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Impact of geriatric consultations on clinical outcomes of elderly trauma patients: A retrospective analysis. Am J Surg 2017; 214:1048-1052. [DOI: 10.1016/j.amjsurg.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022]
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Ackroyd-Stolarz S, Bowles SK, Giffin L. Validating administrative data for the detection of adverse events in older hospitalized patients. Drug Healthc Patient Saf 2014; 6:101-8. [PMID: 25143755 PMCID: PMC4137915 DOI: 10.2147/dhps.s64359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED Older hospitalized patients are at risk of experiencing adverse events including, but not limited to, hospital-acquired pressure ulcers, fall-related injuries, and adverse drug events. A significant challenge in monitoring and managing adverse events is lack of readily accessible information on their occurrence. PURPOSE The objective of this retrospective cross-sectional study was to validate diagnostic codes for pressure ulcers, fall-related injuries, and adverse drug events found in routinely collected administrative hospitalization data. METHODS All patients 65 years of age or older discharged between April 1, 2009 and March 31, 2011 from a provincial academic health sciences center in Canada were eligible for inclusion in the validation study. For each of the three types of adverse events, a random sample of 50 patients whose records were positive and 50 patients whose records were not positive for an adverse event was sought for review in the validation study (n=300 records in total). A structured health record review was performed independently by two health care providers with experience in geriatrics, both of whom were unaware of the patient's status with respect to adverse event coding. A physician reviewed 40 records (20 reviewed by each health care provider) to establish interrater agreement. RESULTS A total of 39 pressure ulcers, 56 fall-related injuries, and 69 adverse drug events were identified through health record review. Of these, 34 pressure ulcers, 54 fall-related injuries, and 47 adverse drug events were also identified in administrative data. Overall, the diagnostic codes for adverse events had a sensitivity and specificity exceeding 0.67 (95% confidence interval [CI]: 0.56-0.99) and 0.89 (95% CI: 0.72-0.99), respectively. CONCLUSION It is feasible and valid to identify pressure ulcers, fall-related injuries, and adverse drug events in older hospitalized patients using routinely collected administrative hospitalization data. The information is relatively inexpensive and easy to access with no impact on clinical staff.
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Affiliation(s)
- Stacy Ackroyd-Stolarz
- Performance Excellence Portfolio, Capital District Health Authority, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan K Bowles
- Geriatric Medicine, Capital District Health Authority, Halifax, Nova Scotia, Canada
- College of Pharmacy and Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pharmacy at Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - Lorri Giffin
- South Shore Family Health, Bridgewater, Nova Scotia, Canada
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Ueki T, Nagai K, Ooe N, Nakashima MN, Nishida K, Nakamura J, Nakashima M. Case-controlled study on risk factors for the development of constipation in hospitalized patients. YAKUGAKU ZASSHI 2011; 131:469-76. [PMID: 21372545 DOI: 10.1248/yakushi.131.469] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Constipation is a common problem in hospitalized patients; however, the relative risks of its development with various factors have not been clarified. To clarify the risk factors associated with constipation, we performed a case-controlled study of 165 hospitalized patients who were not laxative users on admission. They were divided into case (n=35) and control (n=130) groups according to laxative administration during hospitalization. Comparison of the patient backgrounds in the two groups revealed significant differences in the activities of daily living, length of fasting, rest level on admission, cerebrovascular disease, and administration of hypnotics. Multiple logistic regression analysis using these five factors as autonomous variables showed that administration of hypnotics (odds ratio, 2.79; 95% confidence interval, 1.10-7.06; p=0.031) was significantly related to laxative use. Therefore, the administration of hypnotics may be the principal cause of constipation development in hospitalized patients and they should be used with caution.
