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Kroken BA, Bergum D, Berg KS, Espinasse M, Fossum OK, Garratt AM, Klepstad P, Kvåle R, Strand B, Flaatten HK, Frisvold SK. Frailty and health-related life quality in long-term follow up of intensive care patients above 65 years old: Protocol for a Norwegian prospective, observational multicenter study. Acta Anaesthesiol Scand 2024. [PMID: 39353584 DOI: 10.1111/aas.14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/09/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Frailty is strongly correlated with mortality in intensive care unit patients, yet routine screening among intensive care patients is rarely performed. The aim of this study is to assess frailty and health-related quality of life (HRQoL) in patients before intensive care admission and to compare this with outcomes after 3 and 12-months. The Clinical Frailty Scale and EQ-5D-5L will be used to assess frailty and HRQoL, respectively. METHODS This is an ongoing, prospective observational study including patients from five Norwegian ICU's. Inclusion criteria are patients aged ≥65 years requiring invasive mechanical ventilation for ≥24 h. The Clinical Frailty Scale and EQ-5D-5L are administered at baseline (before critical illness) and at 3- and 12-months post-inclusion. Additional data collected includes patient characteristics, ICU treatment details, illness severity and mortality. The EQ-5D-5L will be compared to Norwegian population norms and assessed for measurement properties. RESULTS Inclusion started July 2022 and will be stopped at 350 patients. The study will be completed in 2025. CONCLUSION The study will assess the feasibility and measurement properties of the Clinical Frailty Scale and EQ-5D-5L in ICU survivors by telephone at long-term follow-up study and will give additional information on the frailty and HRQoL of intensive care survivors. CLINICAL TRIAL REGISTRATION The study is registered in ClinicalTrials.gov NCT06012942. Protocol version 2.7.1, 19.05.2023.
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Affiliation(s)
- B A Kroken
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromso, Norway
- Department of Anaesthesia and Intensive care, University Hospital of North Norway, Tromso, Norway
| | - D Bergum
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway
| | - K S Berg
- Department of Anaesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital Trust, Bodø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - M Espinasse
- Department of Clinical Research, University Hospital of North Norway, Tromso, Norway
| | - O K Fossum
- Department of Anaesthesia and Intensive care, Akershus University Hospital, Oslo, Norway
| | - A M Garratt
- Division for the Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Pal Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway
| | - Reidar Kvåle
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Anaesthesia and Intensive Care, Haukeland University, Bergen, Norway
- K1, Medical Faculty, University of Bergen, Bergen, Norway
| | - B Strand
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Shirin K Frisvold
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromso, Norway
- Department of Anaesthesia and Intensive care, University Hospital of North Norway, Tromso, Norway
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Brandvold M, Rustøen T, Hagen M, Stubberud J, van den Boogaard M, Hofsø K. Inter-rater agreement between patient- and proxy-reported cognitive functioning in intensive care unit patients: A cohort study. Aust Crit Care 2024; 37:701-709. [PMID: 38614955 DOI: 10.1016/j.aucc.2024.03.003] [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: 08/14/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Health status, including cognitive functioning before critical illness, is associated with long-term outcomes in intensive care unit survivors. Premorbid data are therefore of importance in longitudinal studies. Few patients can self-report at intensive care admission. Consequently, proxy assessments of patients' health status are used. However, it remains unclear how accurately proxies can report on an intensive care patient's cognitive status. OBJECTIVES The aim of this study was to examine the agreement between patient- and proxy-reporting of the Cognitive Failures Questionnaire and to compare the agreement between proxy reports using the latter questionnaire and the Informant Questionnaire of Cognitive Decline in the Elderly as a reference. METHODS The present cohort study is part of a longitudinal multicentre study collecting both patient and proxy data using questionnaires and clinical data from medical records during intensive care unit stays. Agreement on patient and proxy pairs was examined using intraclass correlation coefficient (ICC), Spearman's correlation, percentage agreement, and Gwet's AC1 statistics. Agreement between the proxy-reported questionnaires was examined using percentage agreement and Gwet's AC1 