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Thorsted AB, Thygesen LC, Jezek AH, Pedersen MM, Jorgensen MG, Vinding K, Kannegaard PN, Pedersen SGH. The De Morton Mobility Index (DEMMI) in hospitalized geriatric patients is associated with risk of readmission, mortality, and discharge to a post-acute care facility: A nationwide register-based cohort study. Arch Gerontol Geriatr 2024; 120:105325. [PMID: 38237375 DOI: 10.1016/j.archger.2024.105325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To examine the association between the de Morton Mobility Index (DEMMI) score on admission in geriatric patients and readmission and mortality within 30, 180, and 365 days after discharge, and discharge to a post-acute care facility. METHODS A nationwide register-based cohort study including 23,941 geriatric in-patients aged ≥65 years admitted to a geriatric ward between 2014 and 2017 and included in the Danish National Database for Geriatrics. The DEMMI score was categorized into four subcategories: very low mobility (DEMMI=0-24), low mobility (DEMMI=27-39), moderately reduced mobility (DEMMI=41-57), and independent mobility (DEMMI=62-100). Patients were followed 30, 180 and 365 days after discharge for readmission and mortality. Their risk of being discharged to a post-acute care facility was examined. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. RESULTS HRs for readmission within 30-days were 1.36 (1.24-1.48) for very low mobility, 1.30 (1.20-1.42) for low mobility and 1.17 (1.08-1.28) for moderately reduced compared with independent mobility. Similar results were seen for readmission within 180- and 365-days. For mortality, HR for 30-day mortality ranged from1.93 and 5.66, 180-day mortality between 1.62 and 3.19, and 365-day mortality between 1.54 and 2.81 compared with patients with independent mobility. OR for discharge to a post-acute care facility was 8.76 (7.29-10.53) for lowest compared with the highest DEMMI mobility subcategory. CONCLUSION In geriatric in-patients, lower DEMMI scores on hospital admission are associated with increased rates of discharge to a post-acute care facility, and for readmission, and mortality within one year.
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Affiliation(s)
- Anne B Thorsted
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Andrea H Jezek
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark
| | - Mette M Pedersen
- Department of Clinical Research and Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital at Amager and Hvidovre, Kettegaard alle 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin G Jorgensen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Vinding
- Diagnostic Center, Department of Medicine, Odense University Hospital, Baagøes Alle 31, 5700 Svendborg, Denmark
| | - Pia N Kannegaard
- Department of Geriatric and Palliative Medicine, Bispebjerg-Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Solvejg G H Pedersen
- Department of Medicine 2, Geriatric section, Holbaek University Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.
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2
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Di Rosa M, Sabbatinelli J, Soraci L, Corsonello A, Bonfigli AR, Cherubini A, Sarzani R, Antonicelli R, Pelliccioni G, Galeazzi R, Marchegiani F, Iuorio S, Colombo D, Burattini M, Lattanzio F, Olivieri F. Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study. J Transl Med 2023; 21:835. [PMID: 37990223 PMCID: PMC10664513 DOI: 10.1186/s12967-023-04717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The Neutrophil-to-lymphocyte ratio (NLR) is a marker of poor prognosis in hospitalized older patients with different diseases, but there is still no consensus on the optimal cut-off value to identify older patients at high-risk of in-hospital mortality. Therefore, in this study we aimed at both validating NLR as a predictor of death in older hospitalized patients and assess whether the presence of specific acute diseases can modify its predictive value. METHODS This prospective cohort study included 5034 hospitalizations of older patients admitted to acute care units in the context of the ReportAge study. NLR measured at admission was considered as the exposure variable, while in-hospital mortality was the outcome of the study. ROC curves with Youden's method and restricted cubic splines were used to identify the optimal NLR cut-off of increased risk. Cox proportional hazard models, stratified analyses, and Kaplan-Meier survival curves were used to analyse the association between NLR and in-hospital mortality. RESULTS Both continuous and categorical NLR value (cut-off ≥ 7.95) predicted mortality in bivariate and multivariate prognostic models with a good predictive accuracy. The magnitude of this association was even higher in patients without sepsis, congestive heart failure, and pneumonia, and those with higher eGFR, albumin, and hemoglobin (p < 0.001). A negative multiplicative interaction was found between NLR and eGFR < 45 (p = 0.001). CONCLUSIONS NLR at admission is a readily available and cost-effective biomarker that could improve identification of geriatric patients at high risk of death during hospital stay independent of admitting diagnosis, kidney function and hemoglobin levels.