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Affiliation(s)
- Tetsuya Ueki
- Department of Pharmacy, Kitakyushu City Yahata Hospital
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Li Y, Cai X, Yin J, Glance LG, Mukamel DB. Is higher volume of postacute care patients associated with a lower rehospitalization rate in skilled nursing facilities? Med Care Res Rev 2011; 69:103-18. [PMID: 21810798 DOI: 10.1177/1077558711414274] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study determined whether higher patient volume of skilled nursing facility (SNF) care was associated with a lower hospital transfer rate. Using the nursing home Minimum Data Set and the Online Survey, Certification, and Reporting file, we assembled a national cohort of Medicare SNF postacute care admissions between January and September of 2008. Multivariable analyses based on Cox proportional hazards models found that patients admitted to high-volume SNFs (annual number of admissions in the top tertile group) showed an approximately 15% reduced risk for 30-day rehospitalization and an approximately 25% reduced risk for 90-day rehospitalization, compared with patients admitted to low-volume SNFs (annual number of admissions in the bottom tertile group, or <45). Similar patterns of volume-outcome associations were found for hospital-based and freestanding facilities separately. The inverse volume-outcome association in postacute SNF care may reflect a "practice makes perfect" effect, a "selective referral" effect, or both.
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Affiliation(s)
- Yue Li
- University of Iowa, Iowa City, IA 52242, USA.
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An evidence-based construction of the models of decline of functioning. Part 1: two major models of decline of functioning. Int J Rehabil Res 2009; 32:189-92. [DOI: 10.1097/mrr.0b013e3283021961] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Camicioli RM, Kaye JA, Brummel-Smith K. Recognition of neurologic diseases in geriatric inpatients. Acta Neurol Scand 2009. [DOI: 10.1111/j.1600-0404.1998.tb00648.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yamazaki T, Yokogawa M, Tachino K. Effects of combined stretching and clenbuterol on disuse atrophy in rat soleus muscle. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2009; 12:13-9. [PMID: 25792889 DOI: 10.1298/jjpta.12.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 05/24/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Clinically, disuse muscle atrophy is often seen among patients who are severely debilited and are on prolonged bed rest. Common physical therapy interventions are not successful in preventing disuse muscle atrophy early in the medical treatment of critically ill patients. In situations such as this, the use of a β 2-adrenergic agonist such as clenbuterol (Cb) may be of benefit in preventing atrophy. Also, recent studies have suggested that stretching is possible in preventing disuse muscle atrophy and the decline in muscle strength. The objective of this study was to evaluate the effects of Cb medication combined with stretching (ST) on rat soleus muscle (SOL) during the progression of disuse muscle atrophy. SUBJECTS Thirty-five male Wistar rats were used in this study. METHODS The rats were divided into five groups: control (CON), hindlimb-unweighting (HU) only, HU+ST, HU+Cb medication, and HU+ST+Cb groups. The right SOL in stretching groups was maintained a stretched position for one hour daily by passively dorsiflexing the ankle joint under non-anesthesia. The experimental period was 2 weeks. RESULTS In the ST group, peak twitch tension per cross-sectional area in soleus muscle was significantly larger than in the Cb group, while there was no significant difference between the CON and ST groups. The conversion of type I to type II fibers that was observed in the Cb group was not recognized in the combined ST and Cb group. DISCUSSION AND CONCLUSION Distinct effect of combined stretching and Cb medication was not recognized statistically. The results indicate that Cb affects muscle morphological characteristics while stretching affects contractile properties. These data suggest that a combined ST and Cb intervention considered the type-specificity of muscle fiber may be need more consideration for preventing disuse muscle atrophy and the decline in muscle strength.
