1
|
Rivasi G, Bulgaresi M, Mossello E, Zimmitti S, Barucci R, Taverni I, Tofalos SE, Cinelli G, Nicolaio G, Secciani C, Bendoni A, Rinaldi G, Nakano Da Silva DM, Barchielli C, Baggiani L, Bonaccorsi G, Ungar A, Benvenuti E. A New Hospital-At-Home Model for Integrated Geriatric Care: Data From a Preliminary Italian Experience. J Am Med Dir Assoc 2024:105295. [PMID: 39379008 DOI: 10.1016/j.jamda.2024.105295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE Hospital-at-home (HaH) has emerged as an alternative to conventional in-hospital care in older adults, possibly reducing hospital admissions and related complications. This study aimed to describe the characteristics and outcomes of patients referred to "Gruppo di Intervento Rapido Ospedale-Territorio" (GIROT), a HaH service based on comprehensive geriatric assessment, developed in Florence, Italy, during the postpandemic period. DESIGN Retrospective longitudinal study. SETTING AND PARTICIPANTS GIROT provided home-based care to patients with acute or exacerbated chronic diseases and a high risk of hospital-related complications (ie, patients with moderate-to-severe disability and/or dementia), referred from primary care, emergency departments, or in-hospital units. METHODS All-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated. RESULTS Among 391 patients (mean age, 88.4 years; 62.4% female) referred from emergency departments (58.6%), primary care (27.9%), and acute medical units (13.6%), the main diagnoses were respiratory failure (28.4%), acute heart failure (25.3%), and delirium (13.6%). Patients referred from primary care were older and showed a higher prevalence of severe disability and hypomobility. After 1, 3, and 6 months, mortality rates were 34.5%, 45.6%, and 53.8%, and hospitalization rates 7.2%, 21.5%, and 37.9%, respectively. Predictors of 6-month mortality included age (odds ratio [OR], 1.039), severe disability (OR, 3.446), impossible/assisted walking (OR, 4.450) and referral from primary care (OR, 2.066). High global satisfaction with the service was reported. CONCLUSIONS AND IMPLICATIONS The GIROT model may help expanding acute health care capacity for older adults at high risk of hospital-related complications. Customized care plans are needed in patients with severe disability/hypomobility, considering also simultaneous palliative care.
Collapse
Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy.
| | - Matteo Bulgaresi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | | | - Riccardo Barucci
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Irene Taverni
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| | - Sofia Espinoza Tofalos
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | - Giacomo Cinelli
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | - Giulia Nicolaio
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | - Camilla Secciani
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | - Arianna Bendoni
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | - Giada Rinaldi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | | | - Chiara Barchielli
- Health and Management Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Lorenzo Baggiani
- Department of Community Healthcare Network, Health District "Toscana Centro", Florence, Italy
| | | | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital, and University of Florence, Florence, Italy
| | - Enrico Benvenuti
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy
| |
Collapse
|
2
|
Pan C, Luo H, Cheung G, Zhou H, Cheng R, Cullum S, Wu C. Identifying Frailty in Older Adults Receiving Home Care Assessment Using Machine Learning: Longitudinal Observational Study on the Role of Classifier, Feature Selection, and Sample Size. JMIR AI 2024; 3:e44185. [PMID: 38875533 PMCID: PMC11041467 DOI: 10.2196/44185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/22/2023] [Accepted: 01/01/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Machine learning techniques are starting to be used in various health care data sets to identify frail persons who may benefit from interventions. However, evidence about the performance of machine learning techniques compared to conventional regression is mixed. It is also unclear what methodological and database factors are associated with performance. OBJECTIVE This study aimed to compare the mortality prediction accuracy of various machine learning classifiers for identifying frail older adults in different scenarios. METHODS We used deidentified data collected from older adults (65 years of age and older) assessed with interRAI-Home Care instrument in New Zealand between January 1, 2012, and December 31, 2016. A total of 138 interRAI assessment items were used to predict 6-month and 12-month mortality, using 3 machine learning classifiers (random forest [RF], extreme gradient boosting [XGBoost], and multilayer perceptron [MLP]) and regularized logistic regression. We conducted a simulation study comparing the performance of machine learning models with logistic regression and interRAI Home Care Frailty Scale and examined the effects of sample sizes, the number of features, and train-test split ratios. RESULTS A total of 95,042 older adults (median age 82.66 years, IQR 77.92-88.76; n=37,462, 39.42% male) receiving home care were analyzed. The average area under the curve (AUC) and sensitivities of 6-month mortality prediction showed that machine learning classifiers did not outperform regularized logistic regressions. In terms of AUC, regularized logistic regression had better performance than XGBoost, MLP, and RF when the number of features was ≤80 and the sample size ≤16,000; MLP outperformed regularized logistic regression in terms of sensitivities when the number of features was ≥40 and the sample size ≥4000. Conversely, RF and XGBoost demonstrated higher specificities than regularized logistic regression in all scenarios. CONCLUSIONS The study revealed that machine learning models exhibited significant variation in prediction performance when evaluated using different metrics. Regularized logistic regression was an effective model for identifying frail older adults receiving home care, as indicated by the AUC, particularly when the number of features and sample sizes were not excessively large. Conversely, MLP displayed superior sensitivity, while RF exhibited superior specificity when the number of features and sample sizes were large.
Collapse
Affiliation(s)
- Cheng Pan
- Department of Computer Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Huiquan Zhou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Reynold Cheng
- Department of Computer Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Sarah Cullum
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Chuan Wu
- Department of Computer Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
| |
Collapse
|
3
|
Julià-Móra JM, Blanco-Mavillard I, Prieto-Alomar A, Márquez-Villaverde E, Terrassa-Solé M, Leiva-Santos JP, Rodríguez-Calero MÁ. Analysis of palliative care needs in hospitalized patients. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:261-268. [PMID: 37419323 DOI: 10.1016/j.enfcle.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/16/2023] [Indexed: 07/09/2023]
Abstract
AIM To determine the prevalence of palliative care needs in patients in an acute care hospital and to analyze the profile of these patients. DESIGN We conducted a prospective cross-sectional study in an acute care hospital, in April 2018. The study population consisted of all patients over 18 years of age admitted to hospital wards and intensive care units. Variables were collected on a single day by six micro-teams using the NECPAL CCOMS-ICO© instrument. The descriptive analysis, on patient mortality and length of stay, was performed at a one-month follow-up. RESULTS We assessed 153 patients, of whom 65 (42.5%) were female, with a mean age of 68.17±17.03 years. A total of 45 patients (29.4%) were found to be SQ+, of which 42 were NECPAL+ (27.5%), with a mean age of 76.64±12.70 years. According to the disease indicators, 33.35% had cancer, 28.6% had heart disease, and 19% had COPD, resulting in a ratio of 1:3 between patients with cancer and non-cancer disease. Half of the inpatients in need of palliative care were in the Internal Medicine Unit. CONCLUSIONS Almost 28% of patients were identified as NECPAL+, most of them not identified as under palliative care in clinical records. Greater awareness and knowledge from healthcare professionals would facilitate the early identification of these patients and avoid overlooking palliative care needs.