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Affiliation(s)
- Mirko Di Rosa
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Ancona, Italy
| | - Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Laboratory Medicine Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCSS INRCA, C.da Muoio Piccolo, 87100, Cosenza, Italy.
| | - Andrea Corsonello
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Ancona, Italy
- Unit of Geriatric Medicine, IRCSS INRCA, C.da Muoio Piccolo, 87100, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
| | | | | | - Roberta Galeazzi
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
| | | | | | | | | | | | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
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3
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Bogler O, Kirkwood D, Austin PC, Jones A, Sinn CLJ, Okrainec K, Costa A, Lapointe-Shaw L. Recent functional decline and outpatient follow-up after hospital discharge: a cohort study. BMC Geriatr 2023; 23:550. [PMID: 37697250 PMCID: PMC10496187 DOI: 10.1186/s12877-023-04192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Functional decline is common following acute hospitalization and is associated with hospital readmission, institutionalization, and mortality. People with functional decline may have difficulty accessing post-discharge medical care, even though early physician follow-up has the potential to prevent poor outcomes and is integral to high-quality transitional care. We sought to determine whether recent functional decline was associated with lower rates of post-discharge physician follow-up, and whether this association changed during the COVID-19 pandemic, given that both functional decline and COVID-19 may affect access to post-discharge care. METHOD We conducted a retrospective cohort study using health administrative data from Ontario, Canada. We included patients over 65 who were discharged from an acute care facility during March 1st, 2019 - January 31st, 2020 (pre-COVID-19 period), and March 1st, 2020 - January 31st, 2021 (COVID-19 period), and who were assessed for home care while in hospital. Patients with and without functional decline were compared. Our primary outcome was any physician follow-up visit within 7 days of discharge. We used propensity score weighting to compare outcomes between those with and without functional decline. RESULTS Our study included 21,771 (pre-COVID) and 17,248 (COVID) hospitalized patients, of whom 15,637 (71.8%) and 12,965 (75.2%) had recent functional decline. Pre-COVID, there was no difference in physician follow-up within 7 days of discharge (Functional decline 45.0% vs. No functional decline 44.0%; RR = 1.02, 95% CI 0.98-1.06). These results did not change in the COVID-19 period (Functional decline 51.1% vs. No functional decline 49.4%; RR = 1.03, 95% CI 0.99-1.08, Z-test for interaction p = 0.72). In the COVID-19 cohort, functional decline was associated with having a 7-day physician virtual visit (RR 1.15; 95% CI 1.08-1.24) and a 7-day physician home visit (RR 1.64; 95% CI 1.10-2.43). CONCLUSIONS Functional decline was not associated with reduced 7-day post-discharge physician follow-up in either the pre-COVID-19 or COVID-19 periods. In the COVID-19 period, functional decline was positively associated with 7-day virtual and home-visit follow-up.
