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Xiong B, Bailey DX, Prudon P, Pascoe EM, Gray LC, Graham F, Henderson A, Martin-Khan M. Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review. Int J Nurs Sci 2024; 11:120-132. [PMID: 38352291 PMCID: PMC10859579 DOI: 10.1016/j.ijnss.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Recognition of the cognitive status of patients is important so that care can be tailored accordingly. The objective of this integrative review was to report on the current practices that acute care hospitals use to identify people with cognitive impairment and how information about cognition is managed within the healthcare record as well as the approaches required and recommended by policies. Methods Following Whittemore & Knafl's five-step method, we systematically searched Medline, CINAHL, and Scopus databases and various grey literature sources. Articles relevant to the programs that have been implemented in acute care hospitals regarding the identification of cognitive impairment and management of cognition information were included. The Mixed Methods Appraisal Tool and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) Checklist were used to evaluate the quality of the studies. Thematic analysis was used to present and synthesise results. This review was pre-registered on PROSPERO ( CRD42022343577). Results Twenty-two primary studies and ten government/industry publications were included in the analysis. Findings included gaps between practice and policy. Although identification of cognitive impairment, transparency of cognition information, and interaction with patients, families, and carers (if appropriate) about this condition were highly valued at a policy level, sometimes in practice, cognitive assessments were informal, patient cognition information was not recorded, and interactions with patients, families, and carers were lacking. Discussion By incorporating cognitive assessment, developing an integrated information management system using information technology, establishing relevant laws and regulations, providing education and training, and adopting a national approach, significant improvements can be made in the care provided to individuals with cognitive impairment.
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Affiliation(s)
- Beibei Xiong
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel X. Bailey
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women’s Hospital, Brisbane, Australia
| | - Paul Prudon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Frederick Graham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Dementia and Delirium, Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Amanda Henderson
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Australia
- Griffith Health, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Brisbane, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- School of Nursing, University of Northern British Columbia, Prince George, Canada
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Abstract
Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.
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Feasibility of reducing frailty components in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial (AD-HOMEX). Exp Gerontol 2021; 150:111390. [PMID: 33962026 DOI: 10.1016/j.exger.2021.111390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES There is a need for interventions to reduce frailty in older people with Alzheimer's dementia (AD). The purpose of this study was to investigate the effect of a home-based multimodal exercise program for older adults with AD (AD-HOMEX) on frailty. DESIGN A parallel single-blind randomized controlled trial comparing a home-based exercise program and usual care. SETTING AND PARTICIPANTS A home-based program in Brazil. Forty individuals aged 65years or older with mild to moderate AD. METHODS The intervention group (IG) participated in a 16-week protocol involving three 60-minute sessions per week of progressive individualized physical exercises supervised by a physical therapist. The participants in the control group (CG) maintained their usual care. Frailty was assessed using the FRAIL questionnaire, the Edmonton Frail Scale (EFS) and a subjective assessment by the evaluator (SAE) at baseline and follow-up. Per-protocol analysis was performed. RESULTS Thirty-five participants completed the program (IG = 16; CG = 19). Frailty improved in the IG based on the EFS (P = .004) and FRAIL (P ≤ .001). An interaction between group and time (P = .008) and a significant difference between times (P = .047) were found for the SAE responsiveness domain. An improvement in the classification of frailty (EFS and FRAIL) was found between times in the IG (P = .003) and between groups at follow-up (P = .027). A significant difference in the SAE classification was found between groups at follow-up (P = .034), with a worsening between times in the CG (P = .032). Interestingly, a more favorable frailty transition pattern was found in the IG based on both the EFS and FRAIL. CONCLUSIONS AND IMPLICATIONS AD-HOMEX seems to reduce frailty and improve frailty transition patterns. Our findings provide a further theoretical basis for designing home-based physical interventions as routine practice for older frail adults with AD.