statistics. RESULTS In total, we collected 99 pairs of patient-proxy assessments and 158 proxy-proxy assessments. The ICC for the sum scores revealed moderate agreement (n = 99; ICC = 0.59; 99% confidence interval [CI]: [0.30-0.76]) between patient and proxy. Agreement on items was poor (AC1 = 0.13; 99% CI: [0.01-0.24]) to moderate (AC1 = 0.55; 99% CI: [0.43-0.68]). Agreement using cut-off scores (>43) to indicate cognitive impairment was very good (89.9%, AC1 = 0.87; 99% CI: [0.79-0.95]). Agreement between the proxy-reported Cognitive Failures Questionnaire (>43) and the reference questionnaire (≥3.5) was also very good (n = 158; 85%, AC1 = 0.82; 99% CI: [0.74-0.90]). CONCLUSIONS Proxy assessments of the Cognitive Failures Questionnaire (>43) may be used to indicate cognitive impairment if patients are unable to self-report. Agreement was high between the two questionnaires determined by proxies, showing that these can be used interchangeably to assess cognitive functioning if proxy reporting is needed.
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Affiliation(s)
- Malin Brandvold
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O.box 1089 Blindern, 0318 Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O.box 1089 Blindern, 0318 Oslo, Norway
| | - Milada Hagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Faculty of Health Sciences, Department of Public Health, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass 0130 Oslo, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, P.O. Box 1094 Blindern, 0317 Oslo, Norway; Department of Research, Lovisenberg Diaconal Hospital, P.O. Box 4970 Nydalen, 0440 Oslo, Norway
| | - Mark van den Boogaard
- Radboud University Medical Center, Department of Intensive Care, P.O. Box 91016500 HB Nijmegen, the Netherlands
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggata 15b, 0456 Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway
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Kvalsvik F, Larsen BH, Eilertsen G, Falkenberg HK, Dalen I, Haaland S, Storm M. Health Needs Assessment in Home-Living Older Adults: Protocol for a Pre-Post Study. JMIR Res Protoc 2024; 13:e55192. [PMID: 38635319 PMCID: PMC11066750 DOI: 10.2196/55192] [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: 12/05/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Conducting a health needs assessment for older adults is important, particularly for early detection and management of frailty. Such assessments can help to improve health outcomes, maintain overall well-being, and support older adults in retaining their independence as they age at home. OBJECTIVE In this study, a systematic approach to health needs assessment is adopted in order to reflect real-world practices in municipal health care and capture the nuances of frailty. The aim is to assess changes in frailty levels in home-living older adults over 5 months and to examine the observable functional changes from a prestudy baseline (t1) to a poststudy period (t2). Additionally, the study explores the feasibility of conducting the health needs assessment from the perspective of home-living older adults and their informal caregivers. METHODS Interprofessional teams of registered nurses, physiotherapists, and occupational therapists will conduct 2 health needs assessments covering physical, cognitive, psychological, social, and behavioral domains. The study includes 40 home-living older adults of 75 years of age or older, who have applied for municipal health and care services in Norway. A quantitative approach will be applied to assess changes in frailty levels in home-living older adults over 5 months. In addition, we will examine the observable functional changes from t1 to t2 and how these changes correlate to frailty levels. Following this, a qualitative approach will be used to examine the perspectives of participants and their informal caregivers regarding the health needs assessment and its feasibility. The final sample size for the qualitative phase will be determined based on the participant's willingness to be interviewed. The quantitative data consist of descriptive statistics, simple tests, and present plots and correlation coefficients. For the qualitative analysis, we will apply thematic analysis. RESULTS The initial baseline assessments were completed in July 2023, and the second health needs assessments are ongoing. We expect the results to be available for analysis in the spring of 2024. CONCLUSIONS This study has potential benefits for not only older adults and their informal caregivers but also health care professionals. Moreover, it can be used to inform future studies focused on health needs assessments of this specific demographic group. The study also provides meaningful insights for local policy makers, with potential future implications at the national level. TRIAL REGISTRATION ClinicalTrials.gov NCT05837728; https://clinicaltrials.gov/study/NCT05837728. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55192.