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Affiliation(s)
- Orly Bogler
- Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - David Kirkwood
- Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aaron Jones
- Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Chi-Ling Joanna Sinn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Karen Okrainec
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Toronto General Hospital Research Institute, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Andrew Costa
- Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada
| | - Lauren Lapointe-Shaw
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Department of Medicine, University Health Network, Toronto, ON, Canada
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Campbell J, Hubbard R, Ostaszkiewicz J, Green T, Coyer F, Mudge A. Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes. Age Ageing 2023; 52:afad181. [PMID: 37738169 PMCID: PMC10516354 DOI: 10.1093/ageing/afad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Incontinence is common in hospitalised older adults but few studies report new incidence during or following hospitalisation. OBJECTIVE To describe prevalence and incidence of incontinence in older inpatients and associations with clinical outcomes. DESIGN Secondary analysis of prospectively collected data from consecutive consenting inpatients age 65 years and older on medical and surgical wards in four Australian public hospitals. METHODS Participants self-reported urinary and faecal incontinence 2 weeks prior to admission, at hospital discharge and 30 days after discharge as part of comprehensive assessment by a trained research assistant. Outcomes were length of stay, facility discharge, 30-day readmission and 6-month mortality. RESULTS Analysis included 970 participants (mean age 76.7 years, 48.9% female). Urinary and/or faecal incontinence was self-reported in 310/970 (32.0%, [95% confidence interval (CI) 29.0-35.0]) participants 2 weeks before admission, 201/834 (24.1% [95% CI 21.2-27.2]) at discharge and 193/776 (24.9% [95% CI 21.9-28.1]) 30 days after discharge. Continence patterns were dynamic within the peri-hospital period. Of participants without pre-hospital incontinence, 74/567 (13.1% [95% CI 10.4-16.1) reported incontinence at discharge and 85/537 (15.8% [95% CI 12.8-19.2]) reported incontinence at 30 days follow-up. Median hospital stay was longer in participants with pre-hospital incontinence (7 vs. 6 days, P = 0.02) even in adjusted analyses and pre-hospital incontinence was significantly associated with mortality in unadjusted but not adjusted analyses. CONCLUSION Pre-hospital, hospital-acquired and new post-hospital incontinence are common in older inpatients. Better understanding of incontinence patterns may help target interventions to reduce this complication.
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Affiliation(s)
- Jill Campbell
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Geriatric Medicine Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Joan Ostaszkiewicz
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia
- Health and Innovation Transformation Centre, Federation University, Ballarat, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Theresa Green
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Australia
- Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Alison Mudge
- Internal Medicine and Aged Care Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Lattanzio F, Corigliano V, Soraci L, Fumagalli A, Onder G, Volpato S, Cherubini A, Ruggiero C, Cozza A, Guarasci F, Corsonello A. Unveiling the Burden of Interactions Among Clinical Risk Factors for 1-Year Mortality in Hospitalized Older Patients. Front Med (Lausanne) 2021; 8:771115. [PMID: 34901086 PMCID: PMC8655869 DOI: 10.3389/fmed.2021.771115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Hospitalized older patients are particularly exposed to adverse health outcomes. Objective: In this study, we aimed at investigating the prognostic interactions between disability in basic activities of daily living (BADL), cognitive impairment, low handgrip strength, anticholinergic cognitive burden (ACB), and depression on 1-year mortality. Setting and Subjects: Our series consisted of 503 older patients discharged from acute care hospitals. Methods: Disability in at least one BADL, ACB, depression, cognitive impairment, and low handgrip strength was considered in the analysis. One-year mortality was investigated by Cox regression analysis and prognostic interactions among study variables were assessed by survival tree analysis. Results: Basic activities of daily living disability, ACB, cognitive impairment, and low handgrip strength were significantly associated with 1-year mortality. Survival tree analysis showed that patients with BADL disability and high ACB carried the highest risk of poor survival [hazard ratio (HR): 16.48 (2.63–74.72)], followed by patients with BADL disability and low ACB (HR: 8.43, 95% CI: 1.85–38.87). Patients with cognitive impairment and no BADL disability were characterized by a lower but still significant risk of mortality (HR: 6.61, 95% CI: 1.51–28.97) and those with high ACB scores and good cognitive and functional performance (HR: 5.28, 95% CI: 1.13–24.55). Conclusion: Basic activities of daily living dependency, cognitive impairment, and ACB score were the three main predictors of 1-year mortality among patients discharged from acute care hospitals; the interaction between BADL dependency and ACB score was found to significantly affect survival. Early identification of such high-risk patients may help tailor targeted interventions to counteract their detrimental effects on prognosis.