Collapse
Affiliation(s)
- Joana Maria Julià-Móra
- Equipo de Soporte de Cuidados Paliativos, Hospital de Manacor, Manacor, Spain; Grupo de investigación en Cuidados, Cronicidad y Evidencias en Salud (CurES), Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Ian Blanco-Mavillard
- Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Spain.
| | | | | | | | | | - Miguel Ángel Rodríguez-Calero
- Departamento de Calidad, Hospital Torrecárdenas, Almería, Spain; Departamento de Enfermería y Fisioterapia, Universidad de las Islas Baleares, Palma, Spain; Grupo de investigación en Cuidados, Cronicidad y Evidencias en Salud (CurES), Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| |
Collapse
|
4
|
Gallego-González E, Mayordomo-Cava J, Vidán MT, Valadés-Malagón MI, Serra-Rexach JA, Ortiz-Alonso J. Functional trajectories associated with acute illness and hospitalization in oldest old patients: Impact on mortality. Front Physiol 2022; 13:937115. [PMID: 36187794 PMCID: PMC9515786 DOI: 10.3389/fphys.2022.937115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The literature pays low attention to functional changes during acute illness in older patients. Our main objectives were to separately describe the different functional changes occurring before and after hospital admission in oldest old medical patients, to investigate their association with mortality, and identify predictors associated with in-hospital failure to recover function.Methods: Secondary analysis of data from a prospective cohort study conducted in a tertiary teaching hospital. The study followed the STROBE criteria. The sample included 604 consecutive patients aged 65 or older hospitalized for acute illness, discharged alive, and not fully dependent at baseline. Activities of daily living measured at baseline, admission, and discharge were used to classify patients into four functional trajectories depending on whether they decline or remain stable between baseline and admission (prehospital) and whether they decline, remain stable, or recover baseline function between admission and discharge (in-hospital). Multivariate models were used to test the association between functional trajectories with mortality, and predictors for in-hospital recovery.Results: Functional trajectories were: “stable-stable” (18%); “decline-recovery” (18%); “decline-no recovery” (53%); “in-hospital decline” (11%). Prehospital decline occurred in 75% and 64% were discharged with worse function than baseline. “In-hospital decline” and “decline-no recovery” trajectories were independently associated with higher 6- and 12-month mortality. Extent of prehospital decline and dementia were predictors of failure to in-hospital recovery.Conclusion: In acutely ill older people, differentiating between prehospital and in-hospital functional changes has prognostic implications. Lack of functional regain at discharge is associated with higher mortality at 6- and 12-months.
Collapse
Affiliation(s)
- Eva Gallego-González
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Hospital Universitario HM Montepríncipe, Madrid, Spain
- *Correspondence: Jennifer Mayordomo-Cava,
| | - María T. Vidán
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | | | - José A. Serra-Rexach
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Ortiz-Alonso
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| |
Collapse
|
5
|
Conroy S, Thomas M. Urgent care for older people. Age Ageing 2022; 51:6146885. [PMID: 33620421 DOI: 10.1093/ageing/afab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Geriatric medicine is the clinical specialty that focuses upon the care of older people-especially those with frailty (a state of increased vulnerability). In hospital, older people living with frailty are at high risk of developing a range of unpleasant outcomes such as delirium, falls, fractures, pressure sores and death. Comprehensive geriatric assessment is a form of holistic care that incorporates a specific set of clinical competencies that are able to reduce these adverse outcomes. Over the years, geriatric medicine has moved from being more of a community-based service towards a more acute specialty-encroaching now upon emergency department care. The challenge now is to work out how best to deliver geriatric care across the whole hospital (older people with frailty are not just cared for in geriatric wards!). The themed collection published on the Age & Ageing journal website outlines key articles that are attempting to develop solutions to this challenging conundrum. We hope that you enjoy reading them.
Collapse
Affiliation(s)
- Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Matt Thomas
- Department of Medicine for Older People, Poole Hospital, Poole BH15 2JB, UK
| |
Collapse
|
6
|
Hum A, George PP, Tay RY, Wu HY, Ali NB, Leong I, Chin JJ, Lee A, Tan L, Koh M. Prognostication in Home-Dwelling Patients with Advanced Dementia: The Palliative Support DEMentia Model (PalS-DEM). J Am Med Dir Assoc 2020; 22:312-319.e3. [PMID: 33321077 DOI: 10.1016/j.jamda.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/17/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Difficulties with prognostication prevent more patients with advanced dementia from receiving timely palliative support. The aim of this study is to develop and validate a prognostic model for 6-month and 1-year mortality in home-dwelling patients with advanced dementia. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The data set of 555 home-dwelling patients with dementia at Functional Assessment Staging Test stage 7 was split into derivation (n = 275) and validation (n = 280) cohorts. METHODS Cox proportional hazards regression modeled survival in the derivation cohort using prognostic variables identified in univariate analysis. The model was validated internally and using 10-fold cross-validation. Area under the receiver operating characteristic curve measured the accuracy of the final model. RESULTS Four hundred nineteen (75.5%) patients died with a median follow-up of 47 days [interquartile range (IQR) 161]. Prognostic variables in the multivariate model included serum albumin level, dementia etiology, number of homecare admission criteria fulfilled, presence of moderate to severe chronic kidney disease, peripheral vascular disease, quality of life in late-stage dementia scores, housing type, and the Australian National Sub-Acute and Non-Acute Patient palliative care phase. The model was refined into a parsimonious 6-variable model [Palliative Support DEMentia Model (PalS-DEM)] consisting of age, dementia etiology, Functional Assessment Staging Test stage, Charlson Comorbidity Index scores, Australian National Sub-Acute and Non-Acute Patient palliative care phase, and 30-day readmission frequency for the prediction of 1-year mortality. The area under the receiver operating characteristic curve was 0.65 (95% confidence interval 0.59-0.70). Risk scores categorized patients into 3 prognostic groups, with a median survival of 175 days (IQR 365), 104 days (IQR 246), and 19 days (IQR 88) for the low-risk (0‒1 points), moderate-risk (2‒4), and high-risk (≥5) groups, respectively. CONCLUSIONS AND IMPLICATIONS The PalS-DEM identifies patients at high risk of death in the next 1 year. The model produced consistent survival results across the derivation, validation, and cross-validation cohorts and will help healthcare providers identify patients with advanced dementia earlier for palliative care.