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Affiliation(s)
- Toshiaki Yamazaki
- Division of Health Science, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
| | - Masami Yokogawa
- Division of Health Science, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
| | - Katsuhiko Tachino
- Division of Health Science, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan
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Sáez López P, Madruga Galán F, Rubio Caballero J. Detección de problemas en pacientes geriátricos con fractura de cadera. Importancia de la colaboración entre traumatólogo y geriatra. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0482-5985(07)75541-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Detection of Health Conditions in Elderly Patients with a Hip Fracture. Importance of Collaboration between Orthopedic and Geriatric Specialists. Rev Esp Cir Ortop Traumatol (Engl Ed) 2007. [DOI: 10.1016/s1988-8856(07)70025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Steeman E, Moons P, Milisen K, De Bal N, De Geest S, De Froidmont C, Tellier V, Gosset C, Abraham I. Implementation of discharge management for geriatric patients at risk of readmission or institutionalization. Int J Qual Health Care 2006; 18:352-8. [PMID: 16861721 DOI: 10.1093/intqhc/mzl026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate whether implementation of discharge management by trained social workers or nurses reduces hospital readmissions and institutionalizations of geriatric patients in a real-world setting. DESIGN Quasi-experimental design. SETTING Six general hospitals in Belgium. PARTICIPANTS A representative sample of 824 patients, 355 of whom were assigned to the experimental group receiving comprehensive discharge management and 469 to the control group receiving usual care. Inclusion criteria were patients admitted to a geriatric, rehabilitation, or internal medicine ward, not residing in a nursing home, and showing risk of readmission or institutionalization on admission in the hospital. INTERVENTION In-hospital discharge planning according to a case management protocol allowing for adjustment to participating hospitals' case mix and patients' and families' specific needs. MAIN OUTCOME MEASURES Hospital readmission within 15 and 90 days post discharge; institutionalization at discharge and within 15 and 90 days post discharge. RESULTS Discharge management resulted in fewer institutionalizations (n = 53; 14.9%) compared with usual care (n = 130; 23.7%) (adjusted odds ratio = 0.47; CI 95% = 0.31-0.70). Readmission rates between the intervention and usual care group were not significantly different. CONCLUSIONS This implementation project showed that a discharge planning intervention can reduce institutionalization rates of elderly patients in real-life settings.
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Affiliation(s)
- Els Steeman
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium
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Elliott RA, Woodward MC, Oborne CA. Quality of Prescribing for Elderly Inpatients at Nine Hospitals in Victoria, Australia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2003. [DOI: 10.1002/jppr2003332101] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Boockvar K, Lachs M. Hospitalization Risk Following Admission to an Academic Nursing Home. J Am Med Dir Assoc 2002. [DOI: 10.1016/s1525-8610(04)70454-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Passaro A, Volpato S, Romagnoni F, Manzoli N, Zuliani G, Fellin R. Benzodiazepines with different half-life and falling in a hospitalized population: The GIFA study. Gruppo Italiano di Farmacovigilanza nell'Anziano. J Clin Epidemiol 2000; 53:1222-9. [PMID: 11146268 DOI: 10.1016/s0895-4356(00)00254-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years, the use of benzodiazepines has been recognized as an independent risk factor for falls among the elderly. To evaluate the role of different types of benzodiazepines in determining falls in a hospitalized geriatric population, we conducted a prospective study among 7908 patients consecutively admitted in 58 clinical centers of the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA), during an 8-month observation period (1991 and 1993). Over 70% of the patients were older than 65 years, 50% were women, and 23. 6% had a benzodiazepine prescription during hospital stay. The number of patients who experienced one or more falls during follow-up was 174 (2.2%). Sixty falls occurred among patients taking benzodiazepines (3.2%) and 114 (1.9%) among those who did not use benzodiazepines; the crude odds ratio for users versus non-users was 1.7 (95% CI 1.2-2.3). Multivariate logistic regression analysis showed that benzodiazepines with very short (OR 1.9; CI 1.03-3.3) and short half-life (OR 1.8; CI 1.2-2.8) were positively associated with falls during hospital stay. Patients who used other psychotropic agents (OR 2.3; CI 1.7-3.4), antidiabetic agents (OR 1. 5; CI 1.03-2.2), patients with presence of cognitive impairment (OR 1.6; CI 1.08-2.3), high level of comorbidity (OR 1.7; CI 1.05-2.9), more advanced age (>80 years, OR 2.7; CI 1.5-4.7) and those who stayed in the hospital for 17 days or more (OR 2.1; CI 1.4-3.3) were also at a greater risk. These findings suggest that benzodiazepines with short and very short half-life are an important and independent risk factor for falls and their prescription to elderly hospitalized patients should be carefully evaluated.