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Flanagan J, Boltz M, Ji M. A Predictive Model of Intrinsic Factors Associated with Long-Stay Nursing Home Care After Hospitalization. Clin Nurs Res 2020; 30:654-661. [PMID: 33371742 DOI: 10.1177/1054773820985276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to build a predictive model with intrinsic factors measured upon admission to skilled nursing facilities (SNFs) post-acute care (PAC) to identify older adults transferred from SNFs to long-term care (LTC) instead of home. We analyzed data from Massachusetts in 23,662 persons admitted to SNFs from PAC in 2013. Explanatory logistic regression analysis identified single "intrinsic predictors" related to LTC placement. To assess overfitting, the logistic regression predictive model was cross-validated and evaluated by its receiver operating characteristic (ROC) curve. A 12-variable predictive model with "intrinsic predictors" demonstrated both high in-sample and out-of-sample predictive accuracy in the receiver operating characteristic ROC and area under the ROC among patients at risk of LTC placement. This predictive model may be used for early identification of patients at risk for LTC after hospitalization in order to support targeted rehabilitative approaches and resource planning.
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Affiliation(s)
- Jane Flanagan
- Boston College, Chestnut Hill, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Marie Boltz
- Penn State College of Nursing, University Park, PA, USA
| | - Ming Ji
- University of South Florida, FL, USA
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van Haeften-van Dijk AM, Meiland FJ, Hattink BJ, Bakker TJ, Dröes RM. A comparison of a community-based dementia support programme and nursing home-based day care: Effects on carer needs, emotional burden and quality of life. DEMENTIA 2020; 19:2836-2856. [PMID: 31315451 DOI: 10.1177/1471301219861767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Within an implementation study, we investigated the effectiveness of a combined community-based day care programme for persons with dementia and their carers versus traditional psychogeriatric nursing home-based day care. The effects on needs, sense of competence, burden and quality of life of the family carers were studied. METHODS A pretest-posttest control group design among family carers of people with dementia who joined community-based day care centres (n = 67) or nursing home-based day care centres (n = 64). RESULTS After six months, family carers using community-based day care more often expressed an unmet need for support regarding psychological distress than carers utilising nursing home-based day care. No effect of community-based day care on sense of competence was found. However, carers with a low sense of competence at baseline using community-based compared to nursing home-based day care became less emotionally burdened by behaviour and mood problems of their relative.Conclusion and discussion: Overall, no added value of community-based day care on needs, sense of competence, burden and quality of life was found. Increased unmet needs on psychological distress may have been caused by the increased awareness of carers participating in the carer programme of community-based day care regarding their own unmet support needs. For carers with a low sense of competence, community-based day care proves to decrease the impact of behaviour and mood problems of their relative. A larger controlled follow-up study is recommended to understand the long-term effects of community-based day care over nursing home-based day care.
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Affiliation(s)
| | - Franka J Meiland
- Department of Psychiatry and Department of General Practice and Elderly Care Medicine, Amsterdam UMC, the Netherlands
| | | | - Ton Jem Bakker
- Rotterdam University of Applied Sciences and Stichting Wetenschap Balans, the Netherlands
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Provencher V, Clemson L, Wales K, Cameron ID, Gitlin LN, Grenier A, Lannin NA. Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial. BMC Geriatr 2020; 20:84. [PMID: 32122311 PMCID: PMC7053102 DOI: 10.1186/s12877-020-1494-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. TRIAL DESIGN AND METHODS This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics. RESULTS Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved. CONCLUSIONS Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home. TRIAL REGISTRATION The trial was registered before commencement (ACTRN12611000615987).
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Affiliation(s)
- Véronique Provencher
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke Research Centre on Aging, 3001 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, Sydney, 2006, Australia
| | - Kylie Wales
- School of Health Sciences, University of Newcastle, Callaghan, 2308, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA, 19102, USA
| | - Ariane Grenier
- Research Center on Aging, 1036 Belvédère Sud, Sherbrooke, Québec, Canada
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, 3004, Australia. .,Alfred Health, 55 Commercial Road, Melbourne, 3004, Australia.