Collapse
Affiliation(s)
- Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore; The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore.
| | | | - Ri Yin Tay
- The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore
| | - Huei Yaw Wu
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore; The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore
| | - Noorhazlina Binte Ali
- The Palliative Care Center for Excellence in Research and Education, Singapore; Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Ian Leong
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Jing Jih Chin
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Angel Lee
- St Andrew's Community Hospital, Singapore
| | - Laurence Tan
- The Palliative Care Center for Excellence in Research and Education, Singapore; Department of Geriatric Medicine, Yishun Health System, Singapore
| | - Mervyn Koh
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore; The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore
| |
Collapse
|
7
|
Dent E, Hoogendijk EO, Visvanathan R, Wright ORL. Malnutrition Screening and Assessment in Hospitalised Older People: a Review. J Nutr Health Aging 2019; 23:431-441. [PMID: 31021360 DOI: 10.1007/s12603-019-1176-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
Collapse
Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Level 1, 220 Victoria Square, Adelaide, Australia 5000, Phone: +61 8 8 113 7823,
| | | | | | | |
Collapse
|
8
|
Tosun Tasar P, Sahın S, Akcam NO, Dınckal C, Ulusoy MG, Sarıkaya OF, Duman S, Akcıcek F, Noyan A. Delirium is associated with increased mortality in the geriatric population. Int J Psychiatry Clin Pract 2018; 22:200-205. [PMID: 29179627 DOI: 10.1080/13651501.2017.1406955] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of delirium and its association with mortality rates in elderly inpatients. METHODS The medical records of 1435 patients over 65 years old who were treated at a regional university hospital and were referred to the university's Consultation and Liaison Psychiatry Clinic for psychological evaluation were retrospectively analyzed. Patients with and without a diagnosis of delirium were compared. The National Survival Database was used to determine mortality rates. RESULTS The prevalence of delirium was 25.5%. The delirium group was older (p < .0001) and had a larger proportion of males (p < .0001). Mortality rate was higher in the delirium group at 1, 2, 3, 4, and 5 years (p < .0001 for all). Age, gender, lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease emerged as significant parameters associated with mortality. Multivariate analysis of these parameters indicated that comorbid diseases (lower urinary system diseases, chronic liver disease, solid hematologic malignancy, infections, and Alzheimer's disease) are risk factors for mortality independent of demographic data such as age and gender. CONCLUSIONS Independent of all other factors, delirium is associated with higher mortality risk.
Collapse
Affiliation(s)
- Pinar Tosun Tasar
- a Division of Geriatrics , Erzurum Regional Training and Research Hospital , Erzurum , Turkey
| | - Sevnaz Sahın
- b Department of Internal Medicine Division of Geriatrics , Ege University Hospital , Izmir , Turkey
| | - Nur Ozge Akcam
- c Department of Psychiatry, Division of Consultation Liaison Psychiatry , Ege University Hospital , Izmir , Turkey
| | - Cıgdem Dınckal
- d Department of Internal Medicine , Ege University Hospital , Izmir , Turkey
| | - Merve Gulsah Ulusoy
- e Faculty of Medicine, Department of Biostatistics , Ege University , Izmir , Turkey
| | - Ozan Fatih Sarıkaya
- d Department of Internal Medicine , Ege University Hospital , Izmir , Turkey
| | - Soner Duman
- d Department of Internal Medicine , Ege University Hospital , Izmir , Turkey
| | - Fehmi Akcıcek
- b Department of Internal Medicine Division of Geriatrics , Ege University Hospital , Izmir , Turkey
| | - Aysin Noyan
- c Department of Psychiatry, Division of Consultation Liaison Psychiatry , Ege University Hospital , Izmir , Turkey
| |
Collapse
|
9
|
Pasina L, Cortesi L, Tiraboschi M, Nobili A, Lanzo G, Tettamanti M, Franchi C, Mannucci PM, Ghidoni S, Assolari A, Brucato A. Risk factors for three-month mortality after discharge in a cohort of non-oncologic hospitalized elderly patients: Results from the REPOSI study. Arch Gerontol Geriatr 2018; 74:169-173. [PMID: 29121542 DOI: 10.1016/j.archger.2017.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 10/09/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Short-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients. METHODS This prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR≤29mL/min/1.73m2; severe dementia; albuminemia ≪2.5g/dL; hospital admissions in the six months before the index admission. RESULTS Of 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08-0.19, p≪0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12-3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22-4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22-3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39-7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12-5.44) were significantly associated with higher risk of three-month mortality. CONCLUSIONS Bedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.
Collapse
Affiliation(s)
- Luca Pasina
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Laura Cortesi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Giovanna Lanzo
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Carlotta Franchi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Ca' Granda Maggiore Hospital Foundation and University of Milan, Italy
| | | | | | | |
Collapse
|
10
|
Calsina-Berna A, Martinez-Muñoz M, Bardés Robles I, Beas Alba E, Madariaga Sánchez R, Gómez Batiste Alentorn X. Intrahospital Mortality and Survival of Patients with Advanced Chronic Illnesses in a Tertiary Hospital Identified with the NECPAL CCOMS-ICO© Tool. J Palliat Med 2018; 21:665-673. [DOI: 10.1089/jpm.2017.0339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Agnès Calsina-Berna
- Comprehensive Support Unit, Catalan Institute of Oncology, Badalona, Spain
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
| | - Marisa Martinez-Muñoz
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
- The Qualy Observatory, WHO Collaborating Centre for Public Health Palliative Care Programs, Catalan Institute of Oncology, Barcelona, Spain
| | | | - Elba Beas Alba
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
- The Qualy Observatory, WHO Collaborating Centre for Public Health Palliative Care Programs, Catalan Institute of Oncology, Barcelona, Spain
| | | | - Xavier Gómez Batiste Alentorn
- Department of Palliative Care, University of Vic—Central University of Catalonia, Barcelona, Spain
- The Qualy Observatory, WHO Collaborating Centre for Public Health Palliative Care Programs, Catalan Institute of Oncology, Barcelona, Spain
| |
Collapse
|
11
|
Abe S. Prognostic Factors for the Survival of Elderly Patients Who Were Hospitalized in the Medical Ward of Our Hospital in Japan. Geriatrics (Basel) 2017; 2:geriatrics2040032. [PMID: 31011042 PMCID: PMC6371180 DOI: 10.3390/geriatrics2040032] [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: 09/28/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022] Open
Abstract
It has been a long time since there were many elderly people in Japan. The medical care and costs for the elderly are enormous, and research to lower the mortality rate of the elderly is needed. We retrospectively investigated the prognostic factors for the survival of elderly patients who were hospitalized in the medical ward of our hospital. In total, 277 patients who were hospitalized between 1 January 2014 and 31 May 2017, were included in the retrospective study. Univariate and multivariate analyses of items (vital signs, laboratory data, and so on) were performed, and significant differences between the survival group and death group were subjected to receiver operating characteristic curve analysis. Serum urea nitrogen levels and serum albumin levels provided a relatively high area under the curve (AUC). However, there was no item for which AUC exceeded 0.70, and setting the cutoff value in this study was difficult. For treating the elderly, it is important to carefully evaluate each patient’s prognostic factors, including the demented state, renal function, and nutritional state; personalized treatment of each patient is also important.
Collapse
Affiliation(s)
- Shuichi Abe
- Internal Medicine, Rehabilitation Oomiko Hospital, Oomiko19, Oohara-cho, Tokushima-City, Tokushima 770-8012, Japan.
| |
Collapse
|
12
|
Gómez-Batiste X, Murray SA, Thomas K, Blay C, Boyd K, Moine S, Gignon M, Van den Eynden B, Leysen B, Wens J, Engels Y, Dees M, Costantini M. Comprehensive and Integrated Palliative Care for People With Advanced Chronic Conditions: An Update From Several European Initiatives and Recommendations for Policy. J Pain Symptom Manage 2017; 53:509-517. [PMID: 28042069 DOI: 10.1016/j.jpainsymman.2016.10.361] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/21/2016] [Accepted: 10/07/2016] [Indexed: 11/21/2022]
Abstract
The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer. There is a great need to identify these patients and integrate an early palliative approach according to their individual needs in all settings, as suggested by the World Health Organization. Several tools have recently been developed in different European regions to identify patients with chronic conditions who might benefit from palliative care. Similarly, several models of integrated palliative care have been developed, some with a public health approach to promote access to all in need. We describe the characteristics of these initiatives and suggest how to develop a comprehensive and integrated palliative approach in primary and hospital care and to design public health and community-oriented practices to assess and respond to the needs in the whole population. Additionally, we report ethical challenges and prognostic issues raised and emphasize the need for research to test the various tools and models to generate evidence about the benefits of these approaches to patients, their families, and to the health system.
