fractures as well as functional decline and excess mortality due to fractures, among 482 men and 695 women aged 65 or older in the municipality of Lieto, Finland from 1991 until 2002. In analyses, Poisson’s, Cox proportional Hazards and Cumulative Logistic regression models were used for the control of several confounding variables. During the 12-year follow-up with a total of 10 040 person-years (PY), 307 (26%) persons sustained altogether 425 fractures of which 77% were sustained by women. The total incidence of fractures was 53.4 per 1000 PY (95% confidence intervals [95% CI]: 47.9 - 59.5) in women and 24.9 per 1000 PY (95% CI: 20.4 - 30.4) in men. The incidence rates of fractures at any sites and hip fractures were associated with increasing age. No significant changes in the ageadjusted incidence rates of fractures were found in either gender during the 12-year follow-up. The predictors of fractures varied by gender. In multivariate analyses, reduced handgrip strength and body mass index (BMI) lower than 30 in women and a large number of depressive symptoms in men were independent predictors of fractures. A compression fracture in one or more thoracic or upper lumbar vertebras on chest radiography at baseline was associated with subsequent fractures in both genders. Lower body fractures independently predicted both short- (0-2 years) and long-term (up to 8 years) functional decline in mobility and activities of daily living (ADL) performance during the 8-year follow-up. Upper body fractures predicted decline in ADL performance during longterm follow-up. In the 12-year follow-up, hip fractures in men (Hazard Ratio [HR] 8.1, 95% CI: 4.4-14.9) and in women (HR 3.0, 95% CI: 1.9-4.9), and fractures at the proximal humerus in men (HR 5.4, 95% CI: 1.6-17.7) were independently associated with excess mortality. In addition, leisure time inactivity in physical exercise predicted independently both functional decline and excess mortality. Fractures are common among older people posing serious individual consequences. Further studies about the effectiveness of preventing falls and fractures as well as improving care and rehabilitation after fractures are needed.

Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training - motor movements, verbal association, and categorization - and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

Survey of trace element and dietetic fiber composition of “Leblebi” which is a local snack food consumed in Turkey

Abstract In Turkey and several Middle East countries' people consume “leblebi” which is a traditional snack food made from chickpeas (Cicer arietinum L.). Chickpea products are highly nutritive and a cheap food for human consumption and have become an essential part of daily diets in the world. The present study aims to determine the chemical, nutritional and dietary composition of fifty leblebi samples marketed in Turkey. Protein values of the leblebi ranged from 19.4 to 23.9% dehulled and 20.3 to 20.8% for nondehulled leblebi while a value of 19.1% was recorded for chickpeas. Mineral results showed that Potassium (K) was the most abundant element in leblebi ranging from 6514 to 14431 mg/kg. The amount of dietary components neutral detergent fibre (NDF), acid detergent fibre (ADF), acid detergent lignin (ADL) and cellulose did not vary much between the samples analyzed.

Case Management in der ambulanten gerontopsychiatrischen Versorgung

In der vorliegenden Arbeit wird ein am Strengths-Modell orientiertes Case Management-Projekt zur Prozess- und Ergebnisoptimierung der bereits bestehenden ambulanten gerontopsychiatrischen Versorgungsstruktur untersucht. Dazu arbeitete eine Krankenpflegerin mit psychiatrischer Fachausbildung in einer Berliner Sozialstation auf Basis einer professionellen Beziehung für 4-6 Wochen bei Klientinnen mit gerontopsychiatrischen Problemlagen, erstellte ein Assessment, leistete notwendige Unterstützung zunächst selbst, vermittelte gestützt auf die eigenen Erfahrungen weiterführende Dienste, leitete diese Dienste an, zog sich dann aus dem direkten Kontakt mit den Klientinnen zurück und blieb beratend für die weiterführenden Dienste verfügbar. Zur Untersuchung des Projekts wurden qualitative und quantitative Verfahren eingesetzt. Zur Beschreibung der Inhalte wurden die für jede Klientin verfasste Dokumentation und die Ergebnisse von grob strukturierten Interviews mit der Case Managerin, angelehnt an eine reduzierte Form der Methode Grounded Theory, in einem iterativen Prozess analysiert. In einem zweiten Schritt wurde dann untersucht, inwieweit die einzelnen Arbeitsinhalte des Case Managements die sozial-räumlichdingliche Umweltanpassung und Proaktivität der Klientinnen unterstützten. Die Wirkungen des Projektes auf Kognition, Aktivitäten des täglichen Lebens (ADL), Instrumentelle Aktivitäten des täglichen Lebens (IADL), Stimmung sowie soziales und störendes Verhalten wurden mittels eines standardisierten Fragebogens mit einem quasi-experimentellen prospektiven Untersuchungsdesign analysiert. Zur Analyse der subjektiven Wirkung des Projektes auf Angehörige wurden in den Ergebnissen von grob strukturierten Interviews mittels eines iterativen Prozesses Themen identifiziert. Die Klientinnen (n=11) erhielten durchschnittlich 23 Stunden Case Management. Neben den typischen Case Management-Aufgaben führte die Case Managerin, basierend auf den Gewohnheiten, Interessen und Selbsteinschätzungen der Klientinnen, therapeutische und pflegerische Maßnahmen durch und unterstützte dabei die sozial-dinglichräumliche Umweltanpassung und Proaktivität der Klientinnen. Zusätzlich wurden Hauspflegerinnen von der Case Managerin individuell in der Wohnung von Klientinnen hinsichtlich der Kommunikation mit und Unterstützung der Proaktivität von Klientinnen angeleitet. Die Hauspflegerinnen führten die von der Case Managerin eingeleiteten Maßnahmen erfolgreich fort. Bei den Klientinnen zeigten sich signifikante Verbesserungen in Gedächtnis, Stimmung, IADL-Funktionen und Sozialverhalten, aber nicht in ADL-Funktionen und störendem Verhalten. Diese Verbesserungen wurden subjektiv von den Angehörigen (n=7) bestätigt. Zusätzlich empfanden Angehörige eine zeitliche aber keine psychische Entlastung. Mit diesem Projekt wurde gezeigt, dass ein zeitlich begrenztes klientenzentriertes Case Management kognitive, soziale und emotionale Funktionen von gerontopsychiatrisch Erkrankten verbessert, Angehörige zeitlich entlastet und dass Hauspflegerinnen bei entsprechender Anleitung die vom Case Management eingeleiteten Maßnahmen fortführen können. In Folgestudien mit größerem Umfang sollten diese Ergebnisse überprüft werden um dann zu entscheiden, ob dieser Ansatz geeignet ist, die ambulante gerontopsychiatrische Versorgung gemeindenah zu verbessern.