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Affiliation(s)
- A Passaro
- Second Department of Internal Medicine, University of Ferrara, Italy
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Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc 2000; 48:1572-81. [PMID: 11129745 DOI: 10.1111/j.1532-5415.2000.tb03866.x] [Citation(s) in RCA: 242] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Older persons frequently experience a decline in function following an acute medical illness and hospitalization. OBJECTIVE To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients. DESIGN Randomized controlled trial. SETTING Community teaching hospital. PATIENTS A total of 1,531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997. INTERVENTION ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient-centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness. MEASUREMENTS The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction. RESULTS Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34% vs 40%; P = .027) and during the year following hospitalization (P = .022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79% vs 50%; P = .001), physical therapy consults were obtained more frequently (42% vs 36%; P = .027), and restraints were applied to fewer patients (2% vs 6%; P = .001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P < .05). CONCLUSIONS ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes.
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Affiliation(s)
- S R Counsell
- ACE Clinical Research Office, Summa Health System, Akron, Ohio, USA
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Arbesman MC, Wright C. Mechanical restraints, rehabilitation therapies, and staffing adequacy as risk factors for falls in an elderly hospitalized population. Rehabil Nurs 1999; 24:122-8. [PMID: 10754898 DOI: 10.1002/j.2048-7940.1999.tb02153.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This case-control study of fall-related risk factors for elderly hospitalized patients hypothesized that the use of mechanical restraints, participation in a rehabilitation program, and staffing inadequacy increase the risk of falls. The study included 252 patients, also known as "cases," aged 60 to 85 years, who fell during the period between March 1 and December 31, 1993, in a large metropolitan hospital; and 250 "controls," randomly selected patients aged 60 to 85 years, who were matched with the cases in terms of length of stay to the day of the fall. Analysis using conditional logistic regression revealed that individuals who had been placed in a mechanical restraint at any point during their hospital stay prior to the fall (for the cases) or the selected day (for the controls) had approximately twice the risk of falling as did patients who had not been placed in restraints. Cases and controls showed no significant differences in terms of their participation in occupational therapy, physical therapy, or cardiac rehabilitation, and staffing adequacy was similar for both groups. While the finding of 2 to 4.7 times the risk for falls for those placed in a mechanical restraint only approached statistical significance, the results indicate that the risk of falling is highest soon after a patient has had to be placed in a mechanical restraint.
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Affiliation(s)
- M C Arbesman
- Children's Hospital of Buffalo-KALEIDA Health, Department of Pediatric Surgery, NY 14222, USA
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Barr J, Brown P, Perry G. Risk Factors Associated with Falls in the Elderly Rehabilitation Client. Australas J Ageing 1999. [DOI: 10.1111/j.1741-6612.1999.tb00085.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grad R, Tamblyn R, Holbrook AM, Hurley J, Feightner J, Gayton D. Risk of a new benzodiazepine prescription in relation to recent hospitalization. J Am Geriatr Soc 1999; 47:184-8. [PMID: 9988289 DOI: 10.1111/j.1532-5415.1999.tb04576.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine if recent hospital admission was associated with new outpatient prescribing of benzodiazepines among community-dwelling older people. DESIGN Nested case-control study using administrative data sets of the provincial health insurance board. SETTING Province of Quebec. PARTICIPANTS Cases were 4127 community-dwelling older people who were newly dispensed a benzodiazepine during an 8-month period in 1990. Controls were 16,486 community-dwelling older people who were dispensed any drug (except a benzodiazepine) on the same day as the case-defining index prescription. EXPOSURE AND OUTCOME MEASURES: Admission to an acute care hospital within a 30-day period before a new dispensing of a benzodiazepine. Other variables measured were patient age, gender, number of ambulatory physician visits, healthcare region, Chronic Disease Score (CDS), and use of drugs for depression and psychosis. RESULTS Cases were more than three times as likely as controls to have been hospitalized in the 30-day period before the index date (adjusted odds ratio (OR) 3.09; 95% CI, 2.78-3.45). The use of prescription drugs for physical health problems modified this association in that cases who used more medication were also more likely to receive a new benzodiazepine prescription following a recent hospital admission (adjusted OR 4.09; 95% CI, 3.59-4.65 when the CDS was equal to 5 vs adjusted OR 1.96; 95% CI, 1.66-2.31 when the CDS was equal to 0). CONCLUSIONS Recent hospitalization confers an increased risk of a new outpatient benzodiazepine prescription among community-dwelling older people in Quebec. Those who use more medication, and who may be more vulnerable to drug-related adverse events, are more likely to be newly dispensed a benzodiazepine following a recent, acute-care hospital admission.