Collapse
Affiliation(s)
- Xavier Gómez-Batiste
- The "Qualy" Observatory/WHO Collaborating Center for Palliative Care Public Health Programs, Catalan Institute of Oncology, Barcelona, Spain; Chair in Palliative Care, University of Vic, Barcelona, Spain.
| | - Scott A Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Keri Thomas
- End of Life Care, University of Birmingham, Birmingham, UK
| | - Carles Blay
- Chair in Palliative Care, University of Vic, Barcelona, Spain; Chronic Care Program, Catalan Department of Health, Government of Catalonia, Barcelona, Spain
| | - Kirsty Boyd
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Sebastien Moine
- Education and Health Practices Laboratory, University Paris 13, Sorbonne Paris Cité, Bobigny, France; Health Simulation CenterSimUSanté®, Amiens University Hospital, Amiens, France
| | - Maxime Gignon
- Education and Health Practices Laboratory, University Paris 13, Sorbonne Paris Cité, Bobigny, France; Health Simulation CenterSimUSanté®, Amiens University Hospital, Amiens, France
| | - Bart Van den Eynden
- Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium
| | - Bert Leysen
- Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium
| | - Johan Wens
- Research Group Palliative Care, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Care, University of Antwerp, Antwerp, Belgium
| | - Yvonne Engels
- Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne Dees
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Massimo Costantini
- Palliative Care Unit, IRCCS Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| |
Collapse
|
13
|
Amblàs-Novellas J, Murray SA, Espaulella J, Martori JC, Oller R, Martinez-Muñoz M, Molist N, Blay C, Gómez-Batiste X. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories. BMJ Open 2016; 6:e012340. [PMID: 27645556 PMCID: PMC5030552 DOI: 10.1136/bmjopen-2016-012340] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. SETTING 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban-rural district in Barcelona, Spain. PARTICIPANTS 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. OUTCOME MEASURES The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. RESULTS The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (p<0.05). 48.2% of the total cohort was identified as advanced frailty patients with no advanced disease criteria. CONCLUSIONS Dynamic indicators are present in the 3 trajectories and are especially useful to identify PACC for a progressive PC approach purpose. Most of the other indicators are typically associated with a specific trajectory. These findings can help clinicians improve the identification of patients for a palliative approach.
Collapse
Affiliation(s)
- J Amblàs-Novellas
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu/Hospital Universitari de Vic, Barcelona, Spain Department of Palliative Care, University of Vic, Barcelona, Spain
| | - S A Murray
- St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - J Espaulella
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu/Hospital Universitari de Vic, Barcelona, Spain Department of Palliative Care, University of Vic, Barcelona, Spain
| | - J C Martori
- Data Analysis and Modeling Research Group, Department of Economics and Business, University of Vic, Barcelona, Spain
| | - R Oller
- Data Analysis and Modeling Research Group, Department of Economics and Business, University of Vic, Barcelona, Spain
| | - M Martinez-Muñoz
- Unit of Research Management, Catalan Institute of Oncology, Barcelona, Spain
| | - N Molist
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu/Hospital Universitari de Vic, Barcelona, Spain Department of Palliative Care, University of Vic, Barcelona, Spain
| | - C Blay
- Department of Palliative Care, University of Vic, Barcelona, Spain Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health, Government of Catalonia, Barcelona, Spain
| | - X Gómez-Batiste
- Department of Palliative Care, University of Vic, Barcelona, Spain The Qualy Observatory, WHO Collaborating Centre for Palliative Care Public Health Programs (WHOCC), Catalan Institute of Oncology, Barcelona, Spain
| |
Collapse
|
14
|
Admetlla Falgueras M, Fusté Sugrañes J. Cuidados postagudos. Med Clin (Barc) 2014; 143:29-33. [DOI: 10.1016/j.medcli.2013.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/17/2013] [Accepted: 05/23/2013] [Indexed: 11/15/2022]
|
15
|
|
16
|
Miyata S, Tanaka M, Ihaku D. Full Mini Nutritional Assessment and Prognosis in Elderly Patients with Pulmonary Tuberculosis. J Am Coll Nutr 2013; 32:307-11. [DOI: 10.1080/07315724.2013.826114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
17
|
Soria S, Gallego E, Vidan M, Ortiz J, Serra-Rexach JA. [Development of a risk-mortality index for elderly patients discharged from a geriatric acute care unit]. Rev Esp Geriatr Gerontol 2013; 49:223-7. [PMID: 24060412 DOI: 10.1016/j.regg.2013.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/15/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify predictive factors for 6 and 12-months mortality after discharge from a geriatric acute care unit, and from these, derive a mortality-risk index. METHODS AND ANALYSIS Prospective cohort study will be conducted on patients over 70 years-old admitted to a geriatric acute care unit and survived to hospital discharge. The main outcome measure will be mortality at 6 months and 12 months after discharge. Independent variables include sociodemographics, functional status, comorbidities, and clinical and laboratory characteristics. Risk factors associated with mortality will be constructed using multivariate logistic regression models. To build the mortality index, points will be assigned to each risk factor by dividing each beta coefficient in the logistic model by the lowest beta coefficient. A score will be assigned to each subject by adding up the points for each risk factor present in the model. The predictive accuracy of the model will be determined by comparing the predicted versus observed mortality in the study population and calculating the area under the ROC curves in both populations. CONCLUSIONS The risk-mortality index developed would allow an easy estimate to be made of individual risk of death at 6 months and 12 months after discharge from a geriatric acute care unit, with the purpose of establishing care plans and individualising treatment, according to real objectives.
Collapse
Affiliation(s)
- Selene Soria
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Eva Gallego
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Maite Vidan
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Javier Ortiz
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | |
Collapse
|
18
|
Tsai MC, Chou SY, Tsai CS, Hung TH, Su JA. Comparison of consecutive periods of 1-, 2-, and 3-year mortality of geriatric inpatients with delirium, dementia, and depression in a consultation-liaison service. Int J Psychiatry Med 2013; 45:45-57. [PMID: 23805603 DOI: 10.2190/pm.45.1.d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Dementia, depression, and delirium are the most prevalent psychiatric disorders in elderly medical inpatients and are all associated with higher mortality. The purpose of this study was to assess and compare consecutive periods of 1-, 2-, and 3-year mortality among elderly patients with dementia, depression, and delirium seen by a psychiatry consultation-liaison service in a general hospital. METHODS We consecutively enrolled inpatients 65 years of age and older that were referred for psychiatric consultation (N = 614) from 2002 to 2006: 172 were diagnosed with delirium, 92 with dementia, and 165 with depression. The 1-, 2-, and 3-year mortality rates for the three groups of patients were compared by log-rank test. The Cox proportional hazard regression model was used to identify any possible factors associated with mortality during the study period. RESULTS Only 1-year mortality in the delirium group was significantly higher than that in the depression group (p < 0.05), but there was no significant difference among the three groups in 2- and 3-year mortality. In terms of gender, higher mortality was identified only in depressed male patients. Furthermore, male, older age, and longer length of hospital stay, but not multiple physical comorbidities, were associated with higher mortality. CONCLUSION Clinical physicians should give special attention to delirious patients within the first year after referral. Patients at risk for mortality should be closely followed and early intervention provided in an effort to decrease or delay mortality.