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Dürst A, Spencer B, Büla C, Fustinoni S, Mazzocato C, Rochat E, Rubli Truchard E, Monod S, Jox RJ. Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments. J Am Geriatr Soc 2020; 68:1202-1209. [DOI: 10.1111/jgs.16392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Anne‐Véronique Dürst
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
| | - Brenda Spencer
- Centre for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
| | - Sarah Fustinoni
- Centre for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
| | - Claudia Mazzocato
- Service of Palliative and Supportive Care Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Etienne Rochat
- Institute of Humanities in Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Eve Rubli Truchard
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
- Chair in Geriatric Palliative Care Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Stéfanie Monod
- General Health Department Ministry of Health and Social Action Lausanne Switzerland
| | - Ralf J. Jox
- Service of Palliative and Supportive Care Lausanne University Hospital (CHUV) Lausanne Switzerland
- Institute of Humanities in Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
- Chair in Geriatric Palliative Care Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
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8
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Scharf AC, Gronewold J, Dahlmann C, Schlitzer J, Kribben A, Gerken G, Frohnhofen H, Dodel R, Hermann DM. Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline. BMC Geriatr 2020; 20:75. [PMID: 32085737 PMCID: PMC7035632 DOI: 10.1186/s12877-020-1443-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods Two hundred forty-two in-patients (57.4% male) aged 78.4 ± 6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β = − 0.19, 95% confidence interval (CI) = − 0.66;-0.13), number of admission diagnoses (β = 0.28, 95% CI = 0.16;0.41), ADL impairment (B = 6.66, 95% CI = 3.312;10.01), and signs of depression (B = 6.69, 95% CI = 1.43;11.94) independently predicted length of hospital stay. ADL impairment (B = 1.14, 95%CI = 0.67;1.61), cognition impairment (B = 0.57, 95% CI = 0.07;1.07) and ISAR score (β =0.26, 95% CI = 0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR) = 1.06, 95% CI = 1.04;1.08), ADL impairment (RR = 3.54, 95% CI = 2.29;5.47), cognition impairment (RR = 1.77, 95% CI = 1.20;2.62) and signs of depression (RR = 1.99, 95% CI = 1.39;2.85) predicted receiving physiotherapy. Conclusion Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.
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Affiliation(s)
- Anne-Carina Scharf
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Janine Gronewold
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Christian Dahlmann
- Nursing Headquarters, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jeanina Schlitzer
- Department of Nephrology, Geriatric and Internal Medicine, Alfried Krupp Hospital Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Helmut Frohnhofen
- Department of Nephrology, Geriatric and Internal Medicine, Alfried Krupp Hospital Essen, Essen, Germany.,Faculty of Health, Department of Medicine, University Witten-Herdecke, Witten, Germany
| | - Richard Dodel
- Department of Geriatrics, University Hospital Essen, Essen, Germany
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
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LeDoux CV, Lindrooth RC, Seidler KJ, Falvey JR, Stevens‐Lapsley JE. The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia. J Am Geriatr Soc 2020; 68:867-871. [DOI: 10.1111/jgs.16307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Cherie V. LeDoux
- Department of Physical Medicine and Rehabilitation University of Colorado Anschutz Medical Campus, Aurora Colorado
| | - Richard C. Lindrooth
- Department of Health Systems, Management and Policy Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora Colorado
| | - Katie J. Seidler
- Department of Physical Medicine and Rehabilitation University of Colorado Anschutz Medical Campus, Aurora Colorado
| | - Jason R. Falvey
- Division of Geriatrics Yale University School of Medicine New Haven Connecticut
| | - Jennifer E. Stevens‐Lapsley
- Department of Physical Medicine and Rehabilitation University of Colorado Anschutz Medical Campus, Aurora Colorado
- Veterans Affairs Geriatric Research Education and Clinical Center Aurora Colorado
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Stelmokas J, Rochette AD, Hogikyan R, Kitchen Andren KA, Reckow J, Sciaky A, Bieliauskas L, Alexander NB. Influence of Cognition on Length of Stay and Rehospitalization in Older Veterans Admitted for Post-Acute Care. J Appl Gerontol 2019; 39:609-617. [PMID: 31169053 DOI: 10.1177/0733464819853989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Evaluate the relative contribution of cognitive test performance to post-acute care (PAC) length of stay (LOS) and rehospitalization while controlling for key demographic, medical, and functional outcomes. METHODS Retrospective medical record review of 160 older Veterans, including cognitive test performance (Addenbrooke's Cognitive Examination-Revised [ACE-R]), on admission to a Veterans Administration Hospital Community Living Center (CLC) PAC. RESULTS Individuals with impaired scores on the ACE-R had a longer LOS (10 median days longer; U = 2,547.00, p = .028). Of those rehospitalized, 71.4% (n = 20) screened positive for cognitive impairment. Key medical factors explained the largest amount of variance in CLC-PAC LOS (29.8%), followed by admission ADL (activities of daily living) dependency (4.6%) and ACE-R total score (3.30%). DISCUSSION Cognitive screening should be considered on PAC admission, with impairment on ACE-R predicting geriatric rehabilitation outcomes such as risk of increased LOS and rehospitalization.