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Affiliation(s)
- Fabrizia Lattanzio
- Scientific Direction, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Ancona, Italy
| | - Valentina Corigliano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Cosenza, Italy
| | - Alessia Fumagalli
- Respiratory Unit, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Casatenovo, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, IstitutoSuperiore di Sanitá, Rome, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Center for Clinical Epidemiology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Cherubini
- Geriatria, Accettazionegeriatrica e Centro di Ricerca per l'Invecchiamento, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Ancona, Italy
| | - Carmelinda Ruggiero
- Orthogeriatric and Geriatric Units, Gerontology and Geriatric Sections, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Annalisa Cozza
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Ancona, Italy
| | - Francesco Guarasci
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Medicine, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Cosenza, Italy.,Unit of Geriatric Pharmacoepidemiology and Biostatistics, Istituto Di Ricovero e Cura a Carattere Scientifico Italian National Research Centers on Aging, Ancona, Italy
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6
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Corsonello A, Soraci L, Di Rosa M, Bustacchini S, Bonfigli AR, Lisa R, Liperoti R, Tettamanti M, Cherubini A, Antonicelli R, Pelliccioni G, Postacchini D, Lattanzio F. Prognostic Interplay of Functional Status and Multimorbidity Among Older Patients Discharged From Hospital. J Am Med Dir Assoc 2021; 23:499-506.e1. [PMID: 34384766 DOI: 10.1016/j.jamda.2021.07.012] [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: 04/05/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prognostic weight of multimorbidity and functional impairment over long-term mortality among older patients discharged from acute care hospitals. DESIGN A prospective multicenter observational study. SETTING AND PARTICIPANTS Our series consisted of 1967 adults aged ≥65 years consecutively admitted to acute care wards in Italy, in the context of the Report-AGE project. METHODS After signing a written informed consent, all patients underwent comprehensive geriatric assessment by Inter-RAI Minimum Data Set acute care. The primary endpoint of the present study was long-term mortality. Patients were grouped into 3 functional clusters and 3 disease clusters using the K-medians cluster analysis. The association of functional clusters, disease clusters, and Charlson score categories with long-term mortality was investigated through Cox regression analysis and the intercluster classification agreement was further estimated. Finally, the additive effect of either disease clusters or Charlson score on predictive ability of functional clusters was assessed by using changes in Harrell's C-index and categorical Net Reclassification Index (NRI). RESULTS Functional clusters, disease clusters, and Charlson score were significant predictors of long-term mortality, but the interclassification agreement was poor. Functional clusters predicted mortality with greater accuracy [C-index 0.66, 95% confidence interval (CI) 0.65-0.68] compared with disease clusters (C-index 0.54, 95% CI 0.53-0.56), and Charlson score (C-index 0.58, 95% CI 0.56-0.59). Adding multimorbidity (NRI 0.23, 95% CI 0.14-0.31) or Charlson score (NRI 0.13, 95% CI 0.03-0.20) to functional cluster model slightly improved the accuracy of prediction. CONCLUSIONS AND IMPLICATIONS Functional impairment may better predict prognosis compared with multimorbidity, which may be relevant to optimally address individuals' needs and to design tailored preventive interventions.
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Affiliation(s)
- Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy; Unit of Geriatric Medicine, IRCSS INRCA, Cosenza, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCSS INRCA, Cosenza, Italy.
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | | | | | | | - Rosa Liperoti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Tettamanti
- Geriatric Epidemiology Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | | | - Demetrio Postacchini
- Geriatrics Operative Unit, Italian National Research Centre on Aging (IRCCS INRCA), Fermo, Italy
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Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature. Can J Aging 2021; 40:405-423. [PMID: 33843528 DOI: 10.1017/s0714980820000355] [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: 11/05/2022] Open
Abstract
Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.