Collapse
Affiliation(s)
- Meng-Chang Tsai
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | | | | |
Collapse
|
19
|
Lee WJ, Chou MY, Peng LN, Liang CK, Liu LK, Liu CL, Chen LK, Wu YH. Predicting clinical instability of older patients in post-acute care units: a nationwide cohort study. Geriatr Gerontol Int 2013; 14:267-72. [PMID: 23647665 DOI: 10.1111/ggi.12083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
AIM Although patients admitted to post-acute care (PAC) units are usually clinically stable, unexpected medical conditions requiring acute ward readmissions still occur and can jeopardize the clinical effectiveness of PAC services. The main purpose of the present study was to evaluate predictive factors for clinical instability of patients in PAC units to improve the quality of PAC services. METHODS This was a nationwide multicenter cohort study that recruited patients from five PAC units in Taiwan between July 2007 and June 2009. All patients received the comprehensive geriatric assessment (CGA) within 72 h of PAC unit admissions. Conditions requiring acute ward re-admissions from PAC units were defined as clinical instability. Causes of clinical instability for all patients and data of CGA were collected for analysis. RESULTS Of 918 enrolled participants, 119 (12.9%) experienced acute ward readmissions, including 106 (89.1%) admissions related to medical conditions and 13 (10.9%) for surgical causes. Common conditions included diseases of the respiratory system (n = 32, 26.9%), genitourinary system (n = 24, 20.2%) and digestive system (n = 14, 11.8%). Surgical conditions, mainly fractures and dislocation of upper limbs, were significantly more likely to occur later (P = 0.05) in the PAC unit admissions than medical conditions. Compared with the non-readmission group, the readmission group was leaner (mean body mass index 21.1 ± 2.8 vs 22.0 ± 3.8 kg/m(2) , P = 0.007), having poorer functional status (mean Barthel Index 41.0 ± 19.4 vs 45.4 ± 20.3, P = 0.02; mean IADL: 1.3 ± 1.6 vs 1.7 ± 1.8, P = 0.016), poorer cognitive function (mean Mini-Mental State Examination: 16.8 ± 6.4 vs 18.3 ± 6.4, P = 0.022), poorer ambulation (mean Timed Up & Go test 32.7 ± 18.7 vs 26.6 ± 11.7 s, P = 0.039) and poorer nutritional status (mean Mini-Nutrition Assessment 13.3 ± 5.7 vs 15.4 ± 5.8, P < 0.001), but similar in depression status (mean Geriatric Depression Score 3.7 ± 3.3 vs 3.4 ± 2.8, P = 0.247). In multivariate logistical regression model, lower Mini-Mental State Examination score was the only independent predictor for clinical instability (odds ratio 3.8, 95% confidence interval 1.348-10.870, P = 0.012). CONCLUSION Approximately 13% of PAC patients might experience acute ward readmissions, and nearly 90% of them are caused by medical conditions. Poor cognitive function is a significant predictive factor for clinical instability in PAC, which deserves more clinical attention for all PAC patients.
Collapse
Affiliation(s)
- Wei-Ju Lee
- Division of Geriatric Medicine, Taipei Veterans General Hospital Yuanshan Branch, I-Lan, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Lundin H, Sääf M, Strender LE, Mollasaraie HA, Salminen H. Mini nutritional assessment and 10-year mortality in free-living elderly women: a prospective cohort study with 10-year follow-up. Eur J Clin Nutr 2013; 66:1050-3. [PMID: 22947901 DOI: 10.1038/ejcn.2012.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Mini nutritional assessment (MNA) is the most frequently used screening test for malnutrition in elderly populations in continental Europe and Asia. Most studies on MNA's ability to predict mortality have only included persons admitted to hospital, living in nursing homes or at home with professional help with activities of daily living. The aim of this cohort study was to examine if MNA can predict 10-year mortality in the general elderly female population. SUBJECTS/METHODS Of the 584 free-living elderly women invited, 351 agreed to participate and were tested with MNA between 1999 and 2000. A 10-year follow-up was conducted in 2010 with dates of death obtained from the Swedish death register. RESULTS Participants whose MNA score was ≤ 23.5 points at inclusion had a significantly higher age-adjusted 10-year mortality risk than participants with a MNA score of >23.5 points. The hazard ratio was 2.36 (95% confidence interval 1.25-4.46), P <0.01. CONCLUSIONS Participants with a MNA score, indicating an increased risk for malnutrition, were more than twice as likely to die during the 10-year follow-up as participants whose MNA score indicated normal nutritional status. Hence, MNA can predict mortality in a general, free-living, elderly female population.
Collapse
Affiliation(s)
- H Lundin
- Centre for Family Medicine (CeFAM), Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
21
|
Abstract
Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI <92) and low (GNRI 92–98) nutritional risk were 36·1 and 30·6 %, respectively. At multivariable linear regression, functional status was independently associated with age (P=0·045), arm muscle area (P=0·048), the number of co-morbidities (P=0·027) and mainly with the GNRI (P<0·001). During a median follow-up of 4·7 years (25th–75th percentile 3·7–6·2), 230 (66·5 %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95% CI 1·32, 2·63; P<0·001) and low nutritional risk (HR 1·52, 95% CI 1·08, 2·14; P=0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI <92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95% CI 1·28, 2·91; P<0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly.
Collapse
|
22
|
Dent E, Visvanathan R, Piantadosi C, Chapman I. Nutritional screening tools as predictors of mortality, functional decline, and move to higher level care in older people: a systematic review. J Nutr Gerontol Geriatr 2012; 31:97-145. [PMID: 22607102 DOI: 10.1080/21551197.2012.678214] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This systematic review assessed whether nutritional screening tools (NSTs) predict mortality, functional decline, and move to higher level care in older adults residing in the community or in institutions. In total, 37 prospective studies published between 1999 and 2012 met inclusion criteria and were included in this review. The most commonly used NST in these studies was the Mini Nutritional Assessment (MNA). Comparison of NSTs was limited by variation in follow-up time, lack of uniform definition of functional decline, and biases in many studies. Results of MNA, MNA-Short Form (MNA-SF), and Geriatric Nutrition Risk Index (GNRI) assessments were significantly associated with subsequent mortality, with good negative predictive power (∼0.83), but only modest positive predictive power (PPV∼0.32). MNA-SF and MNA results had a low to moderate association with functional decline (PPV∼0.34). Move to higher level care was less strongly associated with NST scores (PPV∼0.25). Overall, there is evidence that NSTs can predict those at low risk of mortality, functional decline, and, to a lesser extent, move to higher level care in older people.