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Affiliation(s)
- Julija Stelmokas
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, MI, USA.,Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, MI, USA.,University of Michigan, Ann Arbor, USA
| | - Amber D Rochette
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, MI, USA.,Kent State University, OH, USA
| | - Robert Hogikyan
- Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, MI, USA.,University of Michigan, Ann Arbor, USA
| | | | - Jaclyn Reckow
- Mercy Health Physician Partners, Grand Rapids, MI, USA
| | - Alexandra Sciaky
- Veterans Affairs Ann Arbor Healthcare System Mental Health Service, MI, USA
| | | | - Neil B Alexander
- Veterans Affairs Ann Arbor Geriatric Research Education and Clinical Center, MI, USA.,Kent State University, OH, USA
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11
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Rehabilitation strategy for hip fracture, focused on behavioral psychological symptoms of dementia for older people with cognitive impairment: A nationwide Japan rehabilitation database. PLoS One 2018; 13:e0200143. [PMID: 29975757 PMCID: PMC6033436 DOI: 10.1371/journal.pone.0200143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/20/2018] [Indexed: 11/25/2022] Open
Abstract
The aim is to investigate the relationship between a positive outcome on rehabilitation after hip fracture and behavioral psychological symptoms of dementia (BPSD) transition during rehabilitation. This study is a retrospective cohort study based on the Japan Rehabilitation Database. We recruited 756 subjects 65 years of age or older from 31 hospitals in the database. All subjects were in the hospital as patients undergoing rehabilitation for hip fracture. Functional independence measure (FIM), walking ability, Mini-Mental State Examination (MMSE), and BPSD were measured both at the beginning and at the end of rehabilitation. MMSE for 23 or under was defined as the cognitive-impaired group. MMSE for 24 or over was used as the cognitively intact group. Cognitive impaired participants were divided into four groups: participants presented no BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (-/-)), participants presented BPSD at the beginning of rehabilitation but resolved at the end of rehabilitation (Group (+/-)), participants had no BPSD at the beginning of rehabilitation but appeared at the end of rehabilitation (Group (-/+)) and participants had sign of BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (+/+)). The endpoints were waking ability, FIM gain. As results, one hundred thirty-seven cognitive-impaired older people patients out of 471 (29.1%) suffered from BPSD at the beginning of rehabilitation. FIM gains in cognitively intact group, Group (-/-), Group (+/-), Group (-/+) and Group (+/+) were 24.8 ± 18.7, 17.5 ± 16.9, 27.3 ± 19.7, 17.8 ± 12.2 and 12.2 ± 17.2, respectively. The Group (+/-) was significantly connected to a positive outcome for rehabilitation. The present study suggested that the management of BPSD can lead to better functional recovery during rehabilitation.