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8
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Laurent M, Oubaya N, David JP, Engels C, Canoui-Poitrine F, Corsin L, Liuu E, Audureau E, Bastuji-Garin S, Paillaud E. Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study. BMC Geriatr 2020; 20:433. [PMID: 33121435 PMCID: PMC7597031 DOI: 10.1186/s12877-020-01813-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In some European countries, including France, older patients with functional decline in acute units are transferred to geriatric rehabilitation units. Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. Previous prognostic models of functional decline are based on only baseline parameters. However, some events can occur during rehabilitation and modify the association between baseline parameters and rehabilitation performance such as heart failure episode, falls or hospital-acquired infection (HAI). The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. METHODS We used a prospective cohort of consecutive patients aged ≥75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. RESULTS Among the 252 eligible patients, 160 (median age 84 years [interquartile range (IQR) 80-88] had available ADL scores at baseline (median score 7 [IQR 4-10]) and at discharge (median 9 [6-12]). Median CIRS-G score was 11 [8-13], 23 (14%) had a pulmonary HAI; 28 (17.5%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P = 0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P = 0.02, or psychiatric disease, P = 0.02) and albumin level < 35 g/l (p = 0.03). Significant associations were found between functional decline and CIRS-G-R (OR 3.07 [95%CI 1.27-7.41], p = 0.01), between functional decline and pulmonary HAI (OR 3.12 [1.17-8.32],p = 0.02), and between CIRS-G-R and pulmonary HAI (OR 12.9[4.4-37.7], p = 0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 2.26 [0.83-6.16], p = 0.11) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. CONCLUSION Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.
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Affiliation(s)
- Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France. .,AP-HP, Hopital Henri Mondor, Departement de médecine interne et gériatrie, F-94010, Creteil, France.
| | - Nadia Oubaya
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Jean-Philippe David
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Gériatrie, AP-HP, Hôpital Emile Roux, F- 94450, Limeil Brévannes, France
| | - Cynthia Engels
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Univ Paris Est Creteil, Occupational Therapy Institute (IFE), F -94010, Creteil, France
| | - Florence Canoui-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Lola Corsin
- AP-HP, Hopital Henri Mondor, Departement de médecine interne et gériatrie, F-94010, Creteil, France
| | - Eveline Liuu
- CHU de Poitiers, Service de gériatrie, 2, rue de la Milétrie, F-86021, Poitiers, France
| | - Etienne Audureau
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Gériatrie, AP-HP, Hôpital Europeen Georges Pompidou, F-75015, Paris, France
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9
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Aliberti MJR, Covinsky KE, Apolinario D, Smith AK, Lee SJ, Fortes-Filho SQ, Melo JA, Souza NPS, Avelino-Silva TJ, Jacob-Filho W. 10-Minute Targeted Geriatric Assessment Predicts Disability and Hospitalization in Fast-Paced Acute Care Settings. J Gerontol A Biol Sci Med Sci 2020; 74:1637-1642. [PMID: 31056669 DOI: 10.1093/gerona/glz109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited time and resources hinder the use of comprehensive geriatric assessment in acute contexts. We investigated the predictive value of a 10-minute targeted geriatric assessment (10-TaGA) for adverse outcomes over 6 months among acutely ill older outpatients. METHODS Prospective study comprising 819 acutely ill outpatients (79.2 ± 8.4 years; 63% women) in need of intensive management (eg, intravenous therapy, laboratory test, radiology) to avoid hospitalization. The 10-TaGA provided a validated measure of cumulative deficits. Previously established 10-TaGA cutoffs defined low (0-0.29), medium (0.30-0.39), and high (0.40-1) risks. To estimate whether 10-TaGA predicts new dependence in activities of daily living and hospitalization over the next 6 months, we used hazard models (considering death as competing risk) adjusted for standard risk factors (sociodemographic factors, Charlson comorbidity index, and physician estimates of risk). Differences among areas under receiver operating characteristic