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Affiliation(s)
- Fifi Kvalsvik
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Bente Hamre Larsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Grethe Eilertsen
- Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Helle K Falkenberg
- Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Ingvild Dalen
- Section of Biostatistics, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Stine Haaland
- Department of Health and Welfare services, Stavanger kommune, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
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Pasieka P, Surówka A, Fronczek J, Skwara E, Czuczwar M, Borys M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Żukowski M, Kotfis K, Cwyl K, Skowronek J, Solek-Pastuszka J, Biernawska J, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Sierakowska K, Mudyna W, Białka S, Studzińska D, Bernas S, Piechota M, Machała W, Sadowski Ł, Stefaniak J, Owczuk R, Szymkowiak M, Gawda R, Kozera N, Adamik B, Goździk W, Wieczorek A, Janc J, Kluzik A, Trzebicki J, Zatorski P, Gola W, Hymczak H, Krzych LJ, Czajka S, Kościuczuk U, Kudliński B, Flaatten H, Szczeklik W. Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies. J Crit Care 2024; 79:154439. [PMID: 37832351 DOI: 10.1016/j.jcrc.2023.154439] [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: 06/17/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. METHODS We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST. RESULTS 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001). CONCLUSIONS The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.
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Affiliation(s)
- Paweł Pasieka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Anna Surówka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Evan Skwara
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Czuczwar
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Michał Borys
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland; 2nd Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland
| | - Łukasz R Nowak
- Department of Intensive Care and Anaesthesiology, 5(th) Military Clinical Hospital in Kraków, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Center in Lubin, Poland
| | - Jacek Skowronek
- St. Raphael Hospital, Department of Anaesthesiology and Intensive Care, Kraków, Poland
| | - Joanna Solek-Pastuszka
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Paweł Grudzień
- Department of Anaesthesiology and Intensive Therapy, E. Szczeklik Specialist Hospital in Tarnów, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Kraków, Poland; Department of Anaesthesiology and Intensive Care, St Ann Hospital in Miechów, Poland
| | - Natalia Popek
- Department of Anaesthesiology and Intensive Therapy, S. Żeromski Specialist Hospital in Kraków, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland; Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialized Hospital in Kraków, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Anaesthesiology and Intensive Care, St John Grande Hospital in Kraków, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Małgorzata Szymkowiak
- Department of Anaesthesiology and Intensive Care, Provincial Hospital in Poznań, Poland
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wrocław Medical University, Wrocław, Poland
| | - Barbara Adamik
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Waldemar Goździk
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Agnieszka Wieczorek
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Jarosław Janc
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland; Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Trzebicki
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Paweł Zatorski
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1st Depratment of Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Lukasz J Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical Unibersity of Białystok, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Góra, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Norway
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