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12
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Nakanishi M, Shindo Y, Niimura J. Discharge Destination of Dementia Patients Who Undergo Intermediate Care at a Facility. J Am Med Dir Assoc 2016; 17:92.e1-7. [DOI: 10.1016/j.jamda.2015.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/28/2015] [Accepted: 10/23/2015] [Indexed: 11/25/2022]
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13
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Vetrano DL, Landi F, De Buyser SL, Carfì A, Zuccalà G, Petrovic M, Volpato S, Cherubini A, Corsonello A, Bernabei R, Onder G. Predictors of length of hospital stay among older adults admitted to acute care wards: a multicentre observational study. Eur J Intern Med 2014; 25:56-62. [PMID: 24054859 DOI: 10.1016/j.ejim.2013.08.709] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/20/2013] [Accepted: 08/28/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reduction in length of hospital stay (LOS) is considered as a potential strategy to optimize resource consumption and reduce health care costs. We analysed predictors of increased LOS among older patients admitted to acute care wards according to type of admission (through the Emergency Room [ER] or elective). METHODS We analysed data of 1123 older patients, aged 65years or older, consecutively admitted to seven acute care wards. LOS was defined as the number of days from admission to discharge (or death) and categorized according to its median value (10days). RESULTS Mean age of participants was 81±7years and 56% were women. Patients admitted through ER had a shorter LOS compared with those elective (10.4±6.7 vs. 12.0±6.7days; p<0.0001). Factors associated with LOS >10days, for patients admitted through ER, were female gender (OR 0.58; 95% C.I. 0.37-0.90), erythrocyte sedimentation rate (OR 1.02; 95% C.I. 1.01-1.03), and excessive polypharmacy (use of ≥10 drugs during stay) (OR 3.60; 95% C.I. 1.40-9.25). Predictors for elective patients were chronic alcohol consumption (OR 0.54; 95% C.I. 0.32-0.93), walking speed ≥0.8m/s (OR 0.31; 95% C.I. 0.14-0.72), excessive polypharmacy (OR 4.78; 95% C.I. 1.92-11.90), pressure ulcers (OR 2.60; 95% C.I. 1.01-6.79), cerebrovascular disease (OR 0.49; 95% C.I. 0.24-0.99) and dementia (OR 0.18; 95% C.I. 0.08-0.39). CONCLUSIONS LOS differed between patients admitted through emergency and through elective admission. Demographic and clinical parameters can affect LOS and polypharmacy was the strongest and the only common risk factor in both groups.
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Affiliation(s)
- Davide L Vetrano
- Department of Geriatrics, Orthopaedics and Neurosciences, Catholic University of Sacred Heart, Rome, Italy.
| | - Francesco Landi
- Department of Geriatrics, Orthopaedics and Neurosciences, Catholic University of Sacred Heart, Rome, Italy
| | | | - Angelo Carfì
- Department of Geriatrics, Orthopaedics and Neurosciences, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Zuccalà
- Emergency Department, Catholic University of Sacred Heart, Rome, Italy
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonio Cherubini
- Geriatrics, Research Hospital of Ancona, IRCCS, Italian National Research Centre on Aging (INRCA), Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmaco-epidemiology, IRCCS, Italian National Research Centre on Aging (INRCA), Cosenza, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Orthopaedics and Neurosciences, Catholic University of Sacred Heart, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Orthopaedics and Neurosciences, Catholic University of Sacred Heart, Rome, Italy
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14
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de Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, Vellas B, Rolland Y. The Nursing Home Effect: A Case Study of Residents With Potential Dementia and Emergency Department Visits. J Am Med Dir Assoc 2013; 14:901-5. [DOI: 10.1016/j.jamda.2013.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 02/02/2023]
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15
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Seematter-Bagnoud L, Lécureux E, Rochat S, Monod S, Lenoble-Hoskovec C, Büla CJ. Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation. Arch Phys Med Rehabil 2013; 94:2373-2380. [PMID: 23850613 DOI: 10.1016/j.apmr.2013.06.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/17/2013] [Accepted: 06/23/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN Observational study. SETTING Postacute rehabilitation facility. PARTICIPANTS Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.
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Affiliation(s)
- Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Estelle Lécureux
- Medical Direction, Lausanne University Hospital, Lausanne, Switzerland
| | - Stéphane Rochat
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Stéfanie Monod
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Constanze Lenoble-Hoskovec
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Christophe J Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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