Association of Nutritional Status with New-Onset Delirium in Elderly, Acute Care, Orthopaedic Trauma Patients: A Single-Center Observational Study

Preoperative prognostic nutritional index predicts postoperative delirium in aged patients after surgery: A matched cohort study

OBJECTIVE

Prognostic nutritional index (PNI) is an indicator to evaluate the nutritional immune status of patients. This study aimed to assess whether preoperative PNI could predict the occurrence of postoperative POD in aged patients undergoing non-neurosurgery and non-cardiac surgery.

METHOD

The aged patients undergoing non-neurosurgery and non-cardiac surgery between January 2014 and August 2019 were included in the retrospective cohort study. The correlation between POD and PNI was investigated by univariate and multivariable logistic regression analysis, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and subgroup analysis.

RESULTS

In the cohort (n = 29,814), the cutoff value of PNI was 46.01 determined by the receiver operating characteristic (ROC) curve. In univariate and three multivariable regression analysis, the ORs of PNI ≤ 46.01 was 2.573(95% CI:2.261-2.929, P < 0.001),1.802 (95% CI:1.567-2.071, P < 0.001),1.463(95% CI:1.246-1.718, P < 0.001),1.370(95% CI:1.165-1.611, P < 0.001). In the PSM model and IPTW model, the ORs of PNI ≤ 46.01 were 1.424(95% CI:1.172-1.734, P < 0.001) and 1.356(95% CI:1.223-1.505, P < 0.001).

CONCLUSION

The PNI was found to have a predictive value for POD in patients undergoing non-neurosurgery and non-cardiac surgery. Improving preoperative nutritional status may be beneficial in preventing POD for aged patients.

Fast-track and person-centred care in geriatric traumatology in a German-speaking Swiss hospital - A practice development project

INTRODUCTION

Elderly persons have an increased risk for negative health-related outcomes, including higher mortality rates. A centre for geriatric traumatology was established in a German-speaking Swiss hospital to provide more specialised, person-centred care and to lower negative health outcomes. Adaptations and changes in the patient pathway were made by implementing fast-track and person-centred care to better address individual needs.

METHODS

The current patient pathway was analysed by an interprofessional and interdisciplinary geriatric traumatology expert team. The practice development methodology and the Person-Centred Practice Framework (PCP-Framework) were used throughout this engagement process. In consensus within the expert team, the sample was defined as elderly persons aged 65 years or older with suspected hip joint closed fractures. The focus was on three elements of "practice environment" from the PCP-Framework. These were: (1) supportive organisational systems; (2) the physical environment; (3) appropriate skill mix.

RESULTS

Several adaptations and changes were made addressing the three elements of "practice environment". These were for example: (1) use of specific assessments, shared decision-making; (2) proper and effective use of aids; (3) integration of Advanced Practice Nurses. The adaptations in the patient pathway were integrated into the standard operating procedures.

CONCLUSIONS

Through active engagement with the practice development methodology and the focus on person-centredness, the process of care for elderly persons was adapted. Thus, by addressing individual needs, fast-track and person-centred care in geriatric traumatology is provided. Further research is needed to evaluate and to verify implications in clinical practice.

The Significance of the Treatment for Elderly Severe Trauma Patients Who Required Intensive Care

Purpose Elderly trauma patients have a higher risk of severe disability and death, and this outcome burden in elderly trauma patients must be addressed in countries in which the population is aging. The clarification of the unique clinical features of elderly people who have experienced trauma is important. The purpose of this study is to evaluate the significance of the treatment for elderly severe trauma patients based on the prognosis and total hospital cost. Methods Trauma patients transferred to our emergency department (ED) and admitted to our intensive care unit (ICU) directly or through emergency surgery between January 2013 and December 2019 were examined. We divided patients into three groups: <65 years old (Group Y); 65-79 years old (Group M); and ≥80 years old (Group E). We compared the pre- and post-trauma American Society of Anesthesiology Physical Status (ASA-PS) score and the Katz Activities of Daily Living (ADL) questionnaire at arrival among the three groups. In addition, the duration of ICU and hospital stays, hospital mortality, and total treatment costs were compared. Results There were 1,652 patients admitted to ICU through the ED from January 2013 to December 2019. Of those patients, 197 trauma patients were analyzed. There was no significant difference in injury severity scores between the groups. Significant differences in both the ASA-PS and Katz-ADL scores in posttrauma status were observed among the three groups (posttrauma ASA-PS, 2.0 (2.0, 2.8) in Group Y, 3.0 (2.0, 3.0) in Group M, 3.0 (3.0, 3.0) in Group E, p < 0.001*, posttrauma Katz-ADL, 10.0 (3.3, 12.0) in Group Y, 5.5 (2.0, 10.0) in Group M, 2.0 (0.5, 4.0) in Group E, p < 0.001). The duration of both ICU and hospital stay was significantly longer in Group E compared to the other groups (ICU stay, 4.0 (3.0, 6.5) days in Group Y, 4.0 (3.0, 9.8) days in Group M, 6.5 (3.0, 15.3) days, p = 0.006, hospital stay, 16.9 (8.6, 33.0) days in Group Y, 26.7 (12.0, 51.8) days in Group M, 32.5 (12.8, 51.5) days in Group E, p = 0.005). ICU and hospital mortality were highest in Group E compared with the other groups, but the differences were not significant. Finally, the total hospital cost in Group E was significantly higher than the other groups. Conclusions In elderly trauma patients who required intensive care, PS and ADL in posttrauma status were worse, ICU and hospital stays were longer, and ICU and hospital mortality were higher compared with younger patients. In addition, medical costs were greater in elderly patients. It is supposed that the therapeutic effect observed in young trauma patients cannot be expected in elderly trauma patients.

Association between Malnutrition and Delirium in Older Chronic Kidney Disease Patients Admitted to Intensive Care Units: A Data Linkage Study

BACKGROUND

Independently, malnutrition and delirium in older hospitalised adults is prevalent. However, there is limited evidence on the association between these two conditions in older hospitalised adults with chronic kidney disease (CKD).

OBJECTIVES

To determine the association between malnutrition and delirium in older CKD patients admitted to intensive care units (ICU).

METHODS

This data linkage study utilised administrative data from New South Wales (NSW) hospitals in Australia between 2017 and 2020.Admitted patient data was linked with Cause of Death Unit Record File, and NSW Registry of Deaths (RBD). The study population comprised all CKD patients aged 65 and over admitted to ICUs. Descriptive statistics were used to summarise patient characteristics. Binary logistic tested for association between malnutrition and delirium.

RESULTS

The study population included 748 CKD patients with a total 948 admissions in the study period. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) was used to code for all outcomes and comorbidities. The incidence of delirium was 15.5% (n=141) and malnutrition was recorded in 11.3% (n=103) across all admissions. The adjusted odds ratio (OR) of a delirium diagnosis was 2.07 (95% CI: 1.27-3.39) for CKD patients that were malnourished compared to non-malnourished CKD patients.

CONCLUSIONS

This study showed a significant association between delirium and malnutrition in older CKD patients admitted to ICU. Management of malnutrition could be critical in reducing the risk of delirium in older hospitalized patients with CKD. Additionally, more education and awareness around delirium and its association with malnutrition are needed in clinical practice.