Collapse
Affiliation(s)
- Elsa Dent
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | | | | | | |
Collapse
|
23
|
One-year follow-up of non-institutionalized dependent older adults: mortality, hospitalization, and mobility. Can J Aging 2012; 31:357-61. [PMID: 22805052 DOI: 10.1017/s0714980812000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Non-institutionalized dependent older adults present high morbidity and mortality, demand care from their families, and consume primary health care resources. To expand knowledge about this group, we conducted a population-based one-year prospective cohort study of 130 non-institutionalized dependent older persons (age 60 and older), stratified according to baseline mobility: independent walking (group A), use of walking aids (group B), and bedridden or confined to a wheelchair (group C). The outcomes analysed were death, hospitalization, and mobility disability. Total mortality was 8.5 per cent (p = .05). Overall hospitalization rate was 34.6 per cent; the main causes were stroke and pneumonia. After one year, there was a decline in the proportion of subjects classified as independent walking (57% vs. 43%; p = .03). We conclude that there was a high rate of mortality and hospitalization in this group of dependent older people, and an increase in disability after a one-year follow-up.
Collapse
|
24
|
Matzen LE, Jepsen DB, Ryg J, Masud T. Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit. BMC Geriatr 2012; 12:32. [PMID: 22731680 PMCID: PMC3462125 DOI: 10.1186/1471-2318-12-32] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/15/2012] [Indexed: 11/25/2022] Open
Abstract
Background Functional decline is associated with increased risk of mortality in geriatric patients. Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission was studied as a predictor of survival in older patients admitted to an acute geriatric unit. Methods All first admissions of patients with age >65 years between January 1st 2005 and December 31st 2009 were included. Data on BI, sex, age, and discharge diagnoses were retrieved from the hospital patient administrative system, and data on survival until September 6th 2010 were retrieved from the Civil Personal Registry. Co-morbidity was measured with Charlson Co-morbidity Index (CCI). Patients were followed until death or end of study. Results 5,087 patients were included, 1,852 (36.4%) men and 3,235 (63.6%) women with mean age 81.8 (6.8) and 83.9 (7.0) years respectively. The median [IQR] length of stay was 8 days, the median follow up [IQR] 1.4 [0.3; 2.8] years and in hospital mortality 8.2%. Mortality was greater in men than in women with median survival (95%-CI) 1.3 (1.2 -1.5) years and 2.2 (2.1-2.4) years respectively (p < 0.001). The median survivals (95%-CI) stratified on BI groups in men (n = 1,653) and women (n = 2,874) respectively were: BI 80-100: 2.6 (1.9-3.1) years and 4.5 (3.9-5.4) years; BI 50-79: 1.7 (1.5-2.1) years and 3.1 (2.7-3.5) years; BI 25-49: 1.5 (1.3-1.9) years and 1.9 (1.5-2.2) years and BI 0-24: 0.5 (0.3-0.7) years and 0.8 (0.6-0.9) years. In multivariate logistic regression analysis with BI 80-100 as baseline and controlling for significant covariates (sex, age, CCI, and diseases of cancer, haematology, cardiovascular, respiratory, infectious and bone and connective tissues) the odds ratios for 3 and 12 months survival (95%-CI) decreased with declining BI: BI 50-79: 0.74 (0.55-0.99) (p < 0.05) and 0,80 (0.65-0.97)(p < 0.05); BI 25-49: 0.44 (0.33-0.59)(p < 0.001) and 0.55 (0.45-0.68)(p < 0.001); and BI 0-24: 0.18 (0.14-0.24)(p < 0.001) and 0.29 (0.24-0.35)(p < 0.001) respectively. Conclusion BI is a strong independent predictor of survival in older patients admitted to an acute geriatric unit. These data suggest that assessment of ADL may have a potential role in decision making for the clinical management of frail geriatric inpatients.
Collapse
Affiliation(s)
- Lars E Matzen
- Department of Geriatric Medicine, Odense University Hospital, DK-5000, Odense C, Denmark.
| | | | | | | |
Collapse
|
25
|
Dhaussy G, Dramé M, Jolly D, Mahmoudi R, Barbe C, Kanagaratnam L, Nazeyrollas P, Blanchard F, Novella JL. Is Health-Related Quality of Life an Independent Prognostic Factor for 12-Month Mortality and Nursing Home Placement Among Elderly Patients Hospitalized via the Emergency Department? J Am Med Dir Assoc 2012; 13:453-8. [DOI: 10.1016/j.jamda.2011.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/03/2011] [Accepted: 10/12/2011] [Indexed: 11/17/2022]
|
26
|
Ekdahl AW, Hellström I, Andersson L, Friedrichsen M. Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study. BMJ Open 2012; 2:e001063. [PMID: 22654092 PMCID: PMC3367145 DOI: 10.1136/bmjopen-2012-001063] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/27/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients. DESIGN A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire. SETTING AND PARTICIPANTS The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients. RESULTS Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: 'being challenged' by this patient group and 'being a small part of the healthcare production machine'. Both categories were explained by the core category 'lacking in time'. The reasons for the feeling of 'being challenged' were explained by the subcategories 'having a feeling of incompetence', 'having to take relatives into consideration' and 'having to take cognitive decline into account'. The reasons for the feeling of 'being a small part of the healthcare production machine' were explained by the subcategories 'at the mercy of routines' and 'inadequate remuneration system', both of which do not favour elderly patients with multimorbidity. CONCLUSIONS Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients.
Collapse
Affiliation(s)
- Anne Wissendorff Ekdahl
- Department of Geriatric Medicine, Vrinnevi Hospital, Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - Ingrid Hellström
- Department of Geriatric Medicine, Vrinnevi Hospital, Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - Lars Andersson
- National Institute for the Study of Ageing and Later Life (NISAL), Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Maria Friedrichsen
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
- Palliative Education and Research Center, Vrinnevi Hospital, Norrköping, Sweden
| |
Collapse
|
27
|
Tan WS, Ding YY, Chong WF, Tay JC, Tan JYL. Impact of data source and time reference of functional status on hospital mortality prediction. BMC Health Serv Res 2012; 12:115. [PMID: 22583538 PMCID: PMC3418212 DOI: 10.1186/1472-6963-12-115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 05/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study objective was to compare physical function documented in the medical records with interview data, and also to evaluate hospital mortality predictions using pre-admission and on-admission functional status derived from these two data sources. METHODS A prospective cohort study of 1402 subjects aged 65 years and older to the general medicine department of an acute care hospital was conducted. Patient-reported pre-admission and on-admission functional status for impairment in any of the five activities of daily living (ADLs) items (feeding, dressing, grooming, toileting and bathing), transferring and walking, were compared with those extracted from the medical records. For the purpose of mortality prediction, pre-admission and on-admission impairment in transferring from the two data sources were included in separate multivariable logistic regression models. We used a variable selection method that combines bootstrap resampling with stepwise backward elimination. RESULTS For all ADL categories, the agreement between the data sources was good for pre-admission functional status (k: 0.53-0.75) but poor for on-admission status (k: 0.18-0.31). On-admission impairment was higher in the medical records than at interview for all basic ADLs. Using interview data as the gold standard, although sensitivity for pre- and on-admission ADLs was high (59-93%), specificity for on-admission status was poor (30-37%). The pre-admission models using interview data predicted mortality better than the model using medical records (c-statistic: 0.83 versus 0.82). Similar results were found for models incorporating on-admission functional status (c-statistic: 0.84 versus 0.81). However, the differences between the four models were not statistically significant. CONCLUSION Medical records can be a good source for pre-admission functional status but on-admission functional impairment was over-reported in the medical records. The discriminatory power of the hospital mortality prediction model was significantly improved with the incorporation of functional status information but it was not significantly affected by their time reference or source of data.