curves (AUROC) examined whether 10-TaGA improves outcome discrimination when added to standard risk factors. RESULTS Medium- and high-risk patients, according to 10-TaGA, presented a higher incidence of new activities of daily living dependence (21% vs 7%, adjusted subhazard ratio [aHR] = 2.4, 95% CI = 1.3-4.5; 40% vs 7%, aHR = 5.0, 95% CI = 2.8-8.7, respectively) and hospitalization (27% vs 13%, aHR = 2.0, 95% CI = 1.2-3.3; 37% vs 13%, aHR = 2.9, 95% CI = 1.8-4.6, respectively) than low-risk patients. The 10-TaGA remarkably improved the discrimination of models that incorporated standard risk factors to predict new activities of daily living dependence (AUROC = 0.76 vs 0.71, p < .001) and hospitalization (AUROC = 0.71 vs 0.68, p < .001). CONCLUSIONS The 10-TaGA is a practical and efficient comprehensive geriatric assessment tool that improves the prediction of adverse outcomes among acutely ill older outpatients.
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Affiliation(s)
- Márlon J R Aliberti
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Brazil.,Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF).,Veterans Affairs Medical Center, San Francisco, CA
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF).,Veterans Affairs Medical Center, San Francisco, CA
| | - Daniel Apolinario
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Brazil
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF).,Veterans Affairs Medical Center, San Francisco, CA
| | - Sei J Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF).,Veterans Affairs Medical Center, San Francisco, CA
| | - Sileno Q Fortes-Filho
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Brazil
| | - Juliana A Melo
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Brazil
| | - Natalia P S Souza
- Gerontology, School of Arts, Sciences and Humanities, University of Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Brazil
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10
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Rodrigues C, Mendonça D, Martins MM. Functional trajectories of older acute medical inpatients. ENFERMERIA CLINICA 2019; 30:260-268. [PMID: 31076259 DOI: 10.1016/j.enfcli.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/16/2019] [Accepted: 03/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the changes in basic activities of daily living (BADL) function before and during hospital admission in older patients admitted to an acute medical unit and to assess the effect of age on loss of BADL function. METHODS Prospective observational study. The study included 91 patients aged 65 and older consecutively admitted to an acute medical unit of an urban public teaching hospital in Portugal, between May and September 2017. Functional status was measured at three times: at hospital admission; at about 2 weeks before hospital admission (baseline); an on the discharge day. The functional condition was evaluated using the Katz index. Differences in scores for BADL between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline. RESULTS Pre-admission, in-hospital and overall functional decline occurred in 78.0%, 4.4% and 63.7% of the participants, respectively. In contrast, in-hospital functional improvement occurred in a minority of the patients (14.3%). Hospitalized older people are discharged with BADL function that is worse than their baseline function. The oldest patients are at high risk of poorer functional outcomes because they are less likely to recover BADL function lost before admission. CONCLUSION These results emphasize the overriding need for implementing in-hospital processes to prevent functional decline and enhance functional recovery. This study also highlights the need for nurses to closely monitor the functional status of hospitalized older people, particularly in oldest-old patients.
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Affiliation(s)
- Cecília Rodrigues
- Doutoramento em Ciências de Enfermagem, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Medicina C, Departamento de Medicina, Centro Hospitalar do Porto, Porto, Portugal; Gabinete de Governação Clínica, Departamento da Qualidade, Centro Hospitalar do Porto, Porto, Portugal.
| | - Denisa Mendonça
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Maria Manuela Martins
- Escola Superior de Enfermagem do Porto, Porto, Portugal; Grupo de Investigação NursID: Inovação e Desenvolvimento em Enfermagem - Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Universidade do Porto, Porto, Portugal
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