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Affiliation(s)
- R Grad
- McGill University and the Royal Victoria Hospital, Montreal, Quebec
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Jacelon CS. Preventing cascade iatrogenesis in hospitalized elders. An important role for nurses. J Gerontol Nurs 1999; 25:27-33. [PMID: 10205421 DOI: 10.3928/0098-9134-19990101-09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C S Jacelon
- University of Massachusetts at Amherst, School of Nursing, USA
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Riedinger JL, Robbins LJ. Prevention of Iatrogenic Illness: Adverse Drug Reactions and Nosocomial Infections in Hospitalized Older Adults. Clin Geriatr Med 1998. [DOI: 10.1016/s0749-0690(18)30086-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leff B, Burton JR. Future Directions: Alternative Approaches to Traditional Hospital Care—Home Hospital. Clin Geriatr Med 1998. [DOI: 10.1016/s0749-0690(18)30095-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A case report is used to discuss common problems and complications of hospitalized elders. The report also illustrates the need for proactive hospital staff who are knowledgeable about the special needs of the aging population if this group is to be cared for successfully. The geriatric resource nurse model involves informal unit-based education aimed at expanding staff nurses' geriatric knowledge and is one of several models sponsored by the Hartford Foundation to improve care of the hospitalized elderly. Teaching rounds between geriatric resource nurses and advanced practice nurses are a primary feature of this model.
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Affiliation(s)
- V K Lee
- University of Virginia Health Sciences Center, Charlottesville, USA
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Abstract
The care of older patients is a challenging and often rewarding experience. Elderly people can be helped to fulfill their needs and realize their goals with a sensitive and comprehensive evaluation, a positive and supportive attitude and an emphasis on illness rather than disease. Health care providers can contribute greatly to improved function and enhanced quality of life through an understanding of and respect for the individual qualities and aspirations of their older patients.
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Affiliation(s)
- S A Sternberg
- Department of Medicine, University of Toronto, Ontario, Canada
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Marchionni N, Ferrucci L, Baldasseroni S, Fumagalli S, Guralnik JM, Bonazinga M, Cecchi F, Masotti G. Item re-scaling of an Italian version of the sickness impact profile: effect of age and profession of the observers. J Clin Epidemiol 1997; 50:195-201. [PMID: 9120513 DOI: 10.1016/s0895-4356(96)00318-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An Italian version of the Sickness Impact Profile (SIP) obtained by professional and nonprofessional translators was checked for cross-cultural equivalence using a back-translation method followed by two scaling studies. The first scaling study involved 30 health professionals who ranked the items within each category for severity of dysfunction. By comparing Italian and US average ranks, 14 highly discordant items were identified. A revised translation was evaluated in a new study involving 120 observers stratified by age (< 65 versus > or = 65 years) and profession (health versus non health professionals) into 4 groups of the same size. The Italian and American item rank orders were almost equivalent, independently of the age and profession of the observers (93% of the ranks showing differences < 2), suggesting that this Italian version of SIP is cross-culturally unbiased. However, older age was associated with higher variability in the rank orders, and some caution is required for use in the geriatric population.