Collapse
Affiliation(s)
- Woan Shin Tan
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore.
| | | | | | | | | |
Collapse
|
28
|
Salpeter SR, Luo EJ, Malter DS, Stuart B. Systematic review of noncancer presentations with a median survival of 6 months or less. Am J Med 2012; 125:512.e1-6. [PMID: 22030293 DOI: 10.1016/j.amjmed.2011.07.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 05/28/2011] [Accepted: 07/09/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival. METHODS The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%. RESULTS The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment. CONCLUSION This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
Collapse
|
29
|
Zekry D, Krause KH, Irminger-Finger I, Graf CE, Genet C, Vitale AM, Michel JP, Gold G, Herrmann FR. Telomere length, comorbidity, functional, nutritional and cognitive status as predictors of 5 years post hospital discharge survival in the oldest old. J Nutr Health Aging 2012; 16:225-30. [PMID: 22456777 DOI: 10.1007/s12603-011-0138-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Telomere length has been considered in many cross-sectional studies as a biomarker of aging. However the association between shorter telomeres with lower survival at advanced ages remains a controversial issue. This association could reflect the impact of other health conditions than a direct biological effect. OBJECTIVE To test whether leukocyte telomere length is associated with 5-year survival beyond the impact of other risk factors of mortality like comorbidity, functional, nutritional and cognitive status. DESIGN Prospective study. SETTING AND PARTICIPANTS A population representative sample of 444 patients (mean age 85 years; 74% female) discharged from the acute geriatric hospital of Geneva University Hospitals (January-December 2004), since then 263 (59.2%) had died (December 2009). MEASUREMENTS Telomere length in leukocytes by flow cytometry. RESULTS In univariate model, telomere length at baseline and cognitive status were not significantly associated with mortality even when adjusting for age (R²=9.5%) and gender (R²=1.9%). The best prognostic predictor was the geriatric index of comorbidity (GIC) (R²=8.8%; HR=3.85) followed by more dependence in instrumental (R²=5.9%; HR=3.85) and based (R²=2.3%; HR=0.84) activities of daily living and lower albumin levels (R²=1.5%; HR=0.97). Obesity (BMI>30: R²=1.6%; HR=0.55) was significantly associated with a two-fold decrease in the risk of mortality compared to BMI between 20-25. When all independent variables were entered in a full multiple Cox regression model (R²=21.4%), the GIC was the strongest risk predictor followed by the nutritional and functional variables. CONCLUSION Neither telomeres length nor the presence of dementia are predictors of survival whereas the weight of multiple comorbidity conditions, nutritional and functional impairment are significantly associated with 5-year mortality in the oldest old.
Collapse
Affiliation(s)
- D Zekry
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Tsai MC, Weng HH, Chou SY, Tsai CS, Hung TH, Su JA. Three-year mortality of delirium among elderly inpatients in consultation-liaison service. Gen Hosp Psychiatry 2012; 34:66-71. [PMID: 22055331 DOI: 10.1016/j.genhosppsych.2011.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study is to assess 3-year mortality in delirious patients receiving consultation-liaison service in a general hospital setting. METHODS We consecutively enrolled inpatients 65 years of age and older that were referred for psychiatric consultation (N=614) from 2002 to 2006. One hundred and seventy-two patients were diagnosed with delirium. The exact date of death was based on the registration data from the Department of Health, Executive Yuan, in Taiwan and was used to calculate the mortality rate and time to death (days) after psychiatric consultation. Furthermore, the 1-year, 2-year and 3-year mortality rates of delirious patients were compared to mortality rates of nondelirious patients. Factors (e.g., age, length of hospital stay, gender, physical illness, use of antipsychotics) were analyzed by using the Cox proportional hazard model to identify possible associations with mortality. RESULTS Delirious patients had a higher mortality rate each year than nondelirious patients. After analysis, 1-year mortality was significantly higher in the delirious group than in the nondelirious group (P=.043), but 2-year and 3-year mortality rates were not significantly different when comparing the delirious and nondelirious groups (P=.149; P=.439). In the Cox proportional hazard regression analysis, 1-year mortality in delirious patients was significantly associated with older age and length of hospital stay (P<.001), but not with gender, physical comorbidity or use of antipsychotics. CONCLUSION These results suggest that elderly delirious inpatients in psychiatric consultation service had significantly higher mortality than nondelirious inpatients, especially in the first year after consultation. Clinical physicians should pay close attention to delirious patients, especially those with mortality-related risk factors, in order to reduce mortality in these patients.
Collapse
Affiliation(s)
- Meng-Chang Tsai
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | | | | | | | | |
Collapse
|
31
|
Ekdahl AW, Andersson L, Wiréhn AB, Friedrichsen M. Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey. BMC Geriatr 2011; 11:46. [PMID: 21851611 PMCID: PMC3170190 DOI: 10.1186/1471-2318-11-46] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 08/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the role elderly people with co-morbidities wish to assume and actually had with regard to information and participation in medical decision making during their last stay in hospital.This study was a cross-sectional survey including three Swedish hospitals with acute admittance. The participants were patients aged 75 years and above with three or more diagnoses according to the International Classification of Diseases (ICD-10) and three or more hospitalisations during the last year. METHODS We used a questionnaire combined with a telephone interview, using the Control Preference Scale to measure each participant's preferred and actual role in medical decision making during their last stay in hospital. Additional questions were asked about barriers to participation in decision making and preferred information seeking role. The results are presented with descriptive statistics with kappa weights. RESULTS Of the 297 elderly patients identified, 52.5% responded (n = 156, 46.5% male). Mean age was 83.1 years. Of the respondents, 42 of 153 patients said that they were not asked for their opinion (i.e. no shared decision making). Among the other 111 patients, 49 had their exact preferred level of participation, 37 had less participation than they would have preferred, and 23 had more responsibility than they would have preferred. Kappa statistics showed a moderate agreement between preferred and actual role (κw = 0.57; 95% CI: 0.45-0.69). Most patients wanted to be given more information without having to ask. There was no correlation between age, gender, or education and preferred role. 35% of the patients agreed that they experienced some of the various barriers to decision making that they were asked about: 1) the severity of their illness, 2) doctors with different treatment strategies, 3) difficulty understanding the medical information, and 4) difficulty understanding doctors who did not speak the patient's own language. CONCLUSIONS Physicians are not fully responsive to patient preferences regarding either the degree of communication or the patient's participation in decision making. Barriers to participation can be a problem, and should be taken into account more often when dealing with hospitalised elderly people.