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van der Velde MGAM, van der Aa MJ, van Daal MHC, Kremers MNT, Keijsers CJPW, van Kuijk SMJ, Haak HR. Performance of the APOP-screener for predicting in-hospital mortality in older COVID-19 patients: a retrospective study. BMC Geriatr 2022; 22:584. [PMID: 35840904 PMCID: PMC9284964 DOI: 10.1186/s12877-022-03274-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A variety of prediction models concerning COVID-19 have been proposed since onset of the pandemic, but to this date no gold standard exists. Mortality rates show a sharp increase with advancing age but with the large heterogeneity of this population in terms of comorbidities, vulnerability and disabilities, identifying risk factors is difficult. Therefore, we aimed to research the multidimensional concept of frailty, measured by the Acute Presenting Older Patient (APOP)-screener, as a risk factor for in-hospital mortality in older COVID-19 patients. METHODS All consecutive patients of 70 years or older, with a PCR confirmed COVID-19 infection and a completed APOP-score, presenting at the Emergency Department (ED) of the Jeroen Bosch Hospital, the Netherlands, between February 27th 2020 and February 1st 2021 were retrospectively included. We gathered baseline characteristics and scored the CCI and CFS from patient records. The primary outcome was in-hospital mortality. RESULTS A total of 292 patients met the inclusion criteria. Approximately half of the patients were considered frail by the APOP or CFS. 127 patients (43.5%) scored frail on the CFS, 158 (54.1%) scored high risk on the APOP-screener. 79 patients (27.1%) died during their hospital admission. The APOP-screener showed a significantly elevated risk of in-hospital mortality when patients scored both high risk of functional and evidence of cognitive impairment (OR 2.24, 95% 1.18-4.25). Significant elevation of in-hospital mortality was found for the high CCI-scores (≥ 5)(OR 1.78, 95% 1.02-3.11), but not for the highest CFS category (5-9, frail) (OR 1.35, 95% 0.75-2.47). The discriminatory performance of the APOP, CFS and CCI were comparable (AUC resp. 0.59 (0.52-0.66), 0.54 (0.46-0.62) and 0.58 (0.51-0.65)). CONCLUSION Although the elevated risk for in-hospital mortality found for the most frail patients as scored by the APOP, this instrument has poor discriminatory value. Additionally, the CFS did not show significance in predicting in-hospital mortality and had a poor discriminatory value as well. Therefore, treatment decisions based on frailty or comorbidities alone should be made with caution. Approaching the heterogeneity of the older population by adding frailty as assessed by the APOP-score to existing prediction models may enhance the predictive value of these models.
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Affiliation(s)
- Marleen G A M van der Velde
- Department of Internal Medicine, Máxima MC, De Run 4600, Veldhoven-Eindhoven, 5504 DB, The Netherlands. .,Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term care Maastricht, Maastricht, the Netherlands.
| | - Merel J van der Aa
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Merel H C van Daal
- Department of Internal Medicine, Máxima MC, De Run 4600, Veldhoven-Eindhoven, 5504 DB, The Netherlands
| | - Marjolein N T Kremers
- Department of Internal Medicine, Máxima MC, De Run 4600, Veldhoven-Eindhoven, 5504 DB, The Netherlands.,Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term care Maastricht, Maastricht, the Netherlands.,Department of Emergency Medicine, Sint Jans Gasthuis, Weert, The Netherlands
| | | | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Harm R Haak
- Department of Internal Medicine, Máxima MC, De Run 4600, Veldhoven-Eindhoven, 5504 DB, The Netherlands.,Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term care Maastricht, Maastricht, the Netherlands.,Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Therapeutic Drug Monitoring of Antibiotics in the Elderly: A Narrative Review. Ther Drug Monit 2021; 44:75-85. [PMID: 34750337 DOI: 10.1097/ftd.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Antibiotic dosing adaptation in elderly patients is frequently complicated by age-related changes affecting the processes of drug absorption, distribution, metabolism, and/or elimination. These events eventually result in treatment failure and/or development of drug-related toxicity. Therapeutic drug monitoring (TDM) can prevent suboptimal antibiotic exposure in adult patients regardless of age. However, little data are available concerning the specific role of TDM in the elderly. METHODS This review is based on a PubMed search of the literature published in the English language. The search involved TDM studies of antibiotics in the elderly performed between 1990 and 2021. Additional studies were identified from the reference lists of the retrieved articles. Studies dealing with population pharmacokinetic modeling were not considered. RESULTS Only a few studies, mainly retrospective and with observational design, have specifically dealt with appropriate antibiotic dosing in the elderly based on TDM. Nevertheless, some clinical situations in which the selection of optimal antibiotic dosing in the elderly was successfully guided by TDM were identified. CONCLUSIONS Elderly patients are at an increased risk of bacterial infections and inadequate drug dosing compared to younger patients. Therefore, the availability of TDM services can improve the appropriateness of antibiotic prescriptions in this population.
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