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Affiliation(s)
- N Marchionni
- The University Department of Gerontology and Geriatric Medicine, Florence, Italy
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Shindul-Rothschild J, Berry D, Long-Middleton E. Where have all the nurses gone? Final results of our Patient Care Survey. Am J Nurs 1996; 96:25-39. [PMID: 8918353 DOI: 10.1097/00000446-199611000-00034] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Rich MW, Shah AS, Vinson JM, Freedland KE, Kuru T, Sperry JC. Iatrogenic congestive heart failure in older adults: clinical course and prognosis. J Am Geriatr Soc 1996; 44:638-43. [PMID: 8642152 DOI: 10.1111/j.1532-5415.1996.tb01824.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the prevalence, risk factors, clinical course, and prognosis of iatrogenic congestive heart failure in older patients. DESIGN AND SETTING Prospective observational study at a university teaching hospital. PARTICIPANTS A total of 401 patients 70 years of age or older hospitalized with congestive heart failure. The mean age was 80 +/- 6 years; 59% were female, and 65% were white. MEASUREMENTS Comprehensive data, including an assessment of the etiology and precipitating factors leading to the development of heart failure, were collected at the time of diagnosis. Iatrogenic heart failure was defined as heart failure precipitated by medications or excessive fluid administration, or occurring as a procedural complication. All patients were followed for 1 year, and the primary outcome measure was total mortality. RESULTS Using strict criteria, 28 patients (7.0%) were considered to have iatrogenic heart failure. Compared with noniatrogenic patients (n = 373), iatrogenic cases had less severe premorbid cardiac disease but more marked noncardiac disability and longer hospital stays (29 +/- 24 vs 13 +/- 12 days, P < .001). Hospital mortality was 32% in iatrogenic heart failure patients compared with 9% in noniatrogenic cases (P < .001). Cumulative mortality at 1 year was 68% in iatrogenic patients versus 39% in noniatrogenic patients (P < .01). Using a Cox proportional hazards model, iatrogenic congestive heart failure was associated with a relative mortality risk during follow-up of 2.5 (95% confidence interval 1.5-4.3) after adjusting for age, sex, prior history of heart failure, New York Heart Association class, diabetes mellitus, systolic blood pressure, hemoglobin, blood urea nitrogen, and serum albumin. CONCLUSIONS Frail, debilitated older patients are at increased risk for developing iatrogenic heart failure, even in the absence of clinically evident cardiac disease. In this population, iatrogenic heart failure serves as a marker for poor short- and long-term prognosis, but further study is required to determine the optimal approach to management of these patients.
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Affiliation(s)
- M W Rich
- Jewish Hospital, Washington University Medical Center, St. Louis, Missouri 63110, USA
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Abstract
OBJECTIVE To describe the incidence and characteristics of aggressive behaviors in a group of institutionalized elderly. DESIGN Retrospective survey. SETTING 350-bed, urban skilled nursing facility. PATIENTS All nursing home residents who had an incident report completed after an aggressive behavior. MEASUREMENTS Examination of all incident reports of aggressive behavior for 1 year. RESULTS There were 94 reports of aggressive behaviors. Twenty-nine residents exhibited one aggressive behavior, 12 residents two, and six residents exhibited three or more aggressive behaviors. These six residents accounted for 44% of all events. The incidence of aggressive behavior was 0.27 per resident per year for the entire facility; on the Alzheimer's unit the incidence was 0.75 per resident per year. Sixty-two percent of the victims of aggressive behavior were other nursing home residents, 37% were employees, and 1% were visitors. The charts of the six residents with three or more aggressive behaviors were reviewed. These residents received trials of multiple scheduled psychotropic medications, often exhibited several additional agitated behaviors around the time of the attack, were at risk for psychiatric hospitalizations during the study period, and often were noted to have underlying acute medical illnesses near the time of the attack. CONCLUSION Approximately two aggressive behaviors per week occurred in a large nursing home. Residents and staff of Alzheimer's units have a higher risk of being victims of aggressive behavior. A small number of patients account for nearly half of the behaviors, even on the Alzheimer's unit. Aggressive behaviors may be clinical indicators of underlying acute medical illnesses.
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Affiliation(s)
- M L Malone
- University of Wisconsin Medical School, Milwaukee
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Gorbien MJ. In reply. J Am Geriatr Soc 1993. [DOI: 10.1111/j.1532-5415.1993.tb01920.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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