Impact of sward type, cutting date and conditioning temperature on mass and energy flows in the integrated generation of solid fuel and biogas from semi-natural grassland

Energy production from biomass and the conservation of ecologically valuable grassland habitats are two important issues of agriculture today. The combination of a bioenergy production, which minimises environmental impacts and competition with food production for land with a conversion of semi-natural grasslands through new utilization alternatives for the biomass, led to the development of the IFBB process. Its basic principle is the separation of biomass into a liquid fraction (press fluid, PF) for the production of electric and thermal energy after anaerobic digestion to biogas and a solid fraction (press cake, PC) for the production of thermal energy through combustion. This study was undertaken to explore mass and energy flows as well as quality aspects of energy carriers within the IFBB process and determine their dependency on biomass-related and technical parameters. Two experiments were conducted, in which biomass from semi-natural grassland was conserved as silage and subjected to a hydrothermal conditioning and a subsequent mechanical dehydration with a screw press. Methane yield of the PF and the untreated silage was determined in anaerobic digestion experiments in batch fermenters at 37°C with a fermentation time of 13-15 and 27-35 days for the PF and the silage, respectively. Concentrations of dry matter (DM), ash, crude protein (CP), crude fibre (CF), ether extract (EE), neutral detergent fibre (NDF), acid detergent fibre (ADF), acid detergent ligning (ADL) and elements (K, Mg, Ca, Cl, N, S, P, C, H, N) were determined in the untreated biomass and the PC. Higher heating value (HHV) and ash softening temperature (AST) were calculated based on elemental concentration. Chemical composition of the PF and mass flows of all plant compounds into the PF were calculated. In the first experiment, biomass from five different semi-natural grassland swards (Arrhenaterion I and II, Caricion fuscae, Filipendulion ulmariae, Polygono-Trisetion) was harvested at one late sampling (19 July or 31 August) and ensiled. Each silage was subjected to three different temperature treatments (5°C, 60°C, 80°C) during hydrothermal conditioning. Based on observed methane yields and HHV as energy output parameters as well as literature-based and observed energy input parameters, energy and green house gas (GHG) balances were calculated for IFBB and two reference conversion processes, whole-crop digestion of untreated silage (WCD) and combustion of hay (CH). In the second experiment, biomass from one single semi-natural grassland sward (Arrhenaterion) was harvested at eight consecutive dates (27/04, 02/05, 09/05, 16/05, 24/05, 31/05, 11/06, 21/06) and ensiled. Each silage was subjected to six different treatments (no hydrothermal conditioning and hydrothermal conditioning at 10°C, 30°C, 50°C, 70°C, 90°C). Energy balance was calculated for IFBB and WCD. Multiple regression models were developed to predict mass flows, concentrations of elements in the PC, concentration of organic compounds in the PF and energy conversion efficiency of the IFBB process from temperature of hydrothermal conditioning as well as NDF and DM concentration in the silage. Results showed a relative reduction of ash and all elements detrimental for combustion in the PC compared to the untreated biomass of 20-90%. Reduction was highest for K and Cl and lowest for N. HHV of PC and untreated biomass were in a comparable range (17.8-19.5 MJ kg-1 DM), but AST of PC was higher (1156-1254°C). Methane yields of PF were higher compared to those of WCD when the biomass was harvested late (end of May and later) and in a comparable range when the biomass was harvested early and ranged from 332 to 458 LN kg-1 VS. Regarding energy and GHG balances, IFBB, with a net energy yield of 11.9-14.1 MWh ha-1, a conversion efficiency of 0.43-0.51, and GHG mitigation of 3.6-4.4 t CO2eq ha-1, performed better than WCD, but worse than CH. WCD produces thermal and electric energy with low efficiency, CH produces only thermal energy with a low quality solid fuel with high efficiency, IFBB produces thermal and electric energy with a solid fuel of high quality with medium efficiency. Regression models were able to predict target parameters with high accuracy (R2=0.70-0.99). The influence of increasing temperature of hydrothermal conditioning was an increase of mass flows, a decrease of element concentrations in the PC and a differing effect on energy conversion efficiency. The influence of increasing NDF concentration of the silage was a differing effect on mass flows, a decrease of element concentrations in the PC and an increase of energy conversion efficiency. The influence of increasing DM concentration of the silage was a decrease of mass flows, an increase of element concentrations in the PC and an increase of energy conversion efficiency. Based on the models an optimised IFBB process would be obtained with a medium temperature of hydrothermal conditioning (50°C), high NDF concentrations in the silage and medium DM concentrations of the silage.