Collapse
Affiliation(s)
- Anne W Ekdahl
- Geriatric Department, Vrinnevi Hospital, Gamla Ö vägen 25, 601 82 Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
| | - Lars Andersson
- National Institute for the Study of Ageing and Later Life, NISAL, Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
| | - Ann-Britt Wiréhn
- Local Health Care Research and Development Unit, County Council in Östergötland, Linköping University, St. Larsgatan 9 D, 581 85 Linköping, Sweden
| | - Maria Friedrichsen
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Kungsgatan 40, 601 74 Norrköping, Sweden
- Palliative Education and Research Center, Vrinnevi Hospital, Gamla Ö vägen 25, 601 82 Norrköping, Sweden
| |
Collapse
|
32
|
Chan M, Lim YP, Ernest A, Tan TL. Nutritional assessment in an Asian nursing home and its association with mortality. J Nutr Health Aging 2010; 14:23-8. [PMID: 20082050 DOI: 10.1007/s12603-010-0005-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study the nutritional status of nursing home residents in a multi-racial Asian society and its role in predicting short-term mortality independent of functional status and comorbidities. DESIGN Cross-sectional study with prospective collection of mortality data. SETTING Nursing home facility in Singapore. SUBJECTS A total of 154 patients (mean age 77 +/- 12 years, 53.2% women). METHODS We evaluated the demographic details, Mini Nutritional Assessment (MNA) scores, body mass index (BMI) and anthropometric measurements of the participants. Functional status and comorbidities were characterized by the modified Barthel Index and Charlson's comorbidity index respectively. RESULTS Prevalence of undernutrition were 52% (n= 80) and 39% (n=60) when determined by BMI < 18.5 kg/m2 and MNA <17 respectively. Mortality was 25.3% (n= 39) over 2 years. Baseline factors associated with mortality include increased age, low Barthel's score, BMI < 18.5 kg/m2 and MNA < 17 (OR= 1.05, 1.01, 3.08 and 3.03 respectively, all p < 0.05). The association between low BMI and mortality remained significant (p=0.027) after adjustment for patient's age, gender, Barthel's and Charlson's scores, and prior nutritional intervention, but the association between MNA and mortality was diminished (p=0.106). CONCLUSION There was a high prevalence of undernutrition in this nursing home population, and the diagnosis is an important predictor of mortality. Formal nutritional screening and targeted interventions may improve important clinical outcomes.
Collapse
Affiliation(s)
- M Chan
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore 308433.
| | | | | | | |
Collapse
|
33
|
Cunha FCMD, Cintra MTG, Cunha LCMD, Giacomin KC, Couto ÉDAB. Fatores que predispõem ao declínio funcional em idosos hospitalizados. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2009. [DOI: 10.1590/1809-9823.2009.00013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
RESUMO INTRODUÇÃO: O aumento da expectativa de vida é uma realidade mundial e determina maior prevalência de doenças crônicas e maior demanda pelos serviços de saúde, incluindo os hospitalares. Atualmente, estudos têm focalizado o declínio funcional e suas consequências - demanda por recursos materiais e humanos, institucionalização e hospitalização. O objetivo foi a revisão crítica da literatura disponível sobre os fatores de risco associados ao declínio funcional em idosos hospitalizados. METODOLOGIA: Pesquisa nas bases de dados MEDLINE, LILACS e SCIELO, nos idiomas inglês e português, entre 2000 e 2007, utilizando as palavras-chave hospital, elderly, functional status, aged e functional decline e referências bibliográficas dos artigos selecionados. RESULTADOS: Satisfizeram os critérios de inclusão 31 publicações. Após leitura crítica do ABSTRACT, os 15 artigos mais relevantes foram selecionados. CONCLUSÃO: O declínio funcional pode ocorrer antes, durante e/ou após a hospitalização. Idade avançada, comprometimento funcional prévio, déficit cognitivo, iatrogenias, gravidade da condição clínica e histórico de quedas foram os fatores de risco mais citados. A capacidade funcional, como marcador de saúde desse grupo, merece maior investigação.
Collapse
|
34
|
Silva TJA, Jerussalmy CS, Farfel JM, Curiati JAE, Jacob-Filho W. Predictors of in-hospital mortality among older patients. Clinics (Sao Paulo) 2009; 64:613-8. [PMID: 19606235 PMCID: PMC2710432 DOI: 10.1590/s1807-59322009000700002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 04/01/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit. INTRODUCTION The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality. METHODS This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine). RESULTS The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65-6.44, P<.001), neoplastic disease (OR=3.38, CI=2.11-5.42, P<.001), serum albumin levels at admission < 3.3 mg/dL (OR=3.23, CI=2.03-5.13, P<.001), serum creatinine levels at admission > or = 1.3 mg/dL (OR=2.39, CI=1.53-3.72, P<.001), history of heart failure (OR=1.97, CI=1.20-3.22, P=.007), immobility (OR=1.84, CI=1.16-2.92, P =.009), and advanced age (OR=1.03, CI=1.01-1.06, P=.019). CONCLUSIONS This study strengthens the perception of delirium as a mortality predictor among older inpatients. Cancer, immobility, low albumin levels, elevated creatinine levels, history of heart failure and advanced age were also related to higher mortality rates in this population.
Collapse
Affiliation(s)
- Thiago J A Silva
- Geriatric Service, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.
| | | | | | | | | |
Collapse
|
35
|
The Mini Nutritional Assessment (MNA) after 20 years of research and clinical practice. ACTA ACUST UNITED AC 2008. [DOI: 10.1017/s095925980800258x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
36
|
Alarcón T, Ignacio González-Montalvo J. Situación funcional en el anciano hospitalizado: un marcador pronóstico relevante. Med Clin (Barc) 2008; 131:173-4. [DOI: 10.1157/13124961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
37
|
Wong RY, Miller WC. Adverse outcomes following hospitalization in acutely ill older patients. BMC Geriatr 2008; 8:10. [PMID: 18479512 PMCID: PMC2391142 DOI: 10.1186/1471-2318-8-10] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 05/14/2008] [Indexed: 12/04/2022] Open
Abstract
Background The longitudinal outcomes of patients admitted to acute care for elders units (ACE) are mixed. We studied the associations between socio-demographic and functional measures with hospital length of stay (LOS), and which variables predicted adverse events (non-independent living, readmission, death) 3 and 6 months later. Methods Prospective cohort study of community-living, medical patients age 75 or over admitted to ACE at a teaching hospital. Results The population included 147 subjects, median LOS of 9 days (interquartile range 5–15 days). All returned home/community after hospitalization. Just prior to discharge, baseline timed up and go test (TUG, P < 0.001), bipedal stance balance (P = 0.001), and clinical frailty scale scores (P = 0.02) predicted LOS, with TUG as the only independent predictor (P < 0.001) in multiple regression analysis. By 3 months, 59.9% of subjects remained free of an adverse event, and by 6 months, 49.0% were event free. The 3 and 6-month mortality was 10.2% and 12.9% respectively. Almost one-third of subjects had developed an adverse event by 6 months, with the highest risk within the first 3 months post discharge. An abnormal TUG score was associated with increased adjusted hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.03 to 1.59, P = 0.03. A higher FMMSE score (adjusted HR 0.89, 95% CI 0.82 to 0.96, P = 0.003) and independent living before hospitalization (adjusted HR 0.42, 95% CI 0.21 to 0.84, P = 0.01) were associated with reduced risk of adverse outcome. Conclusion Some ACE patients demonstrate further functional decline following hospitalization, resulting in loss of independence, repeat hospitalization, or death. Abnormal TUG is associated with prolonged LOS and future adverse outcomes.
Collapse
Affiliation(s)
- Roger Y Wong
- Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Canada.
| | | |
Collapse
|